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Feasibility and Validity of Dementia Assessment by Trained Community Health Workers Based on Clinical Dementia Rating

Authors


Address correspondence to Dr. Hae-Ra Han, The Johns Hopkins University School of Nursing, 525 N. Wolfe St. Room 526, Baltimore, MD 21205. E-mail: hhan3@jhu.edu

Abstract

Objectives

To determine the level of agreement between dementia rating by trained community health workers (CHWs) based on the Clinical Dementia Rating (CDR) and the criterion standard: physician diagnosis.

Design

Cross-sectional validation study.

Setting

Community gathering places such as ethnic churches, senior centers, low-income elderly apartments, and ethnic groceries in the Baltimore–Washington metropolitan area.

Participants

Ninety community-dwelling Korean-American individuals aged 60 and older.

Measurements

The CDR is a standardized clinical dementia staging instrument used to assess cognitive and functional performance using a semistructured interview protocol. Six CHWs trained and certified as CDR raters interviewed and rated study participants. A bilingual geriatric psychiatrist evaluated participants independently for dementia status.

Results

CHWs rated 61.1% of the participants as having mild cognitive impairment (MCI; CDR = 0.5) or dementia (CDR≥1), versus 56.7% diagnosed by the clinician. A receiver operating characteristic (ROC) curve analysis demonstrated good predictive ability of CDR rating by trained CHWs (area under the ROC curve = 0.86, 95% confidence interval = 0.78–0.93, sensitivity = 85.5%, specificity = 88.6%) in detecting MCI and dementia.

Conclusion

The findings provide preliminary evidence that trained CHWs can effectively identify community-dwelling elderly Korean adults with MCI and dementia for early follow-up assessment and care in a community with scarce bilingual caregivers and programs.

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