Rural, older Floridians encounter a multitude of factors that put them at higher risk for developing Alzheimer's disease (AD) such as limited education, decreased health literacy, low income, increased heart disease, lack of insurance, and limited access to health care. Minorities face an additional risk -- African-Americans are nearly twice as likely and Hispanics are 1.8 times more likely than Whites to develop AD.
These disparities are especially prevalent in the culturally diverse, rural community of Belle Glade located in south central Florida in Palm Beach County, which has a higher percentage of residents over the age 65 (26.5 percent compared with the national average of 18 percent). More than one-third of the residents live below the poverty level. Belle Glade is designated as a Medically Underserved Area and a Health Professional Shortage Area for primary and specialty care.
With only two local physicians and two public primary care health clinics in the area, patients have to wait hours to see a health practitioner and cannot make appointments in advance. For older patients, this is a major barrier to seeking health care. Even if these rural older adults are aware of the need for cognitive assessment, there are insufficient providers to screen, diagnose, and treat the illness. These facilities are overwhelmed with waiting lists of patients needing appointments, and there are no urgent-care facilities available in the area. Consequently, residents treat the emergency room as the clinic.
Researchers from the Christine E. Lynn College of Nursing at Florida Atlantic University have received a $95,133 grant from the Ed and Ethel Moore Alzheimer's Disease Research Program of the Florida Department of Health to test a novel mechanism in Belle Glade for early detection, diagnosis and treatment of AD in the home setting to reduce AD-related costs in underserved communities. The long-term goal of the study is to create a model for increasing early detection and treatment of AD that can be replicated in other underserved communities in Florida. A key outcome of this study is to delay earlier transitions to skilled nursing facilities, which could decrease health care costs by up to 30 percent for people with AD. Prior studies have shown that Medicaid can provide home care based services to three people for the cost of caring for one person in a long-term care institution.
"The lack of easily accessible, culturally proficient, and gerontology-trained providers creates a unique challenge for older adults in rural communities and really warrants further investigation," said Lisa Wiese, Ph.D., principal investigator of the study and an assistant professor in FAU's College of Nursing. "We anticipate that offering health care access to a nurse practitioner at either a rural clinic site or home health visit will be more effective than the current practice of waiting until symptoms develop. We also expect that home-based dementia screening and detection services will be more effective than screening and treatment at a local clinic."
The study will examine a cohort of diverse rural residents' perceptions and behaviors regarding health screenings and follow-up in the home as compared to a clinical setting and will compare the effectiveness of home-based or clinic screenings and follow-up evaluations. Gerontology-trained and culturally competent nurse practitioners will conduct dementia-specific geriatric assessments in individuals identified as being at risk through the home or clinic screening efforts. Continuing care management by a nurse practitioner will be provided. The researchers will pilot-test a referral program, "ROAD (Rural Older Adults with Dementia)-Next-Steps," modeled after the Alzheimer's Association Next Steps' program of following patients after cognitive assessment to ensure that rural Florida residents receive continuing support as needed.
"Providing earlier cognitive assessment to facilitate earlier management of cognitive decline issues can assist with aging-in-place and decreased health care costs," said Marlaine Smith, Ph.D., dean of FAU's College of Nursing. "With more convenience, a less threatening environment and elimination of barriers like cost, transportation and long wait times, we can help individuals in rural areas live with greater independence at home and avoid admission to acute or long-term care institutions."
In Florida, nearly 38 percent of individuals who have AD are undiagnosed, and more than 50 percent of Americans with dementia do not receive a cognitive assessment before they are institutionalized.
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