Perceived Threat of Alzheimer's Disease and Help-seeking Behavior in Older Adults with Memory Complaints

Alzheimer’s disease (AD) is a chronic disorder with a high burden of suffering for affected individuals, their caregivers, families, and communities. An increased emphasis on early AD detection may benefit affected individuals and their caregivers, especially where disparities already exist in health care and outcomes, but may also unnecessarily heighten perceived AD threat among healthy older adults. Relatively few studies have examined predictors of perceived AD threat and help-seeking behavior among a large and diverse sample that is broadly representative of the U.S. adult population. Informed by health behavior theory, my dissertation 1) identifies factors that influence formal help-seeking for memory complaints through a systematic review of the literature, 2) examines psychosocial and cognitive predictors of perceived AD threat, an understudied construct related to help-seeking, among a nationally representative sample of U.S. adults from the Health and Retirement Study, and 3) explores demographic, health care access, and health status predictors of help-seeking among older adults with memory complaints using Behavioral Risk Factor Surveillance System data. Findings from the systematic review suggest that individual, interpersonal, and structural/policy level factors each play a key role in help-seeking. Multivariate analyses of perceived AD threat revealed that perceived threat was significantly higher for respondents aged 50-64 and 65-74 than for those over 75. Higher perceived threat was also associated with a family history of AD (compared to no experience), stronger beliefs that stress or genetics are important AD risk factors, more depressive symptoms, poorer self-rated memory, and lower cognitive function. Respondents with lower education levels were significantly less likely to seek help. Those who reported more memory-related functional difficulty, more frequent days of poor mental health, and having a primary care provider, were more likely to seek help. These findings highlight the need for education and community outreach to raise awareness about early dementia symptoms, provide specific factors that health care providers should consider in clinical encounters, and highlight the need for careful initial cognitive screening of individuals with memory complaints. These findings also provide insight about the help-seeking process, and a starting point for interventions aimed at increasing timely AD diagnosis and treatment.