Highlights
- •What is the primary question addressed by this study?How do dementia prevalence and cognitive impairment severity vary according to race, ethnicity, educational attainment, and neighborhood context in a population of older adults receiving Medicaid-funded home- and community-based services in lieu of nursing home care?
- •What is the main finding of this study?Compared with non-Hispanic White individuals, Hispanic, but not non-Hispanic Black, individuals in the study cohort had greater severity of cognitive impairment. Dementia prevalence and cognitive impairment severity were both greater among those with less than high school education, and both were greater among those living in neighborhoods that were less socially vulnerable.
- •What is the meaning of the finding?Racial and ethnic group differences in dementia and cognitive impairment severity are less pronounced among older adults receiving Medicaid home- and community-based services than among other community-dwelling older adults, and older adults receiving these services may be more likely to move to lower social vulnerability neighborhoods where family members reside when they have dementia and more severe cognitive impairment.
Abstract
Objective
While racial, ethnic, and socioeconomic group disparities in cognitive impairment
and dementia prevalence are well-documented among community-dwelling older adults,
little is known about these disparity trends among older adults receiving Medicaid-funded
home- and community-based services (HCBS) in lieu of nursing home admission. The authors
determined how dementia prevalence and cognitive impairment severity compare by race,
ethnicity, educational attainment, and neighborhood context in a Medicaid HCBS population.
Design/Setting
A cross-sectional study in Connecticut.
Participants
Adults age ≥65 in the HCBS program, January-March 2019 (N = 3,520).
Measurements
The data source was Connecticut's HCBS program Universal Assessment tool. The authors
employed two outcomes: Cognitive Performance Scale (CPS2), a 9-point measure ranging
from cognitively intact-very severe impairment; and presence or not of either diagnosed
dementia or CPS2 score ≥4 (major impairment). Neighborhood context was measured using
the Social Vulnerability Index (SVI).
Results
Cohort characteristics: 75.7% female; mean(SD) age = 79.1(8.2); Non-Hispanic White = 47.8%;
Hispanic = 33.6%; Non-Hispanic Black = 15.9%. Covariate-adjusted multivariate analyses
revealed no dementia/major impairment prevalence differences among White, Black, and
Hispanic individuals, but impairment severity was greater among Hispanic participants
(b = 0.22; p = 0.02). People with more than HS education had less severe impairment
(b = −0.12; p <0.001) and lower likelihood of dementia/major impairment (AOR = 0.61;
p <0.001). Dementia/major impairment likelihood and impairment severity were greater
in less socially vulnerable neighborhoods.
Conclusion
Racial and ethnic group differences in cognitive impairment are less pronounced in
Medicaid-funded HCBS cohorts than in other community-dwelling older adult cohorts.
SVI results suggest that, among other possible explanations, older adults with dementia
may move to lower social vulnerability neighborhoods where supportive family members
reside.
Key Words
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Article info
Publication history
Published online: December 04, 2022
Accepted:
December 1,
2022
Received in revised form:
November 30,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
An earlier version of this article was presented virtually at the all-online 2021 Annual Scientific Meeting of the Gerontological Society of America, November 10, 2021.
Identification
Copyright
© 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
