Achieving Equity in Dementia Diagnosis and Care
Schneider, Myra, Lafronza, Vincent, Aging Today
People of color are the fastest growing segment of those older than age 65 in the United States. Such Americans of diverse racial and ethnic backgrounds experience higher rates of disease than Caucasian Americans, and lower quality health services. They are less likely to receive routine medical procedures, and have higher rates of morbidity and mortality than whites. According to a Secretary of Health and Human Services report (http://www.cdc.gov/nchs/ data/misc/EliHealthDisp.pdf), differences in health status, access to care and the provision of health services are significantly related to race, ethnicity, primary language, neighborhood factors, educational status and wealth.
Two recent online surveys on aging preparedness conducted by the national, nonprofit public health organization CommonHealth ACTION (commonhealth action.org/news-and-events/news-agingsurvey.html) also found differences in self-reported worries about retirement savings and health insurance. An overarching goal of Healthy People 2020, a project funded through the Department of Health and Human Services with a set of 10-year objectives, is to achieve health equity, eliminate disparities and improve the health of all groups.
In line with Healthy People 2020's goal, we have an ethical imperative to address inequities in dementia, and to reduce adverse impacts on families and communities. Dementia is a disabling and burdensome chronic disease in which Alzheimer's disease accounts for 50 percent to 70 percent of cases. Worldwide, there are 24 million people living with dementia, and 4.6 million new cases every year. Approximately 3.8 million Americans are living with dementia.
By 2020, there will be nearly 29 million people with dementia in both developed and developing countries, according to the Bulletin of the World Health Organization (80: 8, 2002, pages 644-52). Family caregivers, the primary support for people with dementia, experience substantial emotional, physical and economic strain. As a consequence of the global aging of the population, dementia will become an increasingly significant burden for these families, the medical and public health systems and social support systems.
Disparities and Dementia
According to the Alzheimer's Association's report, African-Americans and Alzheimer's Disease: The Silent Epidemic, dementia disproportionately affects racial and ethnic minorities, particularly African Americans (alz.org/national/doc uments/reportuafricanamericanssilentep idemic.pdf). The lifetime cumulative risk of developing Alzheimer's is higher for African Americans, who also have higher rates of vascular dementia, a common form stemming from cerebrovascular disease. Non-Hispanic blacks with dementia are more likely to be underdiagnosed or misdiagnosed relative to non-Hispanic whites, and non-Hispanic blacks and Latinos transition to long-term care at more advanced stages. People of color are also less likely to be prescribed anti-dementia medication.
Less is known about dementia in the Asian American population, although Asian American elders have a higher prevalence than the general population, according to the National Asian American Pacific Islander Mental Health Association (naapimha.org/wordpress/media/ facts-longformat.doc). Although the reasons behind this higher prevalence of dementia in ethnic minorities have not been determined, possible explanations include a combination of dietary, gene expression or environmental factors, which may also affect and interact with each other, according to the Morehouse School of Medicine's Dr. …