1. Barriers to Service Delivery and Increased Prevalence of Neurocognitive Disorders in Minority Populations. By: Kathryn Sacharok

2. Introduction Continual access to adequate healthcare throughout the life span has been linked to benefits throughout the aging process. However, how does ones socioeconomic status and ethnicity affect a persons access to health care and knowledge of a growing illness? The focus of this presentation is the link between ethnicity and dementia and the impact of culture and socioeconomic status on access to adequate treatment. The barriers present in seeking and understanding dementia, possible treatment modalities and available programs will also be explored.

3. Background Racial inequalities related to health care and treatment programs are evident. In the majority of studies, reviewed, African American participants were significantly more likely to suffer from some form of Dementia. There is open debate regarding whether there is an innate predisposition for Dementia in minority populations or if the societal discrimination creates increased risk.

4. Background Prevalence of Dementia in the United States: The Aging, Demographics and Memory Study (2007) Plassman et al. Identified a statistically significant correlation between race and Dementia. This study highlighted some of the risk factors related to SES and increased diagnoses of Dementia. Focusing primarily on educational factors. Interestingly, when this study controlled for education the results regarding race and dementia were still elevated. However, no longer statistically significant.

5. Background Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan: (2001) Andrews et al. Studied the relationship between ethnicity and prevalence of Dementia. Findings show the statistically significant correlation between minority populations and confirmed diagnoses of Dementia and Dementia related to AD This study then proceeded to control for Education, Literacy, HTN and hx of stroke. With consistent significant results.

6. Background Andrews et al: * p = 0.001. White individuals were older than African-Americans and Caribbean Hispanics. † p = 0.001. White individuals had more years of education than either African- Americans or Caribbean Hispanics; African-Americans had more years of education than Caribbean Hispanics. ‡ Diabetes was more frequent among African-Americans and Caribbean Hispanics than among white individuals. § p = 0.01. Heart disease was more frequent among Caribbean Hispanics than African-Americans. Neither of these two groups differed from white individuals. ¶ p = 0.001. Hypertension was more frequent among African-Americans and Caribbean Hispanics than among white individuals

7. Background This chart taken from the Andrews et al study illustrates the age related correlation between prevalence of a neurocognitive diagnosis and ethnicity. (Table 2 can be found in results section )

8. Background There is debate on how to best tailor current programs to meet the needs of ethnically diverse cultures and engage impoverished communities in health care programs. One such study, explores the barriers to treatment and potential explanations for increased prevalence. Racial Differences in the Diagnosis of Dementia and in Its Effects on the Use and Costs of Health Care Services (2003) Cain et al.

9. Background The Cain et al study highlights the treatment barriers present in relation to race and Dementia. Focused on Medicare Beneficiaries. This study supported the increased prevalence of Dementia diagnoses in, specifically, African American populations. Also highlighting the increased use of inpatient treatment throughout this population and need for emergency services. The study indicates that African American populations utilized more emergency services and had significantly more outpatient care visits then the Caucasian participants.

10. Background The Cain et al study suggested that the increased prevalence may be related to SES biases of physicians and lack of community awareness regarding risk factors and warning signs of illness. Another such study is :Health Inequalities Among Minority Populations (2005) by:Pamela Jackson This study highlights the racial disparities in treatment that may contribute to increased prevalence.

11. Background Jackson identifies SES characteristics that are subsequently utilized to measure predictors of “health” including; education, income and employment status. The study focuses on these characteristics when identifying the issues in disparity of health based on ethnicity. The study employs multiple assessment/ measurement tools such as ; MacArthur Scale of Subjective Social Status, Cambridge Scale

12. Background The Jackson article highlights the connection between poor health programs and limited access with increased risk of poor health and a negative impact on aging. This article provides insight into how programs can be readjusted to meet the needs of disenfranchised populations with a more inclusive focus. This article exposes the connection between individual and societal level discrimination and inequitable health. Which may result in the increased prevalence of Dementia and Neurocognitive diagnoses

13. Analysis These studies indicate the gap in knowledge surrounding the biological and societal factors that contribute to the statistically significant connection between race and Dementia. One can also observe the effect that societal discrimination has perpetuated a gap in service provision that is now impacting the older population (i.e. 65 and older)

14. Analysis Drawing from these primary resources one can observe that a program that focuses more attention on at risk populations and increased education would be beneficial in reduction of risk. There is a positive correlation present between lower SES and increased health concerns, specifically related to Dementia.

15. Analysis Across group programs, aimed at influencing change for an entire ethnic group or community may prove more effective in meeting the needs of at risk populations as opposed to individually focused treatment modalities. Each study highlights how poverty can perpetuate health disparities. Targeting the underlying issue of access to health care and early intervention appears logical.

16. Analysis Community based agencies, providing culturally competent and multi ethnic services may be able to reach communities more effectively and encourage involvement. This type of treatment approach may reduce barriers in seeking treatment and alleviate some of the risks associated with early and middle life poverty on aging health. The studies support the negative impact of poverty, poor education and lack of access to health care on healthy aging. This community based all-inclusive approach may be the key.

17. Recommendations My program will target individuals in at risk communities, specifically African American and Hispanic populations (as these individuals, based on research are at higher risk of developing Dementia). The program would focus on education, early intervention and access to health care options as well as practitioner training. Based off the continuously similar findings over a variety of studies, in a variety of settings, it is evident that something needs to be done with health care in this area. This proposed initiative that targets specific communities, and is a sustainable presence in said communities. is my recommendation. Specific characteristics are highlighted in the remaining slides.

18. Recommendations Early intervention to ensure adequate health care access and knowledge of risk factors and genetic predisposition is one piece of a larger issue. Education of at risk communities on early warning signs of memory and cognitive impairment, genetic risk factors and awareness. Access to adequate health care that spans generations and cultures and removes bias Community based settings that encourage participation and geographical need

19. Recommendations Encouraged faith-based organizations to aide in outreach to at risk communities Collaborative and patient centered treatment provision to ensure that patient retention.

20. Conclusion Neurocognitive disorders are not a “normal” part of the aging process, it is not guaranteed that as we age we will be diagnosed with one of these disorders. It is so important to understand the risk factors that contribute to increased likelihood of such a diagnoses and address these factors with individuals at increased risk

21. Conclusion Throughout this presentation statistical data has proven that minority populations are at greater risk for diagnosis through the life span. Targeting these populations and understanding the factors that increase risk and educating individuals would go far in decreasing prevalence of diagnoses. Societal changes to impoverished and disenfranchised populations, early intervention in terms of education and warning signs and improving access and decreasing health care disparities will provide a more inclusive treatment process and hopefully decrease prevalence.

22. References 1. Langa, K., Okura, T., Plassman, B., Steffens, D.,(2007). Prevalence Of Neuropsychiatric Symptoms Among Older Adults In The United States: The Aging, Demographics, And Memory Study. Neuroepidomology: Alzheimer's and Dementia, 29(2), P374-P374. doi: November, 2007 2. Andrews H, Bell, K., Costa R., Cross, P., Jacobs DM,, Lantigua R.,Mayeux R, Merchant C, Small S, Stern Y, Tang, MX (2001).: Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology.56 (3) P49–56.

23. References 3. Cain, V., Husain, B., Holzer, C., Levine, R., Moonis, M., &. Sherkat, D (2003). Racial Differences in the Diagnosis of Dementia and in Its Effects on the Use and Costs of Health Care Services. PS Psychiatric Services, 54(1), 92-96. doi:January 2003 4. Jackson, P. (2005). Health Inequalities Among Minority Populations. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60B(Special Issue II), S63-S67. doi:2005 5. Bean, J, Demirovik, J, (2003) Prevalence of Dementia in Three Ethnic Groups: The South Florida Program on Aging and Health: Annals of Epidemiology, Volume 13, Issue 6, Pages 472–478