Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility

• Published in: International journal of geriatric psychiatry 2011-03, Vol.26 (3), p.268-276
• Main Authors: Harris, Dorothy P., Ortiz, Freddy, Adler, Fredric M., Yu, Katherine, Maines, Michele L., Barba, Dora, Viggiani, Sandra I., Wolf, Sheldon M., Fitten, L. Jaime, Chodosh, Joshua, Vickrey, Barbara G.
• Format: Article
• Language: English
• Subjects: Adaptations; Age; Aged; Aged, 80 and over; Biological and medical sciences; Community Mental Health Services - standards; Female; Fundamental and applied biological sciences. Psychology; General aspects; Geriatric psychiatry; Geriatric psychology; Geriatrics; Hispanic Americans; Hispanic elders; Hispanic people; Humans; Male; Mass Screening - methods; Mass Screening - standards; Medical sciences; Medical screening; Memory; Memory Disorders - diagnosis; Memory Disorders - epidemiology; memory screening; Middle Aged; Morbidity; Older people; Primary care; Primary Health Care; Proxy; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; quality improvement; United States - epidemiology; Urban Population
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.2524

Objective Implement a memory impairment screening procedure for elderly Hispanic primary care patients, and analyze its yield and challenges to further triage and diagnostic evaluation. Methods Three hundred twenty nine Hispanic patients aged ≥60 years or proxy informants were enrolled from outpatient primary care clinics at an urban safety‐net medical center. Patients were screened for memory impairment using the WHO‐UCLA AVLT; for those without consent capacity, proxies were given the IQCODE. Bilingual research assistants conducted in‐person or telephone screening. Age, gender, education, comorbidities, acculturation, overall health, access to care, and memory concerns were assessed as potential predictors of memory impairment. Based on identified implementation challenges, a multi‐disciplinary stakeholder committee proposed revised approaches to increase diagnostic evaluation and sustainability. Results Of 677 eligible patients approached, 329 (49%) were screened, and 77 (23%) met criteria for memory impairment using the WHO‐UCLA AVLT (N = 60) or the IQCODE (N = 17). Only male gender and higher comorbidity uniquely predicted memory impairment (ps