Dementia in People from Ethnic Minority Backgrounds: Disability, Functioning, and Pharmacotherapy at the Time of Diagnosis

Abstract

Objectives: Increasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.

Design: Cross-sectional study of patient characteristics at the point of dementia diagnosis.

Setting and participants: In total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015.

Methods: Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record.

Results: Compared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.

Conclusions and implications: At dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.

Keywords: Dementia; antidepressants; ethnic minorities; health inequalities; polypharmacy; psychosis; vascular dementia.