Barriers to early identification of dementia in a safety net healthcare system

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Project Summary Early identification of cognitive impairment and dementia is associated with multiple public health benefits and will become even more important if a disease-modifying treatments for Alzheimer’s disease becomes widely available. However, delayed or missed identification of dementia is common, particularly among racial/ethnic minorities and those from socioeconomically disadvantaged backgrounds. Possible explanations for this delay may include patient beliefs about dementia such as it being part of the aging process or fear of associated stigma; conversely, barriers at the level of provider or health-system may hinder timely diagnostic workup. The overall goal of this mixed-methods study is to identify barriers to early identification of dementia for older adults who receive healthcare in a safety net health system. We hypothesize that both patient and health-system level factors are associated with delay in dementia diagnosis within this patient population. We will first determine if the decision to seek evaluation for memory symptoms, assessed through hypothetical clinical scenarios, is associated with a person’s dementia-specific health literacy after adjusting for demographic factors and health status. We will then evaluate if patient self-report of memory symptoms on a state-mandated preventive care visit is associated with a higher likelihood of undergoing diagnostic evaluation for dementia, assessed using a unique electronic health record-derived dataset. We will complement the analytic aims with semi-structured interviews with patients and caregivers to identify barriers to care for memory disorders as well as unmet needs.This study will help identify specific barriers that can be targeted for future interventions to improve early identification of dementia in the safety net population.