Longitudinal analysis of dementia diagnosis and specialty care among racially diverse Medicare beneficiaries

Emmanuel Fulgence Drabo, Douglas Barthold, Geoffrey Joyce, Patricia Ferido, Helena Chang Chui, Julie Zissimopoulos

Research output: Contribution to journalArticle

Abstract

Introduction: There is insufficient understanding of diagnosis of etiologic dementia subtypes and contact with specialized dementia care among older Americans. Methods: We quantified dementia diagnoses and subsequent health care over five years by etiologic subtype and physician specialty among Medicare beneficiaries with incident dementia diagnosis in 2008/09 (226,604 persons/714,015 person-years). Results: Eighty-five percent of people were diagnosed by a nondementia specialist physician. Use of dementia specialists within one year (22%) and five years (36%) of diagnosis was low. “Unspecified” dementia diagnosis was common, higher among those diagnosed by nondementia specialists (33.2%) than dementia specialists (21.6%). Half of diagnoses were Alzheimer's disease. Discussion: Ascertainment of etiologic dementia subtype may inform hereditary risk and facilitate financial and care planning. Use of dementia specialty care was low, particularly for Hispanics and Asians, and associated with more detection of etiological subtype. Dementia-related professional development for nonspecialists is urgent given their central role in dementia diagnosis and care.

Original languageEnglish (US)
Pages (from-to)1402-1411
Number of pages10
JournalAlzheimer's and Dementia
Volume15
Issue number11
DOIs
StatePublished - Nov 2019

Keywords

  • Alzheimer's disease
  • Dementia specialist
  • Dementia subtype
  • Diagnosis
  • Disparities
  • Unspecified dementia

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience

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