Racial and ethnic disparities undermine dementia care in the US

In the US, people of colour receive worse treatment than white people at every stage of dementia care, from diagnosis to end-of-life treatment, according to an analysis of dozens of studies.

Dementia-causing conditions, such as Alzheimer’s disease, are one of the leading causes of death in the US, and older Black people in the US are twice as likely to be impacted as whites. As people in the US live longer, with the risk of dementia roughly doubling every five years they age, more people of colour than ever will be living with dementia and cognitive impairment.

“Access to good-quality care for people living with dementia is essential to achieve equity,” says Ladson Hinton at the University of California, Davis.

Hinton and his colleagues reviewed 71 studies published over the past two decades to gain a clearer picture of how racial and ethnic disparities impact dementia care. The team found key differences in diagnosis, medication use and end-of-life treatment.

Every study that analysed diagnosis showed lagging diagnosis times for Black and Hispanic people with dementia. A recent comprehensive study revealed that the waiting time was 11 per cent longer for Black people and 40 per cent longer for Hispanics compared with white people.

“If there is a delay in diagnosis, that means that there’s going to be a delay in treatment,” says Joyce Balls-Berry at Washington University in St. Louis, Missouri. “That impacts one’s ability to have a good quality of life.”

Studies also found lower prescription rates of anti-dementia medication for Black and Hispanic people. Black people in the US were also less likely to receive care at long-term facilities or hospices specialising in dementia treatment. Perhaps as a result of delayed treatment, many studies reported increased US hospital admission rates and longer stays for Black people with dementia.

“The higher rates of hospital admission and longer length of stay are really not desirable,” says Hinton. The analysis confirms the concerning ethnic and racial inequities in dementia care, but many questions are still unanswered, he adds.

The review found limited data on Asian Americans, Pacific Islanders and Native Americans with dementia, so it remains unclear how these groups are impacted. Hinton says future research in the field must include people of all racial and ethnic backgrounds.

The root cause of these inequities also remains unproven. Balls-Berry believes access to specialists, proximity to high-quality medical centres, lack of insurance, language barriers and cultural differences could all be contributors, but more research is needed to confirm these connections.

Ladson and Balls-Berry both hope this data spurs changes in clinical practice and policy to close the gaps in dementia care. “Some of these systems were not created for patients of colour,” says Balls-Berry.