Overcoming the COVID-19 Pandemic for Dementia Research: Engaging Rural, Older, Racially and Ethnically Diverse Church Attendees in Remote Recruitment, Intervention and Assessment

Abstract

Background Access to cognitive screening in rural underserved communities is limited and was further diminished during the COVID-19 pandemic. We examined whether a telephone-based cognitive screening intervention would be effective in increasing ADRD knowledge, detecting the need for further cognitive evaluation, and making and tracking the results of referrals. Method Using a dependent t-test design, older, largely African American and Afro-Caribbean participants completed a brief educational intervention, pre/post AD knowledge measure, and cognitive screening. Results Sixty of 85 eligible individuals consented. Seventy-percent of the sample self-reported as African American, Haitian Creole, or Hispanic, and 75% were female, with an average age of 70. AD knowledge pre-post scores improved significantly ( t (49) = −3.4, p < .001). Of the 11 referred after positive cognitive screening, 72% completed follow-up with their provider. Five were newly diagnosed with dementia. Three reported no change in diagnosis or treatment. Ninety-percent consented to enrolling in a registry for future research. Conclusion Remote engagement is feasible for recruiting, educating, and conducting cognitive screening with rural older adults during a pandemic.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

“…We highlight these critical tenants of ADRD rural research and encourage their incorporation in all research moving forward: Local faith-based leaders should be asked to identify congregation members as potential research assistants, which has been shown to be effective in increasing levels of ADRD knowledge, screening, diagnosis rates, 228 and care management after diagnosis in rural areas. 229 The collaboration of community members ensures buyin and support for culturally responsive education programs and interventions to reduce ADRD-related health disparities in rural communities.…”

“…Subsequently, specialist telehealth clinics can support local primary care services to enhance detection and diagnosis 135 . Providing culturally tailored, cost‐effective, and simple solutions for ADRD diagnosis and management is an important step for capacity building in LMICs, indigenous peoples, and other rural populations 228 . Developing, adapting, and validating cognitive assessment tools informed by local values is underway at an international level 229 .…”

“…Developing, adapting, and validating cognitive assessment tools informed by local values is underway at an international level 229 . Training local providers regarding the importance of timely and accurate diagnosis of ADRD and reducing stigma in rural populations should be an ongoing priority for local health systems 228,230 . In addition, capacity building to improve referral pathways for better diagnosis and management using a consensus‐based approach is critical.…”

“…In addition to the stakeholders noted in #2, we recommend inviting managers of senior living facilities (when available), and leaders of local service organizations such as the Area on Aging, Alzheimer's Association, Diabetes Coalition, and American Heart Association to serve on community advisory boards 227 . Local faith‐based leaders should be asked to identify congregation members as potential research assistants, which has been shown to be effective in increasing levels of ADRD knowledge, screening, diagnosis rates, 228 and care management after diagnosis in rural areas 229 . The collaboration of community members ensures buy‐in and support for culturally responsive education programs and interventions to reduce ADRD‐related health disparities in rural communities 227 …”

“…135 Providing culturally tailored, cost-effective, and simple solutions for ADRD diagnosis and management is an important step for capacity building in LMICs, indigenous peoples, and other rural populations. 228 Developing, adapting, and validating cognitive assessment tools informed by local values is underway at an international level. 229 Training local providers regarding the importance of timely and accurate diagnosis of ADRD and reducing stigma in rural populations should be an ongoing priority for local health systems.…”