Individual risk factors for possible undetected dementia amongst communitydwelling older people in New Zealand

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1 Individual risk factors for possible undetected dementia amongst communitydwelling older people in New Zealand Adrián Martínez 1, Ying Huang 2, Susan Gee 3, Hamish Jamieson 4, Gary Cheung 5 1 Department of Demographics, Epidemiology and Social Determinants, National Institute of Geriatrics of Mexico 2 School of Population Health, University of Auckland, Auckland New Zealand 3 Psychiatry of Old Age Academic Unit, Canterbury District Health Board, Christchurch, New Zealand 4 Department of Medicine, University of Otago, Christchurch, New Zealand 5 Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

2 Outline 1.Introduction: NZ 2.Background 3.Methods 4.Results 5.Discussion 6.Conclusion Martínez et al., Dementia in press

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4 Diversity of older people 4

5 NZ health services - primarily funded by central government - based on a communityoriented model - 20 District Health Boards (DHBs) - Primary care - Specialist/hospital care

6 Background Benefits of early diagnosis of dementia Undiagnosed dementia in primary health care settings ranges from 20 to 50% in developed countries, and it increases to 90% in developing countries

7 Factors associated with undiagnosed dementia Milder disease Older Living alone Men A lack of systematic assessment of cognition in aged residential care GPs ability to differentiate between MCI and mild dementia

8 International Residential Assessment (interrai) A comprehensive geriatric assessment developed by a network of health researchers in over 30 countries Provide a clinical assessment of medical, rehabilitation, and support needs and abilities NZ is the first country to implement a mandated comprehensive assessment for all older people who are being assessed for publically-funded community services or aged residential care Cognitive Performance Scale (CPS) and diagnosis of Alzheimer s disease or dementia

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11 Study Aim To compare the sociodemographic factors associated with people with possible undetected dementia and those with diagnosed dementia by linking their CPS scores with a recorded diagnosis of Alzheimer s disease or dementia using the NZ interrai database

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13 Diagnosed dementia group vs Possible undetected dementia group Sociodemographic factors Participation in social activities of long-standing interest Major life stressors (e.g. episode of severe personal illness; death or severe illness of close family member/friend; loss of home; major loss of income/assets; victim of a crime such as robbery; loss of driving license/car) Limited access to home or rooms in home Multiple logistic regression to evaluate the association between sociodemographic characteristics with possible undetected dementia

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16 Discussion A lack of dementia diagnosis was more common among living alone Asian had limited social engagement, had experienced significant recent life events had limited access to their home or parts of their home, and to a small degree among those who were older.

17 Living alone & undiagnosed dementia Cohabiting increases the likelihood that a dementia will be diagnosed Partners are more likely to perceive changes in cognitive performance and encourage medical attention Primary care physicians were less likely to detect dementia in people living alone, perhaps because of the lack of collateral information People living alone with dementia may have difficulty accessing health and home care services; less likely to receive diagnostic investigations such as neuroimaging and lumbar puncture or to be prescribe cholinesterase inhibitors and memantine

18 Asian & undiagnosed dementia Cultural factors and stigmatization can play a role Certain cultures Alzheimer s disease and dementia are considered as part of the normal cognitive aging process Older people of ethnic minorities may have more difficulties with accessing health services, health education and following up their treatment Language and communication barriers

19 Asian & undiagnosed dementia Asian people are the 3 rd largest minority group (about 11%) in NZ National and regional efforts to achieve health care equity have tended to focus on Maori and Pacific people A previous NZ report suggested that the lower rates of access to mental health services by Asian people is probably due to a lack of their inclusion in public health policy programs

20 Limitations Cross-sectional nature of this study Results of this study cannot be generalized to the overall older population in NZ CPS cut-off score ( 3 instead of 2) to be certain about the presence of clinically significant cognitive impairment. Level of education not measured

21 Conclusion Individual characteristics play a role in the underdiagnosis of dementia Community awareness and de-stigmatisation campaign, psychoeducation and cultural friendly dementia services have the potential to improve the journey of dementia diagnosis and post-diagnosis in older Asians GPs and community services providing care for older people living alone can be more vigilant in screening for cognitive impairment

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