Association between experiencing low healthcare quality and developing dementia.

TitleAssociation between experiencing low healthcare quality and developing dementia.
Publication TypeJournal Article
Year of PublicationForthcoming
AuthorsAravena, JM, Chen, X, Levy, BR
JournalJournal of the American Geriatrics Society
ISSN Number1532-5415
KeywordsDementia, healthcare quality indicators, Patient Satisfaction, Perceived Discrimination, Social determinants of health
Abstract

BACKGROUND: Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older.

METHODS: Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors.

RESULTS: Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk.

CONCLUSIONS: As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

DOI10.1111/jgs.18842
Citation Key13791
PubMed ID38415796
Grant ListP30AG021342 / AG / NIA NIH HHS / United States
R01AG067533 / AG / NIA NIH HHS / United States
R01AG077529 / AG / NIA NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
U01AG032284 / AG / NIA NIH HHS / United States