D02 – Family-Centered Primary Care as an Opportunity to Promote Equitable Health Care Among Older Adults with Cognitive Impairment

Summary

Cognitive impairment (e.g., dementia) in older adults can be a difficult condition for patients, families, and their medical providers to address. The identification process is difficult for primary care providers (PCPs) due to time constraints, uncertainty of how to best assess for cognitive concerns, and provider discomfort with diagnosis disclosure. Therefore, formal evaluation of cognitive impairment is often omitted and it remains undetected by providers more than 40% of the time. This is especially true in populations who are underserved and have lower levels of education, which perpetuates health disparities. Family engagement in the primary care setting may help to resolve these concerns but evidence for the effectiveness of family engagement in primary care remains scant.

This presentation reports outcomes from a quantitative vignette-based study exploring the influence of family-provided information on PCP decision making and patient care. Forty-five PCPS participated in an online self-administered survey. Majority of participants were female (74%), white (76%), and practiced family medicine (78%) in urban areas (67%). Grounded in Patient- and Family-Centered Care (PFCC; Johnson & Abraham, 2012) and Intersectionality (Crenshaw, 1989), this study was designed to answer: (a) How does family engagement influence the diagnostic, management, and referral practices of PCPs with older adults exhibiting cognitive impairment, and (b) How do race and gender influence PCP diagnostic and decision-making processes when caring for white and African American patients? Utilizing PFCC with attention to the intersection of patients’ social locations provides a means for engaging and partnering with families in the care of older adults with cognitive impairment that reduces power imbalances between patients, families, and the healthcare team. The results of this study provide better understanding of how family engagement may help to reduce the influence of possible racial and gender biases and promote more equitable health care.