Low-Income Black, Latino Patients Often Slip Between Cracks, Researcher Says
Creating better coordination between health care centers and public health agencies can improve care for Black and Latino people diagnosed with, or at risk from, Alzheimer's disease and related dementias, a UMD researcher says.
Hospitals frequently treat and stabilize people with Alzheimer’s disease and dementia only to release them back into the community where another crisis begins building—a destructive dynamic particularly prevalent in underserved Black and Latino communities.
Supported by a $2.3 million grant from the National Institute on Aging, a University of Maryland School of Public Health researcher is studying ways to integrate health care systems and public health agencies and identify resources to short-circuit this cycle, reducing race- and ethnicity-based health disparities.
Another piece of the puzzle is working to help those at risk from dementia who may not have access to preventive care, or guidance needed to head the condition off early, said Jie Chen, a professor of health policy and management who is leading the study.
“These diseases can develop over decades,” said Chen, director of the Hospital And Public health InterdisciPlinarY Research (HAPPY) laboratory at UMD. “For people not yet diagnosed, how can we help create a better approach to diet, exercise, smoking and other behavioral factors that can delay or prevent them?”
The lack of coordination in treatment and preventive care creates a range of problems: It makes emergency treatment more expensive; distresses patients; and creates problems for part- or full-time care caregivers, who may incur great expense as they put their lives on hold.
“We don’t know the extent that this is being done informally by a daughter, cousin or friend, but it is very widespread,” she said.
Chen’s research suggests structures that create personalized plans for easing the transition from health care facility back to a community setting can make a significant impact for elderly African American and Latino populations with multiple chronic conditions and cognitive limitations.
Her team, including co-investigator Andrew Fenelon, a Penn State assistant professor of public policy, will also focus on individuals receiving assistance from the U.S. Department of Housing and Urban Development (HUD), which includes a significant percentage of African Americans and Hispanics, she said. The HUD-assisted community is crucial to target because they are the hardest to reach with services for Alzheimer’s and dementia, Chen and Fenelon said.
The stress of COVID-related lockdowns and a switch to virtual care has been another challenge for this population. “The COVID-19 crisis has underscored the critical role of public health in advancing population health. Strengthening the integration of public health systems has become even more critical,” Chen said.
To create strategies for interventions, Chen and her team will analyze Medicare claims data over more than a decade to observe patterns of health care utilization and costs among the aging population with complex health needs.
The project has the potential to inform policy decisions on housing assistance at the federal and local levels, including how housing and health care policies could be better integrated to improve health outcomes and reduce disparities in low-income populations, she said.
Chen’s other co-investigators include Luisa Franzini, professor chair of UMD’s health policy and management department; Min Qi Wang, professor of behavioral and community health; J. Carson Smith, professor of kinesiology; and Charles Ma, assistant professor of biostatistics . HAPPY lab doctoral students Deanna Brath, Aitalohi Amaize, Ivy Benjenk, Yang Wang and Asmaa Albaroudi are also a part of the research team.
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