PUMPING IRONY: For Seniors Seeking an Alzheimer’s Diagnosis, Location Matters

Nobody I know seems to be pining for an Alzheimer’s diagnosis, so I didn’t know quite what to think when I came across a study the other day highlighting the regions of the United States in which dementia sufferers were most likely to get one and where they’re harder to come by. At first glance, it struck me as a rather grim version of those emails that land in my inbox from time to time listing the best cities for ordering pizza after midnight or something of that sort.

Upon further review, however, I caught a glimpse of the latest example of our country’s yawning gaps in healthcare services.

The study, published in the journal Alzheimer’s & Dementia, found that someone displaying Alzheimer’s symptoms was about twice as likely to receive a diagnosis of the disease in some regions of the country than in others — even after accounting for regional differences in demographics, education, health, and general diagnostic patterns among healthcare providers.

“These findings go beyond demographic and population-level differences in risk and indicate that there are health system–level differences that could be targeted and remediated,” University of Michigan geriatrician and lead study author Julie Bynum, MD, MPH, explains in a statement. “The message is clear: From place to place the likelihood of getting your dementia diagnosed varies, and that may happen because of everything from practice norms for healthcare providers to individual patients’ knowledge and care-seeking behavior.”

Using Medicare claims filed at 306 hospital referral regions across the country, Bynum and her team analyzed Alzheimer’s diagnoses among some 4.8 million seniors in 2019. They found 143,029 members of that group, or about 3 percent, were diagnosed with the disease in 2019; another 356,656, more than 7 percent, had been diagnosed earlier.

But diagnostic rates varied widely, depending on the region: They found the percentage of seniors diagnosed in 2019 ranged from a low of 1.7 percent in some locales to as high as 5.4 percent in others; previous diagnoses varied from 4 percent in some regions to 14 percent in others.

Accounting for various demographic and lifestyle factors, researchers calculated the “diagnostic intensity” of each region and concluded that patients in the lowest-intensity regions were about 28 percent less likely to receive an Alzheimer’s diagnosis compared with the national average, while those in the highest-intensity areas were about 36 percent more likely to have their dementia symptoms confirmed.

Among those who were generally less apt to receive a diagnosis, Bynum notes, were younger Medicare beneficiaries (ages 66 to 74) as well as Black and Hispanic seniors. This could be attributed to various factors, including healthcare access issues and an individual’s willingness to seek whatever care is available.

Somewhat surprisingly, Bynum and her crew found the lowest-intensity regions were not necessarily concentrated in the so-called “stroke belt” of the southern states, a region long-known for high levels of dementia. It seems that it’s not about the prevalence of the illness as much as the availability of healthcare. Major population centers — throughout the South and nationwide — generally offer patients the best chance of a diagnosis, they concluded, while rural regions tend to offer less-reliable access to diagnostic specialists.

“Our study demonstrates that taking all these factors into account, there remains substantial geographic difference in the likelihood of being diagnosed with [Alzheimer’s],” Bynum concludes, “and that the variation does not follow the ‘stroke belt,’ thereby strengthening the conclusion that the [Alzheimer’s] diagnosis intensity measure is not merely capturing underlying differences in population risk.”

She argues that her findings should be a “call to action for spreading knowledge and increasing efforts to make services available to people.” So, I guess I should feel fortunate to reside in one of those metro areas where there are plenty of dementia specialists available to deliver a diagnosis, should my cognitive function decline more precipitously than normal.

But I can’t help but flinch at the futility of seeking an Alzheimer’s verdict when no reliable — or cost-effective — treatment options are available. I understand that a diagnosis at least allows the patient and their loved ones to access further tests and whatever specialized care happens to be available at the time, but with no cure in sight, it still feels kind of pointless. Like trying to order a pizza after midnight.

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