Clinical Review Article
A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research

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The number of people with dementia from minority ethnic (ME) groups in western countries is projected to rise dramatically, and they may be less able to access dementia services. To compare the use of health and social services, treatments for dementia and dementia research between different ethnic groups. A systematic review of 33 articles fitting predetermined criteria. Compatible results were pooled in a meta-analysis. ME people with dementia were more cognitively impaired, and Hispanic people reported a longer duration of memory loss than non-ME people, at the time of referral to diagnostic dementia services in the United States and Australia {pooled weighted mean difference on Mini-Mental State Examination = 3.48 (95% confidence interval [CI]: 2.87-4.09); z = 11.19, p <0.0001; N = 2,090}. These differences remained after controlling for premorbid level of education. The use of community social services did not vary between ME and non-ME people with dementia, but African Americans were 30% less likely to be prescribed cholinesterase inhibitors {odds ratio (OR) 0.7 [0.6-0.9]; z = −3.1, p = 0.002; N = 175}, and ME groups were underrepresented in U.S. dementia drug trials. ME people with dementia were 40% less likely to enter 24-hour care (pooled hazard ratio 0.59 [95% CI: 0.52-0.69]; z = −7.15, p <0.0001; N = 12,053). The authors found consistent evidence, mostly from the United States, that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement and specific recruitment strategies for ME groups might help address inequalities, and these need to be evaluated. More research is also needed to evaluate ME access to dementia services outside the United States.

Section snippets

OBJECTIVE

To compare the use of dementia treatment, care, and research between different ethnic groups.

Search Strategy

We searched databases ISI web of Science and Pubmed till April 2009. We used the keywords: service(s), treatment, healthcare, service, clinic, adherence, trial, access, refusal, care home, long-term care (LTC) facility, and institutionalization together with dementia and Alzheimer disease (AD); and ethnicity, black, white, Hispanic Latino, and white. We searched references of included articles and review articles and contacted one expert in the field to ask for the articles included in an

RESULTS

Thirty-three studies met our inclusion criteria (see Fig. 1 for results of literature search). All but three15, 16, 17 were published after 1999. We rated 26 (78.8%) as Level 1 or 2 studies. Most (N = 29) took place in the United States, two in Australia, and two in the United Kingdom. The ethnic groups studied largely reflected the ethnic composition of these countries. The U.S. studies mostly compared people of African American, Hispanic, and white non-Hispanic ethnicities. The two U.K.

DISCUSSION

We found excellent evidence that ME people with dementia were less likely to move to a LTC facility than their counterparts. This is in agreement with findings from a recent systematic review.50 It may relate to cultural preferences,11 or in the case of ME people who are not English speaking, a reluctance to place them in facilities where few speak their language. However, we cannot necessarily presume this is due to choice, rather than barriers in accessing facilities.

We found good evidence

CONCLUSIONS

Although the research base has been limited to English-speaking countries, we found consistent evidence that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement has been successful in enabling more ME people with dementia to access social care. Our findings indicate that specific recruitment strategies for ME groups might help

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    GL and CC are authors on one of the reviewed papers.18

    The authors thank Archway healthcare library for help with finding articles, and Joseph Gaugler for providing additional information about his research. Also, thanks to our anonymous reviewer for their helpful comments.

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