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