UF researcher: rural residents less apt to seek Alzheimer’s care from family doctors

June 13, 2001

GAINESVILLE, Fla. — People who live in rural areas rely on their family doctors for everything from delivering babies to dealing with heart trouble and fixing broken bones.

But when faced with the kind of memory difficulties associated with Alzheimer’s disease, just a third of older rural residents with problems ask their primary-care health provider for help, compared with half of their urban counterparts, according to a University of Florida researcher.

In a new study evaluating patterns of health-care use in six Southeastern states, scientists also found that more than 40 percent of people — urban and rural — whose forgetfulness and difficulties with ordinary daily tasks could be signs of Alzheimer’s were not receiving care for such problems.

The study results, published in the current edition of the Journal of Behavioral Health Services and Research, underscore the need for better screening of symptoms, which in turn could lead to improved quality of life for the many currently going without treatment.

“The big take-home message of this is that rural people are less likely to use a primary-care physician for memory-related problems although those doctors are going to increasingly be seeing these patients because of the reorganization of health care and managed care,” said Neale Chumbler a faculty member in UF’s Institute on Aging who is the lead author of the journal article.

“It concerns me that primary-care doctors may not be screening in the community or picking up on the early signs or markers of older adults who have memory-related impairments. The fact that 41 percent of those with memory impairments did not seek services is particularly alarming and suggests that a significant proportion of people have unmet needs in terms of detection, diagnosis and management of Alzheimer’s disease and related dementias,” said Chumbler, an associate professor in the UF College of Medicine’s department of health policy and epidemiology, and a researcher in geriatrics at the North Florida/South Georgia Veterans Health System.

The research, funded by the National Institutes of Health, was part of a larger study conducted at the University of Arkansas for Medical Sciences.

Alzheimer’s, a degenerative disease of the brain that results in impaired memory, thinking and behavior, is not a normal part of aging but becomes an increasing risk as a person grows older. One in 10 who are older than 65 and nearly half of those over 85 may have the disease, according to the Alzheimer’s Association. Some of those with severe impairments live in private homes, rather than nursing homes and other facilities, and little is known about how they receive care for their problems.

Spotting early signs of Alzheimer’s or other forms of dementia is important for a patient’s quality of life, Chumbler said. Several medications have been developed in recent years to slow progression of Alzheimer’s. Moreover, some memory impairments that mimic Alzheimer’s may actually be caused by other treatable problems, such as infections, nutritional deficiencies and medication side effects.

Current questionnaires for detecting dementia are lengthy and time-consuming to administer, making it difficult for busy family doctors. Chumbler suggests that creating a shorter screening tool — such as the eight-item survey used in the study — may make it easier for primary-care physicians to notice signs and make appropriate referrals.

“The finding that rural inhabitants with memory impairments were less likely to use a primary-care provider for their memory problems is a public health concern, and we certainly need to understand those barriers, which may include stigma, lack of available transportation and denial,” said University of Arkansas researcher Brenda Booth one of the journal article’s co-authors.

“Primary-care providers can be of great assistance to families of older adults with dementia by providing them with referrals, counseling and assistance with in-home services. However, if rural older adults with memory problems do not present to their primary-care provider, this important function cannot be mobilized.”

For the study, people were asked about impairments in particular activities of daily life — difficulty using the telephone or transportation, taking medications and handling finances. They also were asked about forgetting recent events or what day it was, losing or misplacing items, and repeatedly asking the same questions, all signs of memory impairment.

The data were collected through a telephone survey of 1,368 people 60 or older in Alabama, Arkansas, Georgia, Louisiana, Mississippi and Tennessee. All of those included in the study had someone else 60 or older living in the same home. About half the surveys were answered by the individuals, the other half by a family member or friend living with them.

Just 59 percent of 118 people who had at least one mental impairment and difficulty in at least one of the daily activities sought care for those problems.

Twenty-five of 51 city dwellers with memory-problems looked to their primary-care physicians for help while 12 sought care from mental-health specialists, such as psychiatrists, psychologists, social workers or community health providers. Of the 67 memory-impaired people living in rural areas, 23 turned to their family doctors for treatment of those difficulties while nine sought attention from specialists.

Surprisingly, rural and urban residents consulted specialists at similar rates. Researchers had expected the rate to be noticeably lower for those outside of the city, given the scarcity and increased costs of such professionals in rural areas.

The study group was large and diverse, including participants from two major cities — Atlanta and New Orleans — and rural residents from known impoverished areas of Arkansas, Mississippi and the Mississippi River Delta region. A limitation, however, was that the information collected was self-reported, with medical records not available to verify dementia, Chumbler said.