Black senior citizens are nearly twice as likely to have Alzheimer’s disease or other forms of dementia as their white counterparts, a statistic the medical community still is trying to fully understand. Hispanic seniors also develop memory disorders at significantly higher rates than white people.

Experts believe there are several reasons for the disparity, according to a report that estimated numbers of people with clinical Alzheimer’s disease and mild cognitive impairment in the United State, published in May 2021 in “Alzheimer’s & Dementia,” the journal of the Alzheimer’s Association.

Rooted in “structural racism”

A team led by Kumar B. Rajan recently estimated that while 10 percent of non-Hispanic white Americans 65 or older had clinical Alzheimer’s disease, the rate was 18.6 percent among African-American seniors and 14.0 percent for Hispanics.

Leading factors for the different rates appear to be general health and socioeconomic disparities “rooted in the history of discrimination against Black individuals and other people of color in the United States,” according to the Alzheimer’s Association report, “2022 Alzheimer’s Disease Facts and Figures.”

“It is pretty alarming,” said Shannon Braun, director of Episcopal Retirement Services’ Center for Memory Support and Inclusion (CMSI). "The data is clear and can no longer be overlooked."

"It doesn’t have to be this way,” Braun said. “That’s what’s the most devastating."

The dementia disparities also are directly related to prevalence of diabetes and hypertension in the Black community, she added. "It’s all connected to our inequitable health-care system, which we should all feel responsible for changing."

Why the dramatic difference?

Several factors apparently tied to the higher rates for older African-Americans, as well as Hispanic older adults, involve real or perceived racial bias, the Alzheimer’s Association has said.

Rajan’s team also recently reported:

• While whites ages 65-74 had Alzheimer’s at a rate of 4.3 percent, Hispanics had a rate of 7.0 percent; and Blacks’ rate was 10.1 percent.
• For those ages 75-84, the prevalence among whites was 11.9 percent; for Hispanics, it was 18.7 percent; for Blacks, it was 25.2 percent.
• Among those older than 85, the estimated rate was 31.6 percent for whites, 44 percent for Hispanics, and 54 percent among Blacks.

The researchers developed those estimates using the Chicago Health and Aging Project (CHAP) study of people 65 or older living in Chicago's south-side neighborhoods.

Differing living/health conditions

The report “2022 Alzheimer’s Disease Facts and Figures” said race itself is not a significant factor in the large differences in rates in people of the same ages developing the disorders, although genetic risk factors may have some influence. 

Instead, the differences likely are tied to socioeconomic and health factors, such as:

• Living health conditions, such as where people have their residences; and exposure to toxins and pollutants;
• Differences in social and physical environments increase risks for chronic conditions that are linked to dementia, such as high blood pressure, cardiovascular disease, and diabetes.
• Access to quality health care, which can lead to worse health in general; and
• Differing education levels and occupations (some types of employment or non-employment can lead to higher dementia rates).

“Structural racism influences environmental factors such as where people can live, the quality of schools in their communities, and exposure to harmful toxins and pollutants,” the 2022 Facts and Figures report states. “It also influences access to quality health care, employment prospects, occupational safety, the ability to pass wealth to subsequent generations, treatment by the legal system, and exposure to violence.”

Reluctance to participate in medical trials

African-Americans and other minorities tend to balk at participating in health studies because of some horrible and unethical American scientific research in past decades.

In the 1930s, the U.S. Public Health Service and the Tuskegee Institute conducted what is known as the “Tuskegee Study of Untreated Syphilis in the Negro Male." The study started with 600 Black men, 399 who had the disease and 201 who did not. They were not properly informed about the study’s parameters. Even though by 1943, penicillin was widely available to treat the disease, the men were not offered treatment.

Such unethical studies haunt medical progress today because people of color are reluctant to participate in modern research toward cures.

Recent surveys found that 62 percent of Black Americans believe medical research is biased against people of color. Only half (53 percent) believe a future cure for Alzheimer’s will be shared equally, regardless of race, color, or ethnicity.

“Historically, there’s understandable ways why certain communities, specifically the Black community, do not participate in drug trials, or any health-care trial,” Braun said. “So I think there’s important work to be done to really make an effort to be more inclusive with trials, with health care.”

“The only way we’re going to make change is to put work into the research,” Braun said. She hopes minorities will participate in dementia research so medical advances will benefit their communities.

More troubling data

There also is more troubling data that should give pause to the medical community about minorities and the way they are treated in doctor’s offices and hospitals. Alzheimer’s Association surveys have found:

• More than one-third of Black Americans (36 percent) and almost one-fifth of Hispanic Americans (18 percent), and Asian Americans (19 percent), consider discrimination a barrier to receiving Alzheimer’s care.
• “Half of Black Americans (50 percent) report they have experienced health care discrimination; more than 2 in 5 Native Americans (42 percent) and one-third of Asian Americans (34 percent) and Hispanic Americans (33 percent) likewise report having experienced discrimination when seeking health care.”
• Among caregivers of seniors, many had faced discrimination when seeking help for those they cared for. Their top concerns were the medical providers or staff “do not listen to what they are saying because of their race, color or ethnicity.” The rates were highest among Black caregivers (42 percent), Native Americans (31 percent), Asian Americans (30 percent), and Hispanics (28 percent), compared to whites (17 percent).
• The overwhelming majorities of people of non-white Americans say it is important for medical providers caring for Alzheimer’s and dementia patients to understand their ethnic or racial background experiences. The percentages who said that were Native Americans (92 percent); Blacks (89 percent); Hispanics (85 percent); and Asian Americans (84 percent).
• Yet, fewer than half of Backs (48 percent) and Native Americans (47 percent) are confident there is access to culturally competent providers. Among Asian Americans and Hispanics, the confidence rates were 63 percent and 59 percent, respectively.

Advice to African-Americans about dementia

Given what’s known about Alzheimer’s disease and other forms of dementia, Braun has some suggestions for African-Americans about working to avoid dementia.

“Make sure you’re seeing your doctor regularly,” Braun said. “Establish a good rapport with your doctor. Find someone who listens to you. And recognize that you don’t have to do it alone.”
One way to get help and peace of mind is by joining a dementia support group, where you can talk with, and commiserate with, others

“There are resources available, there’s help available, there are many other people experiencing similar things, so joining a support group is a good idea,” Braun said.

Some people wrongly believe dementia happens to everybody. It doesn’t, she said.

“It’s abnormal aging,” she said. “There’s a disease process that’s involved. I think if there’s, we consider to be normal, then we become complacent, and don’t take steps that are not too difficult, to try to improve the situation.”

Don’t lose hope!

There is hope. Healthier lifestyles can delay and possibly prevent forms of dementia. Those important ways are physical exercise, mental exercise, getting good sleep, good nutrition, and maintaining strong social connections.

Episcopal Retirement Services (ERS) has a blog about dementia care for, not only those living with the disease but also for ways caregivers can help themselves. It can be found here: blog.episcopalretirement.com.