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'Underlying Systemic Racism': Disparities In Alzheimer's Diagnoses And Care Outlined In New Report

A couple looking at a brochure about Alzheimer's disease.
Alzheimer's Association

In Massachusetts and Connecticut, more than 200,000 residents age 65 and older are living with Alzheimer's disease. That's according to a recent report from the Alzheimer's Association.

Another disturbing statistic from the report is that Black, Hispanic and Native Americans are at greater risk. This, combined with the ongoing COVID-19 pandemic, poses a greater challenge for those individuals to get the proper health care that's needed.

In an interview, Dr. Kristina Zdanys, an associate professor of psychiatry at the University of Connecticut, talked about the racial and ethnic disparities in care.

Dr. Kristina Zdanys: I think some of the statistics that you're alluding to include that older Black Americans, for example, are twice as likely to develop Alzheimer's disease as older white adults, and people of Hispanic and Latino descent are 1.5 times as likely.

I think part of this is that people of color are less likely to see a doctor for memory problems, and doctors are more likely to miss dementia diagnoses among older persons of color as well. I think this is largely related to an underlying systemic racism that's permeating the health care system, which impacts the access to care and quality of care received by older adults in these populations.

I think people of color are also vastly underrepresented in clinical trials. This is something that I know researchers have been focusing on a lot more in recent years, is involving people of Hispanic descent, Latino descent, and also Black Americans in clinical trials to understand more how Alzheimer's disease affects their brains and how we might better work in the context of diagnosing and treating these populations.

Michael Lyle Jr., NEPM: According to the report, fewer than half of Black and Native Americans feel confident that they have access to providers who understand their ethnic or racial background and experiences. What is being done to make it so that they can have the proper access?

I think the more that Alzheimer's and dementia become part of our dialogue, the more we're going to be able to draw attention to places like hospital centers and memory care centers that are offering diagnosis and treatment for these patients.

Beyond that, it does come back to kind of two themes — one being education of folks in these communities who maybe historically have not had access to care about opportunities for places to go for this assessment and understanding that there is a difference between normal aging and the development of Alzheimer's and other types of dementia. But I think it's definitely two-sided. I think a lot of this is going to be the education of our physicians and other medical professionals, as well, in understanding these health care disparities so that we can really make sure that we're addressing the needs of all our patients that we do come into contact with.

We are still in a pandemic and the reports show that COVID-19 is having a devastating impact on those living with Alzheimer's. Can you talk about the impact among your own patients?

I practice here in Connecticut and folks living with Alzheimer's disease and other forms of dementia were at particularly high risk for complications of COVID-19, as well as mortality from COVID-19. I think the statistics came out for 2020 that there were almost 400 more deaths than expected among people who are suffering from Alzheimer's disease. Many of those deaths came in long-term care facilities because people living in long-term care settings are physically often more frail and have many medical comorbidities that could make them more susceptible to suffering from the complications of COVID.

I think part of the problem was that there was lack of testing in the beginning of the pandemic so that COVID really started spreading like wildfire in these long-term care facilities. And when you have a lot of frail, older adults living in close contact with one another, of course, that puts them at tremendous risk.

But I will say I was very proud that Connecticut made huge efforts to get vaccinations out to people who live and work in these facilities very quickly. And we've seen the numbers of people dying of COVID and contracting COVID in long-term care facilities plummet in the past few months. So that's very encouraging.

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