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Does where you live impact the care you receive for early-onset dementia? What research shows about rural-urban healthcare disparities

Kate Ying | Dementia, Alzheimer's

Are you one of the approximately one-fifth of Americans who live in a rural area of the United States? If so, you may already be familiar with the myriad healthcare disparities that rural residents confront, such as a higher risk of health issues like heart disease, stroke, and unintentional injury deaths compared to urban residents. This problem has many root causes, including a shortage of physicians overall and specialists in rural areas. Troublingly, data show that for every 100,000 people, there were just 30 medical specialists in rural areas compared to 263 specialists in urban areas.

How do health inequities between rural and urban populations impact care?

How, in turn, do the health inequities between rural and urban populations impact the care that patients receive for medical conditions that traditionally require specialist oversight, such as from neurologists, psychologists, and speech-language pathologists? More pointedly, how might the rural-urban health disparities impact the diagnosis and treatment of early-onset Alzheimer’s disease and related dementias (ADRDs), a disease which affects hundreds of thousands of Americans?

This article will summarize a recent study published in JAMA Network Open that offers important insights into those questions. Beyond that, it also suggests steps that patients and clinicians can take to mitigate the rural-urban healthcare gap. 

Study design

A 2022 study published in the peer-reviewed journal JAMA Network Open explored how the reduced access to specialist care in rural areas might impact the diagnostic timing and symptom management of early-onset Alzheimer’s disease and related dementias. 

The study used a cross-sectional design to analyze de-identified healthcare data from the IBM Watson MarketScan Commercial Claims and Encounters Database between 2012 and 2018. That data included patient diagnoses, procedures, office visits, age, and residency information, thus providing an ideal window through which to investigate the frequency of early-onset ADRDs and access to specialty care across rural and urban patient segments. Patients between the ages of 40 and 64 with an early-onset ADRD diagnosis, as identified via inpatient or outpatient claims, were included in the study. To determine specialty care access, researchers examined whether a patient with early-onset ADRD had seen a specialist with expertise in dementia within 90 days of the initial diagnosis and/or had received appropriate imaging studies or neuropsychological assessments during that time.  

Main takeaway

The study found that during the 90-day study period, rural residents with early-onset ADRDs, compared to urban residents with the same diagnosis, were more likely to be exclusively diagnosed and treated for their ADRD by a primary care physician. Specifically, while approximately 19% of rural residents only visited a PCP within 90 days of their diagnosis, that was true for just 13% of urban residents. Patients who lived in rural areas were also less likely to visit a psychologist or undergo neuropsychological testing within 90 days of the initial diagnosis. Collectively, those findings indicate that a significantly greater proportion of rural residents living with early-onset ADRD may not be receiving adequate testing or treatment from clinicians with specialty expertise in dementia

Because early-onset ADRDs are thought to progress more rapidly than late-onset variations, early diagnosis and an effective treatment plan are especially important to slow disease progression, preserve cognitive function, and allow for prospective life planning. However, a prior study identified a mean 1.6-year delay of early-onset ADRD diagnosis compared to late-onset ADRD diagnosis. As a result, timely, effective treatment once an early-onset ADRD diagnosis is received is even more important to stem disease progression, maintain cognition, and improve a patient’s quality of life. 

Conclusions

This study’s findings further confirm the deeply entrenched healthcare inequities that exist between rural and urban populations. Moreover, given the broader difficulties of accessing specialist care in rural areas due to chronic provider shortages, it is unlikely that there exists a silver bullet to address all care gaps for rural early-onset ADRD patients in the near term. 

There are, however, proactive steps that patients, caregivers, and clinicians alike can take to counter the effects of such healthcare access disparities. Telehealth, for one, can be a helpful strategy to connect patients in rural settings with specialist providers located farther away. As increasingly, more clinicians begin to offer virtual appointments, patients may be able to overcome at least some barriers to initial diagnoses and ongoing care management through telehealth oversight. 

In a complementary way, patients and clinicians can also turn to accessible, cost-effective, and research-backed brain rehabilitation telehealth solutions, such as Constant Therapy. Notably, a June 2021 study found that Constant Therapy is effective at both preventing further decline of existing cognitive and linguistic skills and improving baseline abilities in people living with dementia. The program can be tailored according to an individual patient’s needs and, just as important, Constant Therapy is fully accessible for patients regardless of how far they live from a specialist. 

Where you live should not determine the quality of care you receive for any health condition, including early-onset Alzheimer’s and other dementias. The ingrained gaps in care between rural and urban communities in the United States should be addressed by targeted policy solutions. In the meantime, patients living with early-onset ADRD can turn to established, accessible treatment options like Constant Therapy to thrive and improve no matter how far away from traditional care they live. All that is needed is a tablet, an internet connection, and a determined mindset.

Read the Research

Xu, W. Y., Jung, J., Retchin, S. M., Li, Y., & Roy, S. (2022). Rural-Urban Disparities in Diagnosis of Early-Onset Dementia. JAMA Network Open, 5(8), e2225805. https://doi.org/10.1001/jamanetworkopen.2022.25805

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