TY - JOUR
T1 - Dementia in people from ethnic minority backgrounds
T2 - Disability, functioning and pharmacotherapy at the time of diagnosis
AU - Tsamakis, Konstantinos
AU - Gadelrab, Romayne
AU - Wilson, Mimi
AU - Bonnici-Mallia, Anne M.
AU - Hussain, Labib
AU - Perera, Gayan
AU - Rizos, Emmanouil
AU - Das-Munshi, Jayati
AU - Stewart, Robert
AU - Mueller, Christoph
N1 - Funding Information:
CM, GP and RS receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London , and RS is a NIHR Senior Investigator. JD receives funding from the Health Foundation working together with the Academy of Medical Sciences for a Clinician Scientist Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Funding Information:
CM, GP and RS receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London, and RS is a NIHR Senior Investigator. JD receives funding from the Health Foundation working together with the Academy of Medical Sciences for a Clinician Scientist Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Objectives: Increasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.
Design: Cross-sectional study of patient characteristics at the point of dementia diagnosis. Setting and Participants: In total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015.
Methods: Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record.
Results: Compared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.
Conclusions and Implications: At dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.
AB - Objectives: Increasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.
Design: Cross-sectional study of patient characteristics at the point of dementia diagnosis. Setting and Participants: In total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015.
Methods: Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record.
Results: Compared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.
Conclusions and Implications: At dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.
UR - https://www.scopus.com/pages/publications/85088876915
U2 - 10.1016/j.jamda.2020.06.026
DO - 10.1016/j.jamda.2020.06.026
M3 - Article
SN - 1525-8610
VL - 22
SP - 446
EP - 452
JO - Journal Of The American Medical Directors Association
JF - Journal Of The American Medical Directors Association
IS - 2
ER -
SDG 10 Reduced Inequalities