The Relationship Between Immigrant Status and Undiagnosed Dementia: The Role of Limited English Proficiency
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ORIGINAL PAPER
The Relationship Between Immigrant Status and Undiagnosed Dementia: The Role of Limited English Proficiency Yujin Franco1 · Eun Young Choi1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study investigates whether immigrant status is a risk factor for developing dementia and having undiagnosed dementia, as well as the role of limited English proficiency (LEP) as a mediator in the association. Data were drawn from the 2011 wave of the National Health and Aging Trends Study. The sample consisted of 7385 adults aged 65 years and older (6567 U.S.-born and 818 foreign-born). Step-wise logistic regression analyses were performed. Older immigrants had 70% greater odds of having dementia compared to U.S.-born participants. Among those with dementia (n = 1920), older immigrants showed 119% higher odds of being undiagnosed compared to the U.S.-born. Mediation analyses showed that the total effects of immigrant status on dementia and undiagnosed dementia explained by LEP were 87.6% and 56.1%, respectively. It is important to tailor dementia education and interventions to the immigrant population with LEP. Keywords Immigrants · Dementia prevalence · Undiagnosed dementia · Limited English proficiency
Introduction Dementia is a condition that can be triggered by various cardiovascular risk factors that influences memory, cognition, behavior, and the ability to perform daily activities [1]. According to the Alzheimer’s Association, 5.6 million older adults aged over 65 have dementia in the U.S. [2]. Although the prevalence of dementia is high, the rate of timely diagnosis of dementia is low among older adults [3, 4]. Only around half of U.S.-born older adults who meet the criteria for dementia have been diagnosed with dementia by a doctor, which implies that approximately half of all dementia cases go undiagnosed [5]. There are many negative outcomes due to undiagnosed dementia. For instance, older adults with undiagnosed dementia have a lower quality of life [6] and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10903-019-00963-w) contains supplementary material, which is available to authorized users. * Yujin Franco [email protected] Eun Young Choi [email protected] 1
Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave, Los Angeles, CA 90089, USA
are more likely to engage in potentially dangerous situations, such as driving and preparing hot meals [7]. Failure to identify dementia promptly could also cause a large economic burden on states and on the federal government [8].
Immigrant Status and Dementia In the U.S., the share of the older adult population that was foreign born in 2016 was 13.55%, and it is expected to increase to 23.26% by 2060 [9]. Such trends suggest that the size of the older adult immigrant population with dementia may increase in coming decades. Previous studies have found that immigrant status and incidence of dementia are closely linked [10–12]. However
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