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The Relationship Between Immigrant Status and Undiagnosed Dementia: The Role of Limited English Proficiency

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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.

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References

  1. Alzheimer’s Disease International. Dementia and risk reduction an analysis of protective and modifiable factors; 2014. https://www.alz.co.uk/research/WorldAlzheimerReport2014.pdf. Accessed 27 April 2019.

  2. Alzheimer’s Association. 2018 Alzheimer’s disease facts and figures. Alzheimers Dement. 2018;14(3):367–429.

    Article  Google Scholar 

  3. Lang L, Clifford A, Wei L, Zhang D, Leung D, Augustine G, Danat IM, Zhou W, Copeland JR, Anstey KJ, Chen R. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ Open. 2017;7(2):e011146.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Savva GM, Arthur A. Who has undiagnosed dementia? A cross-sectional analysis of participants of the Aging, Demographics and Memory Study. Age Ageing. 2015;44(4):642–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Amjad H, Roth D, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults. JGIM. 2018;33(7):1131–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alzheimer’s Disease International. The benefits of early diagnosis and intervention; 2011. https://www.alz.co.uk/research/WorldAlzheimerReport2011ExecutiveSummary.pdf. Accessed 28 April 2019.

  7. Amjad H, Roth DL, Samus QM, Yasa S, Wolff JL. Potentially unsafe activities and living conditions of older adults with dementia. J Am Geriatr Soc. 2016;64(4):1223–32.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Weimer DL, Sager MA. Early identification and treatment of Alzheimer’s disease: social and fiscal outcomes. Alzheimer’s Dement. 2009;5(3):215–26.

    Article  Google Scholar 

  9. U.S. Census Bureau. Projected foreign-born population by selected ages: main projections series for the United States, 2017-2060; 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. Accessed 27 April 2019.

  10. Moon H, Badana ANS, Hwang SY, Sears JS, Haley WE. Dementia prevalence in older adults: variation by race/ethnicity and immigration status. Am J Geriatr Psychiatry. 2019;27(3):241–50.

    Article  PubMed  Google Scholar 

  11. Parlevliet JL, Uysal-Bozkir Ö, Goudsmit M, Van Campen JP, Kok RM, ter Riet G, Schmand B, de Rooij SE. Prevalence of mild cognitive impairment and dementia in older non-western immigrants in the Netherlands: a cross-sectional study. Int J Geriatr Psychiatry. 2016;31(9):1040–9.

    Article  CAS  PubMed  Google Scholar 

  12. Chertkow H, Whitehead V, Phillips N, Wolfson C, Atherton J, Bergman H. Multilingualism (but not always bilingualism) delays the onset of Alzheimer disease: evidence from a bilingual community. Alzheimer Dis Assoc Disord. 2010;24(2):118–25.

    Article  PubMed  Google Scholar 

  13. Xu H, Zhang Y, Wu B. Association between migration and cognitive status among middle-aged and older adults: a systematic review. BMC Geriatr. 2017;17(1):1–15.

    Article  Google Scholar 

  14. Oppas M, Varvin S. Relationships of childhood adverse experiences with mental health and quality of life at treatment start for adult refugees traumatized by pre-flight experiences of war and human rights violations. J Nerv Ment Dis. 2015;209(9):684–95.

    Article  Google Scholar 

  15. Rosenbaum B, Varvin S. The influence of extreme traumatization on body, mind and social relations. Int J Psychoanal. 2007;88(6):1527–42.

    Article  PubMed  Google Scholar 

  16. Nguyen HT, Black SA, Ray LA, Espino DV, Markides KS. Predictors of decline in MMSE scores among older Mexican American. J Gerontol A. 2002;57(3):M181–5.

    Article  Google Scholar 

  17. Angel RJ, Angel JL, Venegas CD. Shorter stay, longer life: age at migration and mortality among the older Mexican-origin population. J Aging Health. 2010;22(7):914–31.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cho Y, Frisbie WP, Hummer RA, Rogers RG. Nativity, duration of residence, and the health of Hispanic adults in the United States. Int Migr Rev. 2004;38(1):184–211.

    Article  Google Scholar 

  19. Markides K, Gerst K. Immigration, aging, and health in the United States. Handbooks of sociology of aging. New York: Springer; 2011.

    Google Scholar 

  20. Pablo-Mendez A. Mortality among Hispanic. JAMA. 1994;270(20):2464–8.

    Google Scholar 

  21. Chicwick BR, Miller PW. Language choice among immigrants in a multi-lingual destination. J Popul Econ. 1994;7(2):119–31.

    Google Scholar 

  22. Zedan AM, Kadir FABA, Yusof MBM, Siren NBH, Mohamed RB, Toure S. The role of language in education: Arabic as case study. Soc Behav Sci. 2013;70:1002–8.

    Article  Google Scholar 

  23. Gordon MM. Assimilation in American life: the role of race, religion, and national origin. Soc Forces. 1964;43(1):125–6.

    Google Scholar 

  24. Ponce NA, Hays RD, Cunningham WE. Linguistic disparities in health care access and health status among older adults. J Gen Intern Med. 2006;21(7):786–91.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tam KW, Page L. Effects of language proficiency on labour, social and health outcome of immigrant in Australia. Econ Anal Policy. 2016;52:66–78.

    Article  Google Scholar 

  26. Dannefer D. Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. J Gerontol B. 2003;58(6):S327–33.

    Article  Google Scholar 

  27. Kim G, Kim M, Park S, Jimenez DE, Chiriboga DA. Limited English proficiency and trajectories of depressive symptoms among Mexican American older adults. The Gerontologist. 2019;59(5):856–64.

    PubMed  Google Scholar 

  28. Barcellos SH, Goldman DP, Smith JP. Undiagnosed disease, especially diabetes, casts doubt on some of reported health ‘advantage’ of recent Mexican immigrants. Health Aff. 2012;31(12):2727–37.

    Article  Google Scholar 

  29. Zallman L, Himmelstein DH, Woolhandler S, Bor DH, Ayanian JZ, Wilper AP, McCormick D. Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US. J Immigr Minor Health. 2013;15(5):858–65.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Carrasquillo O, Carrasquillo AI, Shea S. Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health. 2000;90(6):917–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. LeClere FB, Jensen L, Biddlecome AE. Health care utilization, family context, and adaptation among immigrants to the United States. J Health Soc Behav. 1994;35(4):370–84.

    Article  CAS  PubMed  Google Scholar 

  32. Holahan J, Kim J. Why does the number of uninsured Americans continue to grow? Health Affair. 2000;19(4):188–96.

    Article  CAS  Google Scholar 

  33. Shi L, Lebrun LA, Tashi J. The influence of English proficiency on access to care. Ethn Health. 2009;14(6):625–42.

    Article  PubMed  Google Scholar 

  34. Smith DL. Health care disparities for persons with limited English proficiency: relationships from the 2006 medical expenditure panel study (MEPS). J Health Dispar Res Pract. 2010;3(3):57–67.

    CAS  Google Scholar 

  35. Kim G, Worley CB, Allen RS, Vinson L, Crowther MR, Parmelee P, Chiriboga DA. Vulnerability of older Latinos and Asian immigrants with limited English proficiency. J Am Geriatr Soc. 2011;59(7):1246–52.

    Article  PubMed  Google Scholar 

  36. Ruiz P. Cultural barriers to effective medical care among Hispanic-Americans. Annu Rev Med. 1985;36:63–71.

    Article  CAS  PubMed  Google Scholar 

  37. Cristancho S, Garces DM, Peters KE, Mueller BC. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qual Health Res. 2008;18(5):633–46.

    Article  PubMed  Google Scholar 

  38. Meuter RFI, Gallois C, Segalowitz NS, Ryder AG, Hocking J. Overcoming language barriers in healthcare: a protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Serv Res. 2015;15(371).

  39. Kim EJ, Kim T, Conigaliaro J, Liebschutz JM, Paasche-Orlow M, Hanchate AD. Racial and ethnic disparities in diagnosis of chronic medical conditions in the USA. J Gen Intern Med. 2018;33(7):1116–23.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Montaquila J, Freedman VA, Edwards B, Kasper JD. National Health and Aging Trends Study Round 1 Sample Design and Selection (NHATS Technical Paper No. 1); 2012.

  41. Skehan ME, Spillman BC. STATA programming statements for construction of dementia classification in the National Health and Aging Trends Study. Addendum to NHATS Technical Paper #5. Baltimore: Johns Hopkins University School of Public Health; 2013.

  42. Galvin JE, Roe CM, Powlishta KK, Coats MA, Muich SJ, Grant E, Miller JP, Storandt M, Morris JC. The AD8 A brief informant interview to detect dementia. Neurology. 2005;65(4):559–64.

    Article  CAS  PubMed  Google Scholar 

  43. Kasper JD, Freedman VA, Spillman BC. Classification of persons by dementia status in the National Health and Aging Trends Study (Technical Paper, 5). Baltimore: John Hopkins University School of Public Health; 2013.

    Google Scholar 

  44. Galvin JE, Roe CM, Xiong C, Morris JC. Validity and reliability of the AD8 informant interview in dementia. Neurology. 2006;67(11):1942–8.

    Article  PubMed  Google Scholar 

  45. Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS, Breuer J. Screening for Alzheimer’s disease by clock drawing. J Am Geriatr Soc. 1989;37(8):730–4.

    Article  CAS  PubMed  Google Scholar 

  46. Sternberg SA, Wolfson C, Baumgarten M. Undetected dementia in community-dwelling older people: the Canadian Study of Health and Aging. J Am Geriatric Soc. 2000;48(11):1430–4.

    Article  CAS  Google Scholar 

  47. Montaquila J, Freedman VA, Kasper JD. National Health and Aging Trends Study Round 3 income imputation (NHATS Technical Paper #10). Baltimore: John Hopkins University School of Public Health; 2015.

    Google Scholar 

  48. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.

    Article  PubMed  Google Scholar 

  49. Montaquila J, Freeman VA, Spillman B, Kasper JD. National Health and Aging Trends Study development of round 1 survey weights (NHATS technical paper #2). Baltimore: John Hopkins University School of Public Health; 2012.

    Google Scholar 

  50. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    Article  CAS  PubMed  Google Scholar 

  51. MacKinnon DP, Dwyer JH. Estimating mediated effects in prevention studies. Eval Rev. 1993;17(2):144–58.

    Article  Google Scholar 

  52. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhardt S, editor. Sociological methodology. ASA: Washington DC; 1982. p. 290–312.

    Google Scholar 

  53. Valkanova V, Ebmeier KP, Allan CL. Depression is linked to dementia in older adults. Practitioner. 1800;2017(261):11–5.

    Google Scholar 

  54. Touradji P, Manly JJ, Jacobs DM, Stern Y. Neuropsychological test performance: a study of non-Hispanic White elderly. J Clin Exp Neuropsychol. 2001;23(5):643–9.

    Article  Google Scholar 

  55. Derose KP, Baker DW. Limited English proficiency and Latino’s use of physician services. Med Care Res Rev. 2000;57(1):76–91.

    Article  CAS  PubMed  Google Scholar 

  56. Hinton L, Franz C, Friend J. Pathways to dementia diagnosis: evidence for cross-ethnic differences. Alzheimer Dis Assoc Disord. 2004;18(3):134–44.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave, Los Angeles, CA, 90089, USA

    Yujin Franco & Eun Young Choi

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  1. Yujin Franco
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Correspondence to Yujin Franco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research Involving Human Participants and/or Animals

This research used the data from National Health and Aging Trends Study (NHATS), and the original NHATS investigators received approval from the Johns Hopkins Bloomberg School of Public Health’s Institutional Review Board.

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The original NHATS investigators obtained informed consent from study participants.

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Franco, Y., Choi, E.Y. The Relationship Between Immigrant Status and Undiagnosed Dementia: The Role of Limited English Proficiency. J Immigrant Minority Health 22, 914–922 (2020). https://doi.org/10.1007/s10903-019-00963-w

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