ArticleThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry2023
Association of Race, Ethnicity, Education, and Neighborhood Context With Dementia Prevalence and Cognitive Impairment Severity Among Older Adults Receiving Medicaid-Funded Home and Community-Based Services.
Article in The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 16 citations in OpenAlex.
- Emergency Department Visits and Hospital Admissions Among Older Adults With and Without Dementia Receiving Medicaid-Funded Home- and Community-Based Services.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026Article
- The Modifying Effect of Individual-Level Neighborhood Perceptions on the Relationship Between Census-Level Neighborhood Social Vulnerability and Cognition in Older Latinos.International journal of environmental research and public health · 2026Article
- Social determinants of dementia: A scoping review.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Expanding Geroscience to Vulnerable Populations in Mid-Late Life: Medicaid Home- and Community-Based Service Users and Formerly Incarcerated Individuals.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025Article
- Pathways to Racial/Ethnic Inequalities in Dementia.Annual review of clinical psychology · 2025Review
- Measuring the Adverse Social Exposome Over the Life Course.JAMA network open · 2025Article
- Association between life's essential 8 and cognitive impairment in older patients: results from NHANES 2011-2014.BMC geriatrics · 2024Article
- Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- Plasma Alzheimer's biomarkers and brain amyloid in Hispanic and non-Hispanic older adults.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- The Case for Conducting Pragmatic Dementia Care Trials in Medicaid Home and Community-Based Service Settings.Journal of the American Medical Directors Association · 2023Article
- Plasma p-tau217 concordance with amyloid PET among ethnically diverse older adults.Alzheimer's & dementia (Amsterdam, Netherlands)Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveWhile racial, ethnic, and socioeconomic group disparities in cognitive impairment and dementia prevalence are well-documented among community-dwelling older adults, little is known about these disparity trends among older adults receiving Medicaid-funded home- and community-based services (HCBS) in lieu of nursing home admission. The authors determined how dementia prevalence and cognitive impairment severity compare by race, ethnicity, educational attainment, and neighborhood context in a Medicaid HCBS population. DESIGN/
settingA cross-sectional study in Connecticut.
participantsAdults age ≥65 in the HCBS program, January-March 2019 (N = 3,520). MEASUREMENTS: The data source was Connecticut's HCBS program Universal Assessment tool. The authors employed two outcomes: Cognitive Performance Scale (CPS2), a 9-point measure ranging from cognitively intact-very severe impairment; and presence or not of either diagnosed dementia or CPS2 score ≥4 (major impairment). Neighborhood context was measured using the Social Vulnerability Index (SVI).
resultsCohort characteristics: 75.7% female; mean(SD) age = 79.1(8.2); Non-Hispanic White = 47.8%; Hispanic = 33.6%; Non-Hispanic Black = 15.9%. Covariate-adjusted multivariate analyses revealed no dementia/major impairment prevalence differences among White, Black, and Hispanic individuals, but impairment severity was greater among Hispanic participants (b = 0.22; p = 0.02). People with more than HS education had less severe impairment (b = -0.12; p <0.001) and lower likelihood of dementia/major impairment (AOR = 0.61; p <0.001). Dementia/major impairment likelihood and impairment severity were greater in less socially vulnerable neighborhoods.
conclusionRacial and ethnic group differences in cognitive impairment are less pronounced in Medicaid-funded HCBS cohorts than in other community-dwelling older adult cohorts. SVI results suggest that, among other possible explanations, older adults with dementia may move to lower social vulnerability neighborhoods where supportive family members reside.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.