What older adults do with results from a community‐based dementia screening program

Abstract

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD), and mild cognitive impairment (MCI) are often under‐recognized in the community. Primary care providers are often responsible for the detection, diagnosis, and treatment of ADRD as the number of dementia specialists are not sufficient to meet the growing demands. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or what individuals who completed screening will do with their results.MethodsA community‐based study was conducted to evaluate acceptability of MCI/ADRD screening, and how older adults would make use of the results and information provided to them. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results.ResultsParticipants (n=288) had a mean age 71.5+8.3y, mean education 13.3+4.8y, and were 70% female, 67% White, 26% Black, 48% Hispanic. After 60 days, 75% of participants were contacted; 54% shared results with family, 32% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results, 51% reported HCPs did not follow‐up on the results, and 18% HCPs did not show any interest in the screening. Behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%) and advanced care planning (4%). Predictors of behavioral change were lower comorbidities (OR=0.62, 95%CI:0.39‐0.96), higher A1C (OR=3.24, 95%CI:1.32‐7.95), poorer self‐perceived emotional health (OR=4.67, 95%CI:1.17‐18.67) and increased age (OR=1.14, 95%CI:1.01‐1.29).ConclusionMCI/ADRD screening was well‐accepted in a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did always not act on screening results, 25% ordered further testing and evaluation. Future efforts are needed to (1) increase self‐efficacy of older adults to discuss screening results with their HCPs, and (2) educate HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection, improving patient‐centered outcomes and medical decision‐making.