Clinical Discrimination and Patient Trust: Here’s What An Alzheimer’s Study Found

We’ve talked about Alzheimer’s in Native American communities before – specifically that dementia is on the rise on Indigenous lands because Native elders are living longer. Life expectancy was typically 50something years old for a Native person in the mid-20th century. While the COVID-19 pandemic lowered it a bit, today’s elders can still expect to live into their seventies. Put another way: by 2050, tribes will have 300,000 elders age 85 and older  – a dramatic rise from 42,000 elders just ten years ago.

Our previous blog post covered the need to identify the earliest signs of Alzheimer’s disease and connect Native patients to treatment, which includes treating comorbidities such as hypertension and diabetes. If you haven’t read it yet, take a look. Because there are reasons Alzheimer’s education is so important in Native communities – as a new study from the Alzheimer’s Association has found.

Alzheimer’s Risk: Indifference or Lack of Awareness?

The new report is titled “Race, Ethnicity and Alzheimer’s in America” and it found that Native Americans are the least concerned about Alzheimer’s among all populations for a simple reason – many Native people don’t believe they will live long enough to experience cognitive decline.

Specifically, 35% of Native Americans don’t believe they’ll live long enough to develop Alzheimer’s or other types of dementia. Which perhaps is why only 25% of Native respondents are concerned about developing it, although 65% reporting knowing someone who has it or another dementia. Without awareness of rising life expectancy, Native families may not be trained to watch for signs of beginning dementia. In fact, 53% believe significant loss of memory or cognitive abilities is “a normal part of aging” – and they’re twice as likely as White people to say they would not seek care if they experienced cognitive or memory problems.

When Clinical Discrimination Means Avoiding Medical Care

While the new study focused on Alzheimer’s, it also uncovered disturbing findings about Native Americans and healthcare. These numbers won’t surprise anyone working in Indigenous health – but they do prove why change is needed so badly:

  • 40% of Native Americans believe that medical research is biased against them. The same number believe that being Native makes it harder to get care for dementia.
  • While 92% think it’s important for providers to understand a Native patient’s cultural background, only 47% feel confident they can find providers who understand their background and experiences.
  • 42% have experienced clinical discrimination. The most frequent forms of this discrimination: providers acting as if Native patients aren’t smart (43%) and failing to listen to them (31%).

Recently, our physician recruiter Pamela Amiotte shared in a video that she knows elderly patients who won’t go to the doctor because of how they were treated once by a rude or insensitive provider. This sums up one of the biggest problems in Indigenous healthcare: that poor cultural competency and negative patient encounters have long-lasting and destructive implications for communities. Someone living in a wealthy suburb or big city can simply change medical offices or doctors or hospitals if they dislike the treatment they receive. Someone on a reservation with one IHS or 638 facility available does not have that luxury. And that one encounter can dissuade them from seeking care for years, dramatically impacting their health.

The truth is – if you’re a regular Tribal Health reader, you probably know all this already. But please share these numbers with other providers in your network if you can. The disconnect between modern healthcare and the Native provider experience is still way too big, and we can all work a little harder to fix that.

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