webinar held October 28, 2009

1. Health Disparities in Dementia Current Reality and Estimated Predications for Future By: Shannon Marling, CTRS/ VCU Graduate Student of Gerontology Tracey Gendron, MSG Instructor/ Clinical Coordinator VCU Department of Gerontology

2. Minorities are the fastest growing segment of the older adult population 65 & older Between 1990-2030 population projected increases11

3. Percentages of Minorities within the US Population by Selected Age Groups: 2010-2050 Source: Population Division: US Census Bureau Released: August 14, 2008

6. According to the Alzheimer’s Association 2009 Facts and Figures Report

7. 5.3 Million persons of all ages are affected with Alzheimer’s disease (AD)

8. 1 in 8 individuals 65 and older have AD

9. Every 70 seconds a person is diagnosed with the disease, this is forecasted to become every 33 seconds

11. Prevalence of Dementia for Hispanics One study suggested that barriers to health care access may significantly delay diagnosis and treatment in the Hispanic population

12. Prevalence of Dementia for African American AD often referred to as the “Silent Epidemic” among African Americans due to a disproportionally high rate of diagnosis of the disease African American older adults are reported to have a higher rate of AD and vascular dementia in a diagnostic screening and assessment17 African Americans have a greater filial risk for developing AD Misdiagnosis and under-diagnosis is likely to occur in Non-Hispanic blacks with dementia

13. Prevalence of Dementia for Asian American Population There is a gap in the literature and research in regard to Asian American population affected with dementia Asian American elders show a greater prevalence of dementia than the general population Controlling for lifetime prevalence of mental illness, Asian Americans are less likely to use mental health services than white Americans

14. Why is misdiagnosis and under-diagnosis more likely to occur among minority groups? Variables related to culture, race and education that underlie ethnic group differences on cognitive test performance One study found that older adults who have limited health literacy were significantly less likely to have a primary physician or source of care16 Acculturation – the level at which people participate in the values, language and practices of their own ethnic community verses those of the dominant community One study found that a disconnect existed between the language being used by medical professionals and African Americans accessing services6 Poor assessment tools with cultural and ethnic bias's may result in false–positive screening, especially for African Americans Asian Americans and African Americans have shown through studies to hold the cultural view that dementia is “normal” part of the process of aging12

15. Racial and Ethnic Disparities in Accessing Care Stigmatization of severe and chronic mental illness have been identified as a factors that heavily influences health disparities in Asian Americans Among individuals age 65 and older: Asians have the highest rate of un-insurance 6%, compared to Hispanics 5% Blacks 1%, and White .02 %1 Older adults with a 6th grade reading level are twice as likely to have at least three indicators of poor health care access16 Hispanics have the lowest education levels of any group in the United States

16. Racial and Ethnic Disparities in Accessing Care The 2006 National Health Care Disparities Report (NHDR) found that a lower quality of care was received by Asians as compared to whites for a one third of the measures that were tracked in the report2 African Americans have been underrepresented in clinical trials for potential treatments for AD Some studies have suggested that genetic risk factors for AD are different among ethnicities and that environmental factors may differently affect and interact with genetic factors

17. Reference List: R. D. Williams, (2004) “Medicare and Communities of Color”, Medicare Brief no.11, Washington National Academy of Social Insurance, November. Moy, E., Greenburg, L., Borsky, A. (2008) Community Variation: Disparities In Health Care Quality Between Asian And White Medicare Beneficiaries. Health Affairs, 27(2). Alzheimer's Association (2004). Hispanics/Latinos and Alzheimer’s Disease. Bernstein, A., Remsburg, R. (2007). Estimated Prevalence of People With Cognitive Impairment; Results from Nationally Representative Community and Institutional Surveys. The Gerontologist, 47(3), 350-354. Byrd, L., Fletcher, A., Menifield, C. (2007). Disparities in Health Care: Minority Elders at Risk. ABNF Journal, 51-55. Clark, PP., Kutner, N., Goldstein, F., Peterson-Hazen, S., Garner, V., Zhang, R., Bowles, T. (2005). Impediments to Timely Diagnosis of Alzheimer’s Disease in African Americans. Journal of American Geriatrics Society, 53, 2012-2017. Coogle, C. Caregiver Education and Service Utilization in African American Families Dealing with Dementia. Perspectives, 141-152. Daker-White, G., Beattie, A., Gillard, J., Means, R. (2002). Minority ethnic groups in dementia care: a review of service needs, service provision and models for good practice. Ageing and Mental Health, 6(2), 101-108. Manly, J., Espino, D. (2004). Cultural influences on dementia recognition and management. Clinics in Geriatric Medicine, 20, 93-119. Fenley, R., Bobers, S., Powell, M., Berman, J., Altman, B. (2008). Effects of Alzheimers on Multi-Cultural Person Care Aides. Care Management Journals, 9(1), 4-10. Fitten, J., Ortiz, F., Ponton, M. (2001). Frequency of Alzheimer’s disease and Other Dementia in a Community Outreach Sample of Hispanics. Journal of American Geriatrics Society, 49,1301-1308. Graves, A., Larson, E., Edland, S., Bowen, J., McCormick, W., McCurry, S., Rice, M., Wenzlow, A., Uomoto, J. (1996). Prevalence of Dementia and its Subtypes in the Japanese American Population of King County, Washington State. American Journal of Epidemiology, 144(8), 760-771. Herbert, L., Scherr, P., Bienias, J., Bennett, D., Evans, D. (2003). Alzheimer Disease in the US Population. Achieves of Neurology, 60(8)1119-1122. Liu, D., Hinton, L., Tran, C., Hinto, D., Baker, J. (2008). Reeamining the Relationships Among Dementia, Stigma and Aging in Immigrants and Vietnamese Family Caregivers. Cross Cultural Gerontology, 23,283-299. Masel, M., Peek, K. (2009). Ethnic Differences in Cognitive Function Over Time. AEP (Article still in press). Sudore, R., Mehta, K., Simonsick, E., Harris, T., Newman, A., Satterfield, S., Rosano, C., Rooks, R., Rubin, S., Ayonayon, H., Yaffe, K. (2006). Limited Literacy in Older People and Disparities in Health and Health Care Access. Journal Of American Geriatrics Society ,54,770-776. Plassman, B., Langa, K., Fisher, G., Heeringa, S., Weir, D., Ofstedal, M., Burke, J., Hurd, M., Potter, G., Rodgers, W., Steffens, D., Willis, R., Wallace, R. (2007). Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study. Neuroepidemiology, 29, 125-132. Trinh, N-H., Ahmed, I. (2009). Handbook of mental health and acculturation in Asian American families, 167-178 Valle, R., Yamada, AM., Matiella, A.. (2006). Footnovelas. Clinical Gerontologist, 30(1) 71-88. Yeo, G., Gallager-Thomas. Ethnicity & the Dementias. 1996, Washington, Taylor & Frances. Alzheimer's Association, (2009) Alzheimer's Disease Facts & Figures Report . Mixed Sources

19. PRE-EVENT SURVEY Results compiled October 27, 2009

20. WHAT PERCENTAGE OF THE ELDERLY POPULATION ARE MINORITIES? Choices Selected: 54 Total Responses: 54

21. WHAT WILL THAT NUMBER LOOK LIKE IN 20-30 YEARS? Choices Selected: 54 Total Responses: 54

22. RESPONSE COMPARISON (NOW v. 20-30 YEARS FROM NOW)

23. ARE BRIEF COGNITIVE SCREENING INSTRUMENTS (e.g. the Folstein MMSE) USED AS INDICATORS FOR POSSIBLE DEMENTIA CULTURALLY SENSITIVE? Choices Selected: 53 Total Responses: 53

24. HOW WOULD YOU RANK THE BARRIERS TO SEEKING TREATMENT FOR DEMENTIA SYMPTOMS FOR ETHNIC MINORITIES? Total Responses: 54