Ethnic Differences in the Prevalence and Pattern of Dementia‐Related Behaviors

OBJECTIVES: To determine the prevalence of dementia-related behaviors in a large, multiethnic sample of community-dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991. MEASUREMENTS: Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self-report. Caregivers were asked if the patient typically demonstrated any of eight dementia-related behaviors. To determine the independent association between ethnicity and dementia-related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics. RESULTS: Overall, 92% of patients had one or more dementia-related behaviors. Sixty-one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering. After multivariate adjustment, black patients were significantly more likely than whites to be constantly talkative (odds ratio (OR)=1.41, 95% confidence interval (CI)=1.11-1.80), to have hallucinations (OR=1.89, 95% CI=1.49-2.40) and episodes of unreasonable anger (OR=1.70, 95% CI=1.34-2.15), to wander (OR=1.40, 95% CI=1.08-1.81), and to wake their caregiver (OR=1.33, 95% CI=1.04-1.69). Latinos had a significantly higher likelihood than whites of having hallucinations (OR=1.49, 95% CI=1.10-2.01), episodes of unreasonable anger (OR=1.59, 95% CI=1.18-2.16), combativeness (OR=1.59, 95% CI=1.17-2.17), and wandering (OR=1.59, 95% CI=1.21-2.26). For most behaviors, these adjusted ORs are similar in magnitude of effect and statistical significance to the unadjusted estimates. CONCLUSION: Black and Latino community-dwelling patients with moderate to severe dementia have a higher prevalence of dementia-related behaviors than whites. Therefore, as the aging minority population grows, it will be especially important to target caregiver education, in-home support, and resources to minority communities.