Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
J Am Geriatr Soc. 2021 Mar;69(3):822-834. doi: 10.1111/jgs.16929. Epub 2020 Nov 24.
BACKGROUND/OBJECTIVES: While it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services.
Systematic review with narrative synthesis.
Nonresidential medical, psychiatric, memory, and emergency services.
Twenty studies totaling 94,431 older adults with dementia or mild cognitive impairment.
We searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer-reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings.
Twenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined.
There is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.
背景/目的：尽管人们承认国际背景下的少数族裔（ME）群体在获得痴呆症护理方面面临障碍，但目前尚不清楚他们是否因此而较少获得服务。本研究的目的是通过现有文献，检查 ME 群体在获得痴呆症/记忆服务之前的延迟时间是否更长，是否更频繁地使用急性护理和危机服务，以及是否更不经常使用常规护理服务。我们还检查了 ME 群体在向记忆服务机构就诊时是否存在更严重的痴呆症或认知能力更低的情况。
系统综述与叙述性综合。
非居住医疗、精神科、记忆和急诊服务。
共有 20 项研究，总计纳入了 94431 名患有痴呆症或轻度认知障碍的老年人。
我们从文献检索伊始到 2018 年 11 月，在 Embase、Ovid MEDLINE、全球健康和 PsycINFO 数据库中检索了评估少数民族在痴呆症患者非居住卫生服务使用方面的差异的同行评议观察性研究。使用叙述性综合分析来分析研究结果。
纳入了 20 项研究，其中大多数来自美国（n = 13），也有来自英国（n = 4）、澳大利亚（n = 1）、比利时（n = 1）和荷兰（n = 1）的研究。几乎没有证据表明任何国家的 ME 群体在常规护理方面的使用率与对照组不同，尽管这些研究可能没有足够的效力。有强有力的证据表明，美国的非裔/非裔美国人组比对照组更频繁地使用医院住院服务。初级保健和急诊服务研究较少。研究质量参差不齐，在确定和定义族裔和服务使用结果的方式方面存在很大差异。
有证据表明，某些 ME 群体，例如美国的黑人群体，可能比对照组更多地使用急性护理服务，但关于常规护理使用差异的证据较少。尤其是在美国以外，研究很少。
