Redefining the Care Continuum to Create a Pipeline to Dementia Care for Minority Populations

Abstract

Multiple studies show that racial and ethnic minorities with low socioeconomic status are diagnosed with Alzheimer’s disease and Alzheimer’s disease–related dementias (AD/ADRD) in more advanced disease stages, receive fewer formal services, and have worse health outcomes. For primary care providers confronting this challenge, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups. The New York University Center for the Study of Asian American Health, set out to culturally adapt and translate The Kickstart-Assess-Evaluate-Refer (KAER) framework created by the Gerontological Society of America to support earlier detection of dementia in Asian American communities and assist in this community-clinical coordinated care. We found that CBOs play a vital role in dementia care, and are often the first point of contact for concerns around cognitive impairment in ethnically diverse communities. A major strength of these centers is that they provide culturally appropriate group education that focuses on whole group quality of life, rather than singling out any individual. They also offer holistic family-centered care and staff have a deep understanding of cultural and social issues that affect care, including family dynamics. For primary care providers confronting the challenge of delivering evidence-based dementia care in the context of the busy primary care settings, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups.

The Association between Primary Care Practices’ Structural Capabilities and Hospitalizations among Persons Living with Dementia

“…Another possible explanation is that providers, PLWD, and caregivers do not optimally utilize the available structural capabilities in primary care practices. For example, primary care providers may not view referrals to community resources as a priority due to the time constraints of a busy practice (Sadarangani et al, 2020). Research shows that when providers collaborate with community organizations instead of simply using them as a referral source, benefits to patients and their caregivers may increase exponentially (Sadarangani et al, 2020).…”

“…For example, primary care providers may not view referrals to community resources as a priority due to the time constraints of a busy practice (Sadarangani et al, 2020). Research shows that when providers collaborate with community organizations instead of simply using them as a referral source, benefits to patients and their caregivers may increase exponentially (Sadarangani et al, 2020). Lastly, such services are not broadly adopted because they are poorly reimbursed (Boustani et al, 2019).…”

Quality of Care and Outcomes Among a Diverse Group of Long-Term Care Residents With Alzheimer’s Disease and Related Dementias

“…The present study results extend prior work on racial and ethnic disparities among nursing home residents and people with ADRD (Rivera-Hernandez et al, 2020; Rivera-Hernandez et al, 2018; US Department of Health and Human Services, 2014). Racial and ethnic differences have been documented across the dementia care continuum from detection, diagnosis, and treatment to access to appropriate services (in-home care services or long-term care) and end-of-life care (Chin et al, 2011; Sadarangani et al, 2020; Temkin-Greener et al, 2019; Zuckerman et al, 2008). Others have noted racial/ethnic differences in antidepressant use/prescribing and pain/pain management among nursing home residents (Karkare et al, 2011; Levin et al, 2007; Mack et al, 2018), which may be similar among residents with ADRD.…”

COVID-19 and Asian Americans: Reinforcing the Role of Community-Based Organizations in Providing Culturally and Linguistically Centered Care

“…CBOs' capacity to support the prevention and management of comorbidities has been well demonstrated 35 and is relevant given the increased risk and severity for worse COVID-19 outcomes among older adults and individuals with chronic conditions. 36 CBOs are well-positioned to launch effective, localized, tailored, and targeted health promotion approaches that complement population-level strategies. Evidence-based programs conducted by CBOs and faith-based organizations have increased patient engagement (e.g., health education and counseling, recruitment and outreach) in community-based settings.…”