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Pathways to Dementia Diagnosis: Evidence for Cross-Ethnic Differences

Hinton, Ladson MD*†; Franz, Carol PhD*‡; Friend, Jeffrey MD§

Alzheimer Disease & Associated Disorders: July-September 2004 - Volume 18 - Issue 3 - p 134-144
doi: 10.1097/01.wad.0000127444.23312.ff
Original Article

Summary The diagnosis of dementia often occurs well after the onset of the disease. Studies of help-seeking behavior may help illuminate why delays occur.

Specific Aims (1) To describe pathways to diagnosis from the perspective of family caregivers and (2) to compare help-seeking patterns and experiences across three ethnic groups.

Methods Semi-structured qualitative interviews were conducted with 39 ethnically diverse family dementia caregivers. Interviews were coded for help-seeking events (initial help-seeking, referrals to secondary helpers, and site of final diagnosis), pathway types, and adverse experiences within the healthcare system along pathways to diagnosis.

Results Help-seeking was most often initiated by family members or formal care providers (ie, healthcare providers or social workers), usually in outpatient primary care settings but also elsewhere (eg, social service agencies, hospitals). “Secondary” formal helpers were often involved, usually through self-referral by families rather than by healthcare providers. While most families reported receiving a “final” diagnosis, a small minority of predominantly Chinese-American families did not. Four distinct pathways to diagnosis were identified and found to vary significantly (p < 0.03) across the three ethnic groups, which we label as smooth pathways, crisis events pathways, fragmented pathways, and dead-end pathways. Adverse experiences in the healthcare system were common and included unsatisfactory diagnosis disclosure and explanation, inadequate workup, uncaring or insensitive attitude, language barriers, and discrimination.

Conclusions Cross-ethnic differences were found in both pathway types and in adverse experiences.

From the *Department of Psychiatry and Behavioral Sciences, †Alzheimer’s Disease Center, and ‡Center for Health Services Research in Primary Care, University of California, Davis, CA; and §Department of Psychiatry, Columbia University, New York, NY.

Received for publication April 17, 2003;

accepted December 18, 2003.

Supported by National Institute on Aging P30 AG-12057 (S. Levkoff, Principal Investigator) and K23 AG-19809 (L. Hinton, Principal Investigator).

Reprints: Ladson Hinton, MD, 2230 Stockton Blvd, Sacramento, CA 95817 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.