title: Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility.
abstract: OBJECTIVE
  Implement a memory impairment screening procedure for elderly Hispanic primary care patients, and analyze its yield and challenges to further triage and diagnostic evaluation.
  
  
  METHODS
  Three hundred twenty nine Hispanic patients aged ≥60 years or proxy informants were enrolled from outpatient primary care clinics at an urban safety-net medical center. Patients were screened for memory impairment using the WHO-UCLA AVLT; for those without consent capacity, proxies were given the IQCODE. Bilingual research assistants conducted in-person or telephone screening. Age, gender, education, comorbidities, acculturation, overall health, access to care, and memory concerns were assessed as potential predictors of memory impairment. Based on identified implementation challenges, a multi-disciplinary stakeholder committee proposed revised approaches to increase diagnostic evaluation and sustainability.
  
  
  RESULTS
  Of 677 eligible patients approached, 329 (49%) were screened, and 77 (23%) met criteria for memory impairment using the WHO-UCLA AVLT (N=60) or the IQCODE (N=17). Only male gender and higher comorbidity uniquely predicted memory impairment (ps<0.05). Few screen-positive patients declined further triage and evaluation, but a substantial proportion could not be subsequently contacted. Challenges to implementing a memory screening program included staff time and adequate clinic space for in-person screening; challenges to follow-up of positive screening results included inability to contact patients and lack of primary care continuity to facilitate further triage and referral.
  
  
  CONCLUSIONS
  Nearly one-fourth of primary care Hispanic elders screened as memory-impaired, but few factors predicted positive screening. Stakeholder-guided adaptations are needed-particularly in resource-constrained settings-to overcome challenges to further diagnostic evaluation and referral.
authors.affiliation: Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Dorothy P
authors.initials: DP
authors.lastname: Harris
authors.forename: Freddy
authors.initials: F
authors.lastname: Ortiz
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Adler
authors.forename: Katherine
authors.initials: K
authors.lastname: Yu
authors.forename: Michele L
authors.initials: ML
authors.lastname: Maines
authors.forename: Dora
authors.initials: D
authors.lastname: Barba
authors.forename: Sandra I
authors.initials: SI
authors.lastname: Viggiani
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Wolf
authors.forename: L Jaime
authors.initials: LJ
authors.lastname: Fitten
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services / Q000592:standards; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008569:Memory Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D011320:Primary Health Care; D019727:Proxy; D014481:United States / Q000453:epidemiology; D014505:Urban Population