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Association of Race, Ethnicity, Education, and Neighborhood Context With Dementia Prevalence and Cognitive Impairment Severity Among Older Adults Receiving Medicaid-Funded Home and Community-Based Services.

Publication ,  Journal Article
Fortinsky, RH; Robison, J; Steffens, DC; Grady, J; Migneault, D; Wakefield, D
Published in: Am J Geriatr Psychiatry
April 2023

OBJECTIVE: While racial, ethnic, and socioeconomic group disparities in cognitive impairment and dementia prevalence are well-documented among community-dwelling older adults, little is known about these disparity trends among older adults receiving Medicaid-funded home- and community-based services (HCBS) in lieu of nursing home admission. The authors determined how dementia prevalence and cognitive impairment severity compare by race, ethnicity, educational attainment, and neighborhood context in a Medicaid HCBS population. DESIGN/SETTING: A cross-sectional study in Connecticut. PARTICIPANTS: Adults age ≥65 in the HCBS program, January-March 2019 (N = 3,520). MEASUREMENTS: The data source was Connecticut's HCBS program Universal Assessment tool. The authors employed two outcomes: Cognitive Performance Scale (CPS2), a 9-point measure ranging from cognitively intact-very severe impairment; and presence or not of either diagnosed dementia or CPS2 score ≥4 (major impairment). Neighborhood context was measured using the Social Vulnerability Index (SVI). RESULTS: Cohort characteristics: 75.7% female; mean(SD) age = 79.1(8.2); Non-Hispanic White = 47.8%; Hispanic = 33.6%; Non-Hispanic Black = 15.9%. Covariate-adjusted multivariate analyses revealed no dementia/major impairment prevalence differences among White, Black, and Hispanic individuals, but impairment severity was greater among Hispanic participants (b = 0.22; p = 0.02). People with more than HS education had less severe impairment (b = -0.12; p <0.001) and lower likelihood of dementia/major impairment (AOR = 0.61; p <0.001). Dementia/major impairment likelihood and impairment severity were greater in less socially vulnerable neighborhoods. CONCLUSION: Racial and ethnic group differences in cognitive impairment are less pronounced in Medicaid-funded HCBS cohorts than in other community-dwelling older adult cohorts. SVI results suggest that, among other possible explanations, older adults with dementia may move to lower social vulnerability neighborhoods where supportive family members reside.

Duke Scholars

Published In

Am J Geriatr Psychiatry

DOI

EISSN

1545-7214

Publication Date

April 2023

Volume

31

Issue

4

Start / End Page

241 / 251

Location

England

Related Subject Headings

  • United States
  • Prevalence
  • Medicaid
  • Male
  • Humans
  • Geriatrics
  • Female
  • Ethnicity
  • Educational Status
  • Cross-Sectional Studies
 

Citation

APA
Chicago
ICMJE
MLA
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Fortinsky, R. H., Robison, J., Steffens, D. C., Grady, J., Migneault, D., & Wakefield, D. (2023). Association of Race, Ethnicity, Education, and Neighborhood Context With Dementia Prevalence and Cognitive Impairment Severity Among Older Adults Receiving Medicaid-Funded Home and Community-Based Services. Am J Geriatr Psychiatry, 31(4), 241–251. https://doi.org/10.1016/j.jagp.2022.12.001
Fortinsky, Richard H., Julie Robison, David C. Steffens, James Grady, Deborah Migneault, and Dorothy Wakefield. “Association of Race, Ethnicity, Education, and Neighborhood Context With Dementia Prevalence and Cognitive Impairment Severity Among Older Adults Receiving Medicaid-Funded Home and Community-Based Services.Am J Geriatr Psychiatry 31, no. 4 (April 2023): 241–51. https://doi.org/10.1016/j.jagp.2022.12.001.
Fortinsky, Richard H., et al. “Association of Race, Ethnicity, Education, and Neighborhood Context With Dementia Prevalence and Cognitive Impairment Severity Among Older Adults Receiving Medicaid-Funded Home and Community-Based Services.Am J Geriatr Psychiatry, vol. 31, no. 4, Apr. 2023, pp. 241–51. Pubmed, doi:10.1016/j.jagp.2022.12.001.
Journal cover image

Published In

Am J Geriatr Psychiatry

DOI

EISSN

1545-7214

Publication Date

April 2023

Volume

31

Issue

4

Start / End Page

241 / 251

Location

England

Related Subject Headings

  • United States
  • Prevalence
  • Medicaid
  • Male
  • Humans
  • Geriatrics
  • Female
  • Ethnicity
  • Educational Status
  • Cross-Sectional Studies