Current Reality and Estimated Predications for Future

By:
Shannon Marling, CTRS/ VCU Graduate Student of Gerontology

Tracey Gendron, MSG Instructor/ Clinical Coordinator

VCU Department of Gerontology

S1

Minorities are the fastest growing segment of

the older adult population 65 & older
Between 1990-2030 population projected increases 11

600% 555%

500%

400%
328%
300%
300%

200% 160%
93%
100%

0%
White Non-White Hispanics African-American Asian and Pacific
(non-Hispanic) Islanders
Slide 2

S1 United States Represents indiviudals from 17 spanish speaking countries

Asian Americans represent at least 20 different countries and 60 distinct ethnicities
SMarling, 10/23/2009
S1

Percentages of Minorities within the US Population by

Selected Age Groups: 2010-2050
70
62
60 58
54 54 55
49 49 50
50 45 45 46
40 40 42
40 35 35 35
29
30
24
20
20

10

0
All Ages Under 18 yrs 18-64 yrs 65+
2010 2020 2030 2040 2050
Source: Population Division: US Census Bureau
Released: August 14, 2008
Slide 3

S1 based on population projections, immigration projections and estimates vary with in resources ranges go upwards to 50 or more of population
SAHPAdmin, 10/26/2009
 Projections of the Population by Race and Hispanic Origin for the United States: 2008-50
(Resident population as of July 1. Numbers in thousands)
Race and Hispanic Origin1 2008 2010 2015 2020 2025 2030 2035 2040 2045 2050
Total Population 304,228 310,233 325,540 341,387 357,452 373,504 389,531 405,655 422,059 439,010
One race 299,076 304,734 319,105 333,913 348,831 363,621 378,263 392,875 407,640 422,828
White 242,803 246,630 256,306 266,275 276,281 286,109 295,729 305,247 314,852 324,800
Black 39,031 39,909 42,137 44,389 46,594 48,728 50,810 52,868 54,911 56,944
AIAN 3,076 3,188 3,472 3,759 4,039 4,313 4,590 4,875 5,167 5,462
Asian 13,599 14,415 16,527 18,756 21,109 23,586 26,169 28,836 31,577 34,399
NHPI 564 592 662 734 808 885 965 1,048 1,134 1,222
Two or more races 5,151 5,499 6,435 7,474 8,620 9,883 11,268 12,781 14,418 16,183

Non-Hispanic White alone 199,804 200,853 203,208 205,255 206,662 207,217 206,958 206,065 204,772 203,347

Hispanic 46,697 49,726 57,711 66,365 75,772 85,931 96,774 108,223 120,231 132,792

Race alone or in
combination:2
White 247,261 251,400 261,922 272,835 283,890 294,881 305,782 316,707 327,840 339,441
Black 41,098 42,163 44,906 47,748 50,626 53,519 56,453 59,454 62,534 65,703
AIAN 4,855 5,025 5,463 5,907 6,342 6,770 7,204 7,654 8,119 8,592
Asian 15,519 16,472 18,952 21,586 24,385 27,352 30,472 33,722 37,090 40,586
NHPI 1,118 1,176 1,325 1,480 1,643 1,814 1,993 2,181 2,376 2,577

1 Hispanics may be of any race.

2
'In combination' means in combination with one or more other races. The sum of the five race groups adds to more than the total population
because individuals may report more than one race.
Abbreviations: Black = Black or African American; AIAN = American Indian and Alaska Native; NHPI = Native Hawaiian and Other Pacific
Islander
Note: The original race data from Census 2000 are modified to eliminate the “some other race” category. This modification is used for all
Census Bureau projections products and is explained in the document entitled “Modified Race Data Summary File Technical Documentation
and ASCII Layout” that can be found on the Census Bureau website at http://www.census.gov/popest/archives/files/MRSF-01-US1.html
Source: Population Division, U.S. Census Bureau; Release Date: August 14, 2008
S2

Estimates of Dementia in United States

 The Aging, Demographic, and Memory Study
(ADAMS) study estimated the total number of
individuals in the United States with dementia to be
3.8 million17
 According to the Alzheimer’s Association 2009 Facts
and Figures Report
 5.3 Million persons of all ages are affected with Alzheimer’s
disease (AD)
 1 in 8 individuals 65 and older have AD
 Every 70 seconds a person is diagnosed with the disease, this
is forecasted to become every 33 seconds
 Between 2000- 2025 State and Regional
percentages of increase in the number of individuals
with AD will be in the double digits21
Slide 5

S2 Some regions will experience as much as a 30-50% increase of individuals with AD

Asian Americans are missing from this slide , important to notice that minorities are effected at a greater rate, appears to espeically be true in
the 85 and older adult range
SMarling, 10/27/2009
S4

Types of dementia among Whites, Blacks, Hispanics and Asians

from Nine Alzheimer’s Disease Diagnostic and Treatment Centers20
Slide 6

S4 Study from 4 california memory clinics and reflective of national trends on disease prevelance and ethnicities, higher rate of vascular dementia
in African Americans and hispancis
SAHPAdmin, 10/26/2009
S5

Prevalence of Dementia for Hispanics

 One study suggested that barriers to health care access may
significantly delay diagnosis and treatment in the Hispanic
population
Hispanics living in the US diagnosed with AD3
1,400,000

1,200,000

1,000,000

800,000

600,000

400,000

200,000

2009 2050
Slide 7

S5 Last bullet- important to mention because delay of diagnosis and treatment can skew the prevelance data numbers, we also know that it was
not until about 1993 that educational material was developed or targeted to the hispanic population so there is a delay in education for this
community Dr. Pyles and Dr maximfield will go further into detail on this topic, we also kno
SAHPAdmin, 10/26/2009
S4

Prevalence of Dementia for African American

 AD often referred to as the “Silent Epidemic” among African
Americans due to a disproportionally high rate of diagnosis of
the disease
 African American older adults are reported to have a higher rate
of AD and vascular dementia in a diagnostic screening and
assessment17
 African Americans have a greater filial risk for developing AD

 Misdiagnosis and under-diagnosis is likely to occur in

Non-Hispanic blacks with dementia
Slide 8

S4 - sepaking on bullet # 2 as compared to white non-hispanci

cumulative risk for the development of AD appears to be higher in AA, 60% higher risk of type 2 diabiteis, found to have higer rates of
hypertension
- #4 mis-diagnosi and under diagnoisi is going to skew the data meaning we may not be getting a clear picture of the actual numbers
SMarling, 10/27/2009
S7

Prevalence of Dementia for Asian American

Population
 There is a gap in the literature and research in regard to
Asian American population affected with dementia
 Asian American elders show a greater prevalence of
dementia than the general population
 Controlling for lifetime prevalence of mental illness, Asian
Americans are less likely to use mental health services than
white Americans
Slide 9

S7 the gap in literature is starting to close regarding Asian Americans, even articles as recent as 2008 indicated there still remains a gap in reseach
and literature
Medicare did not have a catorgory for Asians until the 1990, prior to that it was White, Black and Other
Asian Americans are often discoruaged from participating in research
SAHPAdmin, 10/26/2009
S5

Why is misdiagnosis and under-diagnosis

more likely to occur among minority groups?
 Variables related to culture, race and education that underlie ethnic group differences
on cognitive test performance

 One study found that older adults who have limited health literacy were significantly
less likely to have a primary physician or source of care16

 Acculturation – the level at which people participate in the values, language and
practices of their own ethnic community verses those of the dominant community

 One study found that a disconnect existed between the language being used by
medical professionals and African Americans accessing services6

 Poor assessment tools with cultural and ethnic bias's may result in false–positive
screening, especially for African Americans

 Asian Americans and African Americans have shown through studies to hold the
cultural view that dementia is “normal” part of the process of aging12
Slide 10

S5 Language has a huge influence on diagnosis and has been reported by several groups to be an issue in diagnosis and access to services- with
regard to assesment procedures and tool, language has been experienced by some ethnic groups as culturally inappropriote and at times even
racsist
MMSE cut off of 23 has lead to an over diagnosis of dementia among AA
- last bullet- aa who viewed dementia as normal part of the aging process were found in two memeory clincis to access services 5-7 years the
firs signs of dementia - early intervention leads to increase in care, decrease in cost, decrease in care giver burden
SMarling, 10/27/2009
S8

Racial and Ethnic Disparities in Accessing Care

 Stigmatization of severe and chronic mental illness have been
identified as a factors that heavily influences health disparities in Asian
Americans
 Among individuals age 65 and older:
 Asians have the highest rate of un-insurance 6%, compared to

 Hispanics 5%

 Blacks 1%, and

 White .02 %1

 Older adults with a 6th grade reading level are twice as likely to have at
least three indicators of poor health care access16
 Hispanics have the lowest education levels of any group in the United
States
Slide 11

S8 - number 3- one resource indicated that 47% of the population is considered functionally illiterate
SAHPAdmin, 10/26/2009
S3

Racial and Ethnic Disparities in Accessing Care

 The 2006 National Health Care Disparities Report (NHDR)
found that a lower quality of care was received by Asians as
compared to whites for a one third of the measures that were
tracked in the report2
 African Americans have been underrepresented in clinical
trials for potential treatments for AD
 Some studies have suggested that genetic risk factors for AD
are different among ethnicities and that environmental factors
may differently affect and interact with genetic factors
Slide 12

S3 bullet number 2- minorities in general have been found to be less likely to be presribed anit-dementia medications- is this because there is less
eperical data available?
meaning these factors interact differently in the causes of AD, with out enough reseach reasons for this remain unclear
SMarling, 10/27/2009
Reference List:

1. R. D. Williams, (2004) “Medicare and Communities of Color”, Medicare Brief no.11, Washington National Academy of Social Insurance, November.
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Health Affairs, 27(2).
3. Alzheimer's Association (2004). Hispanics/Latinos and Alzheimer’s Disease.
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Institutional Surveys. The Gerontologist, 47(3), 350-354.
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