Dr. Sink was supported by an National Institutes of Health T32 Training Grant (AG000212-10). Dr. Covinsky was supported in part by grants from the National Institute on Aging (R01AG19827), the Agency for Health Care Research and Quality (K23-AG00888), and the Paul Beeson Faculty Scholars Program. Dr. Yaffe was funded by grants from the National Institute on Aging (AG00888) and the Paul Beeson Faculty Scholars Program. The principal study was funded by Health Care Financing Administration Contract 500-89-0069. Presented, in part, at the Society of General Internal Medicine Annual Meeting, May 2003, Vancouver, BC, Canada, and the American Geriatrics Society Annual Meeting, May 2003, Baltimore, Maryland.
Ethnic Differences in the Prevalence and Pattern of Dementia-Related Behaviors
Article first published online: 19 JUL 2004
Journal of the American Geriatrics Society
Volume 52, Issue 8, pages 1277–1283, August 2004
How to Cite
Sink, K. M., Covinsky, K. E., Newcomer, R. and Yaffe, K. (2004), Ethnic Differences in the Prevalence and Pattern of Dementia-Related Behaviors. Journal of the American Geriatrics Society, 52: 1277–1283. doi: 10.1111/j.1532-5415.2004.52356.x
- Issue published online: 19 JUL 2004
- Article first published online: 19 JUL 2004
- Alzheimer disease;
Objectives: To determine the prevalence of dementia-related behaviors in a large, multiethnic sample of community-dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients.
Design: Cross-sectional study.
Participants: A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991.
Measurements: Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self-report. Caregivers were asked if the patient typically demonstrated any of eight dementia-related behaviors. To determine the independent association between ethnicity and dementia-related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics.
Results: Overall, 92% of patients had one or more dementia-related behaviors. Sixty-one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering. After multivariate adjustment, black patients were significantly more likely than whites to be constantly talkative (odds ratio (OR)=1.41, 95% confidence interval (CI)=1.11–1.80), to have hallucinations (OR=1.89, 95% CI=1.49–2.40) and episodes of unreasonable anger (OR=1.70, 95% CI=1.34–2.15), to wander (OR=1.40, 95% CI=1.08–1.81), and to wake their caregiver (OR=1.33, 95% CI=1.04–1.69). Latinos had a significantly higher likelihood than whites of having hallucinations (OR=1.49, 95% CI=1.10–2.01), episodes of unreasonable anger (OR=1.59, 95% CI=1.18–2.16), combativeness (OR=1.59, 95% CI=1.17–2.17), and wandering (OR=1.59, 95% CI=1.21–2.26). For most behaviors, these adjusted ORs are similar in magnitude of effect and statistical significance to the unadjusted estimates.
Conclusion: Black and Latino community-dwelling patients with moderate to severe dementia have a higher prevalence of dementia-related behaviors than whites. Therefore, as the aging minority population grows, it will be especially important to target caregiver education, in-home support, and resources to minority communities.