This application responds to PAR-02-049, NIA Pilot Research Grant Program (R03) objective 20 (Racial/Ethnic differences and health disparities) and objective 24 (Improved measures and methodologies).This project addresses decision-making and delays in the diagnosis of Alzheimefs disease for African-American and Hispanic patients.
Specific Aim 1 : validate a new data collection methodology (Qualitative Decision Analysis) that uses a card sort method to trigger memory for four critical time points: First Notice of memory or behavior change; formal Problem Recognition; First Visit to Physician for evaluation of memory/behavior changes; and medical Diagnosis.
Specific Aim 2 : test for the following effects on decisionmaking and time-to-diagnosis latencies: acculturation, decisionmaking style, family functionality, sociodemographic characteristics, previous experience of AD, and comorbidities (using Kaplan Meier survival functions and Cox Regression).
Specific Aim 3 : generate pilot data for an R0-1 proposal on diagnosis seeking for chronic and degenerative diseases affecting older adults. Predictions are: (1) groups with timelines marked by onset of a major illness/catastrophic event will come to Problem Recognition more quickly than groups with time lines characterized by repetitive, cumulative events; (2) groups with timelines marked by onset of a major illnes/catastrophic event will seek medical attention for family members more quickly than participants with time lines characterized by repetitive, cumulative events; (3) groups with timelines marked by onset of a major illness/catastrophic event will display faster times to Diagnosis than participants with timeslines characterized by repetitive, cumulative events; (4) family decision-makers who are more acculturated, more assertive, have higher family functionality, and higher SES will show shorter times from First Notice to First Physician Visit; (5) when patients have higher numbers of pre-existing illnesses longer times from First Notice to Problem Recognition, but shorter times from Problem Recognition to First Contact will be found; and (6) caregivers with previous experience with ADRD will demonstrate shorter times from First Notice to First Contact. The sample includes 45 Hispanic and 45 African American caregivers who self-identify as key agents in the diagnosis-seeking process and whose family member received a diagnosis from a Primary Care Provider.
