Precision Public Health Approaches to Reduce Disparities in Memory Disorder Screening in Rural Minority Communities

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To address the health needs of an aging population in Florida, a Florida Department of Health Ed and Ethel Moore Alzheimer’s Research grant was submitted and awarded to the Department of Epidemiology at the University of Florida.

More than 9% of the US population living with Alzheimer’s disease (AD) reside in Florida; this will increase to 720,000 in 20251. The burden of unrecognized and untreated AD will disproportionately affect rural African American Florida community members age 60 and older. Members of minority groups are less likely to receive a timely AD diagnosis and treatment compared to their white counterparts even though they have a higher risk. Older adults from racial and ethnic minority groups are underrepresented in AD treatment and research. Among those in minority populations, very long pathways to care have been revealed; the median pathway to care among Whites was 1 year and 9 months while the median length to care among minority populations was 9 years and 2 months2. Due to the continually increasing size of the minority population in the US, increased AD burden, and inadequate care, it is important to prioritize reaching out to people in minority populations to decrease health disparities.

The purpose of this project is to decrease health disparities for AD and dementia mortality among Florida’s diverse, aging population, particularly those in rural areas, who may face additional barriers to care. Community Health Workers (CHWs) engage with older community members in an effort to reduce health disparities and barriers to care for those in need. For this project, adults 60 years of age and older who reside in nine Florida counties with some of the highest mortality rates for AD are being assessed: Putnam, Marion, Bay, Washington, Gulf, Calhoun, Jackson, and Wakulla; Alachua County serves as a comparison site. CHWs are assessing 1,200 adults for cognitive status, risk factors, social determinants of health, and health histories and then screening them for cognitive impairment via the Montreal Cognitive Assessment. Based on the community member’s health needs, concerns, and cognitive screening results, community members are given referrals to medical and social services in their community. If additional evaluation is necessary for community members based on the Montreal Cognitive Assessment, a referral is given for further cognitive screening through their physician. At 60 days and 120 days, CHWs follow up with community members to evaluate their completion of accessing referrals and screening as well as barriers to referral sources. This project strives to improve recognition of AD in counties with large discrepancies between AD mortality and AD case rate.

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This project has 3 aims:

  • Utilize Certified Community Health Workers from our Community Engagement Program, HealthStreet, to screen for cognitive impairment among 1,200 underserved rural or minority older adults in their communities (those at highest risk for AD mortality);
  • Educate participants and caregivers via CHWs and physicians via a continuing medical education video about the need and appropriate actions to take for early detection of AD;
  • Ensure adults who screen positive for cognitive impairment in their communities are assessed by their physicians for further memory disorder evaluation and specialized treatment referrals.

Services Offered


Services for Community Members

  • Assessment of health conditions and health concerns
  • Cognitive screening
  • Linkage to social and medical services in the community based on needs and concerns
  • Linkage to applicable research studies to increase participation of underrepresented populations in research
  • Sustainable, bidirectional, health-promoting, communication with and for the community
  • Facilitation of relationships among community members and health systems to increase trust

Services for Clinicians

In addition to providing services to community members, we are providing medical education to treating clinicians. Primary care and internal medicine clinicians have been invited to participate in a free online continuing medical education (CME) training titled, “From Brain Disorders to Brain Health: Prevention and Management of Cognitive Decline and Dementia.” Through this CME, cognitive health experts from UF provide the latest information on the screening, diagnosis, and treatment of mild cognitive impairment and dementia, including referral to specialty care.

The learning objectives of this CME are to:

  • Define age-related cognitive decline and distinguish between mild cognitive impairment and dementia.
  • Identify and modify the risk of cognitive impairment and dementia.
  • Learn about the etiologic mechanisms of Alzheimer’s disease, therapeutic targets, and emerging therapies.
  • Learn about services provided in the State of Florida and benefits of research participation.

Results


This project is ongoing and will be completed in February 2021. As of March 2020, health assessments have been completed for 471 community members. Of those community members who have completed an assessment, the mean age for women was 68.6 years old, and the mean age for men was 68.5 years old. The majority of these community members were female (60.5 %) and had 12 or more years of education (85.8%). The racial composition of our older community members was as follows: 67.5% White, 26.3% African American, 5.1% other, and 1.1% Asian. Approximately five percent (5.1%) of community members identified as Latino/Hispanic. To date, a total of 1,080 referrals have been given to those community members who have completed this assessment for various social and medical services within their community.

If an adult 60 years or older is interested in completing a cognitive screening,
please call HealthStreet at 352-294-4880.


To learn more about the free CME and how to access it, please visit: http://healthstreet.program.ufl.edu/healthstreet-intiatives/continuing-medical-education-cme/.

  1. 2020 Alzheimer’s disease facts and figures. (2020) Alzheimer’s & Dementia, 16(3), 391-460. doi:10.1002/alz.12068
  2. Schrauf, R.W., & Iris, M. (2012). Very long pathways to diagnosis among African Americans and Hispanics with memory and behavioral problems associated with dementia. Dementia, 11(6): 743-763. doi:10.1177/1471301211416615