Dementia Care in Diverse Older Adults in the U.S. Deep South and the Rest of the United States

Article type: Research Article

Authors: Pisu, Maria^{a; b; *} | Martin, Roy C.^{b; c} | Shan, Liang^a | Pilonieta, Giovanna^{c; d} | Kennedy, Richard E.^{b; e} | Oates, Gabriela^f | Kim, Young-Il^a | Geldmacher, David S.^{b; c}

Affiliations: [a] Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA | [b] Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA | [c] Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA | [d] Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA | [e] Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA | [f] Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence: [*] Correspondence to: Maria Pisu, PhD, 1720 2nd Ave South, MT 636, Birmingham, AL 35294-4410, USA. Tel.: +1 205 975 7366; E-mail: mpisu@uab.edu.

Abstract: Background:Use of specialists and recommended drugs has beneficial effects for older adults living with Alzheimer’s disease and related dementia (ADRD). Gaps in care may exist for minorities, e.g., Blacks, and especially in the United States (U.S.) Deep South (DS), a poor U.S. region with rising ADRD cases and minority overrepresentation. Currently, we have little understanding of ADRD care utilization in diverse populations in this region and elsewhere in the U.S. (non-DS), and the factors that adversely impact it. Objective:To examine utilization of specialists and ADRD drugs (outcomes) in racial/ethnic groups of older adults with ADRD and the personal or context-level factors affecting these outcomes in DS and non-DS. Methods:We obtained outcomes and personal-level covariates from claims for 127,512 Medicare beneficiaries with ADRD in 2013–2015, and combined county-level data in exploratory factor analysis to define context-level covariates. Adjusted analyses tested significant association of outcomes with Black/White race and other factors in DS and non-DS. Results:Across racial/ethnic groups, 33%–43% in DS and 43%–50% in non-DS used specialists; 47%–55% in DS and 41%–48% in non-DS used ADRD drugs. In adjusted analyses, differences between Blacks and Whites were not significant. Vascular dementia, comorbidities, poverty, and context-level factor “Availability of Medical Resources” were associated with specialist use; Alzheimer’s disease and senile dementia, comorbidities, and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with the outcomes. Conclusion:We did not observe significant gaps in ADRD care in DS and non-DS; however, research should further examine determinants of low specialist and drug use in these regions.

Keywords: Access to care, affordability, disparities, drug use, equity, physician availability, socioeconomic context, socioeconomic status, specialist use

DOI: 10.3233/JAD-210240

Journal: Journal of Alzheimer's Disease, vol. 83, no. 4, pp. 1753-1765, 2021