Alzheimer's Disease and Related Dementias Referral Outcomes among Diverse Rural Residents. (20th December 2022)

• Record Type: Journal Article
• Authors: Wiese, Lisa Ann Kirk; Holt, Janet; Williams, Ishan Canty; Group, Research
• Is Part Of: Alzheimer's & dementia. Volume 18(2022)Supplement 11
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-20
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.064820
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: This study to increase dementia detection in rural settings was conducted in a medically underserved area of southcentral Florida referred to as "the Glades." Residents face multiple disparities related to Alzheimer's disease and related dementias, including less than a 60% high school graduation rate, diabetes and hypertension as the primary health diagnosis, and increased exposure to ambient air particles from sugar cane burning. Method: Locations for testing included eight churches and a virtual "location, " for a total of ten sites. Individuals ( N = 217) were cluster sampled within these sites. Participants were administered a brief educational intervention and brain health was screened using Nasreddine's telephone "Mini‐MoCA" (2019), in which a score < 12 indicates cognitive risk. Referrals were determined for 133 participants. Results: The sample consisted of 59 virtual and 74 in‐person participants, with a range of 1 to 14 participants per church. Seventy percent were female, 57% lived alone, 13% had a previous memory test, and less than 1% had been previously diagnosed with dementia. The sample consisted primarily of four ethnicities, n = 44 (33%) African Americans, n = 21 (16%) Afro‐Caribbeans, n = 19 (14%) Hispanics, and n = 45 (34%) Whites. There was substantial variance in outcomes across sites, with an ICC = .179 ( n = 133), indicating that 17.9% of the variance in referrals was between sites. Therefore, a mixed linear model approach was used for analysis with participants nested within sites (Feaster et al., 2011) The covariate of whether they had a previous memory test was not statistically significant and only reduced the ICC by .002. Neither gender, nor whether the person lived alone were statistically significant predictors of referrals, ( p > .05), however adding ethnic group reduced the ICC to .102, a 47% reduction in intercept variance ( N = 131). In particular, African American participants were significantly more likely to have referrals than White participants, g20 = 1.29, p <.001, OR = 3.66. Hispanic and Afro‐Caribbean participants were not significantly more likely to have referrals than White participants, p = .52 and p = .06 respectively. Conclusion: Further investigation is needed to determine place‐based factors that uniquely increase risk for African Americans in an 89% racially/ethnically diverse community.