Access to primary care and cognitive impairment: results from a national community study of aging Americans

Megan A Mullins,Suzanne E Judd,Julie P W Bynum,Philippa J Clarke

doi:10.1186/s12877-021-02545-8

Abstract

BackgroundDespite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.MethodsREGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors.ResultsAmong 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23).ConclusionsOur results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.

Highlights

Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear
Most existing ADRD primary care research has focused on the role of ambulatory/primary care for detecting cognitive impairment and dementia; little is known about the role of primary care
The majority of participants lived in primary care service area (PCSA) where the supply of primary care physicians was within the interquartile range of the nation, with slightly larger proportions of REGARDS participants living in areas at the second and third quartiles (31.0 and 27.7% respectively) compared to the nation as a whole

Summary

Introduction

Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. People with Alzheimer’s disease or related dementias (ADRD) use more health care, including. Little research has examined what role (if any) access to primary care has in preventing cognitive impairment. Mitigation of modifiable risk factors is a potential mechanism by which health care can prevent or delay cognitive impairment [3, 9]. Research on the relationship between cardiovascular health and dementia [10, 11] suggests that access to primary health care may mitigate age-related cognitive decline through effective management of vascular risk factors, such as hypertension and diabetes [12,13,14]. Other modifiable risk factors for dementia are managed or encouraged by primary care physicians, including regular exercise, obesity and stopping smoking [9]

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