Population Ageing DOI 10.1007/s12062-013-9084-1

Developing Dementia Prevalence Rates Among Latinos: A Locally-Attuned, Data-Based, Service Planning Tool Ramón Valle & Mario D. Garrett & Roberto Velasquez

Received: 19 June 2012 / Accepted: 3 April 2013 # Springer Science+Business Media Dordrecht 2013

Abstract The prevalence of Alzheimer’s disease and associated disorders (ADAD) determines the level of need for ADAD services. Since services need to be made available locally, therefore local—rather than national—prevalence levels are instrumental in guiding services to meet these emerging needs. This study employed a three-stage methodology to establish Latino ADAD prevalence estimates within San Diego and Imperial Counties in California for the period 2000–2050. The first stage involved the development of a working algorithm for the ADAD estimates combining existing demographic data with small-scale prevalence data from recent clinical studies of ADAD among Latinos. Results from this algorithm projected an 1,123 % increase of ADAD impacted Latinos in San Diego County and 1,213 % in Imperial County by 2050. Stage two encompassed examining the face validity and efficacy of these projections at the local provider level through focus groups. This stage confirmed the findings that a large sector of the local Latino ADAD community had a profile of lower education and socioeconomic status, more traditional cultural orientations, and high rates of diabetes mellitus and vascular disease which resulted in earlier onset of ADAD. The third stage in the methodology employed a 36-month observational window tracking the impact of the local ADAD prevalence estimates on various programs. The authors of this study argue for the efficacy, and external validity of the methodology employed to define local ADAD preva-

R. Valle (*) Alzheimer’s Cross-Cultural Research and Development [ACCORD], San Diego State University, 6447 Lake Athabaska Pl., San Diego, CA 92119, USA e-mail: [email protected] M. D. Garrett Center on Aging, San Diego State University, San Diego, CA, USA e-mail: [email protected] R. Velasquez Development & Multicultural Services, Southern Caregiver Resource Center, San Diego, CA, USA e-mail: [email protected]

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lence rates for other ethnic groups. This knowledge will promote local communities in developing culturally competent services for their own diverse local service areas based on local estimates. Keywords Latinos . Hispanic . San Diego . Imperial . Alzheimer’s disease . Dementia prevalence . Cultural competency . Secondary data utilization . Participatory research . Demographic change

Introduction Effective and consistent support to families affected by Alzheimer’s disease and associated disorders (ADAD) is determined by services being provided at the local level. The prevalence of ADAD at the local level determines the need for ADAD services. In the United States, while the national organization The Alzheimer’s Association defines its role as the leading “voluntary health organization in Alzheimer's care and support, and the largest private, nonprofit funder of Alzheimer’s research” local Alzheimer’s Association units—called Chapters—determine the local level of needs and services. Although the national organization determines policy, funding and research, the local Chapters are responsible for local services and activities. According to the US 2010 Census, the US is home to 50.5 million Latinos (16 %). Of these, 27.8 % reside in the State of California (Ennis et al. 2010). The US Census record Latinos as responders who self-identify themselves of “Hispanic, Latino or Spanish origin” (U.S. Census Bureau 2006–2010a). Most Latinos in the USA are of Mexican origin (58.5 %), however that proportion increases to 89.6 % in San Diego County (U.S. Census Bureau 2006–2010a) and to 97.5 % in Imperial County (U.S. Census Bureau 2006–2010b). In the last decade, the San Diego/Imperial Chapter of the Alzheimer’s Association had been responding to increased calls for assistance from Latino families. However, in terms of service planning the Chapter found itself constantly trying to match the more globally reported national and state ADAD prevalence estimates against the very different demographic densities and need profiles of Latinos within its area. Moreover, the Chapter understood that the lack of Spanish ADAD information was impeding an effective outreach for both services and research—even when the outreach is based on successfully proven programs (Aranda et al. 2003). It was clear that increased tailored services were needed to meet the increasing demand being made on the Chapter. Especially since Latinos with ADAD were coming later for services (Fitten et al. 2001). The relevance of local prevalence estimates was therefore an especially important consideration. Chapter leadership was well aware that delays in developing timely services can result in a situation where persons with ADAD, and their caregivers, receive help that is too little, too late, or perhaps not at all. Moreover, without planning—because services require time to develop—it might be too late to meet emerging demands. Collectively, these considerations provided the impetus for this study. Specifically, the study conducted ADAD prevalence projections through available secondary data sources focusing on Latinos residing in the two adjacent counties of San Diego and

Developing Dementia Prevalence Rates Among Latinos

Imperial in southern California. Although the methodology developed could easily have been applied to other ethnic groups, this study focused exclusively on the Chapter’s interest in the Latino population. The challenge was to identify a cost effective methodology to develop local Latino ADAD prevalence estimates. This study aimed to demonstrate that demographic data is useful in making informed health and social services recommendations. The method developed in this study applies accessible data that can be utilized by local service agencies to extrapolate prevalence of ADAD among other ethnic groups. The Framework for Developing ADAD Prevalence Estimates for Latinos The algorithm developed in this study is based on US Census demographic data from the year 2000. Five-decade timeframe was selected to coincide with the conventional timeframe for the current U.S. Baby Boomer surge of 80 million persons, with 8 million Latino boomers (Gassoumis et al. 2008). In the US the Baby Boomers are defined as the post second World War cohort born between 1946 and 1964. There were two guiding aims to the approach used: (a) to develop estimates of the growth of the 60+, aging-in-place, Latino and White population over the five decade timeframe; and, (b) using ADAD prevalence from clinical research, to develop projections of ADAD prevalence for the Latino and White population in the two counties of San Diego and Imperial, over a five decade time period (2000–2050). A similar approach has been applied successful in Australia where the lack of national ADAD prevalence statistics was effectively addressed by applying national demographic data and meta-analysis of ADAD prevalence studies (Anstey et al. 2010). U.S. national ADAD prevalence data relies heavily on the 2007 study by Plassman et al. (2007), which updated the 1989 study by Evans et al. (1989). Although Plassman set the early threshold onset of ADAD at age 71, there is strong evidence indicating that because of the influence of some risk factors which are more prominent among Latinos than among the White population, Latinos experience ADAD at the younger age of 60 (Haan et al. 2003; Clark et al. 2005). These risk factors include lower socioeconomic status, lower levels of formal schooling, higher prevalence of diabetes mellitus and vascular disease.

Methods Establishing the Demographic Bases First Step: The Overall vs Local Population Demographics In 2007, Latinos—who continue to be the fastest growing ethnocultural minority population in the US—numbered 45.2 million persons or 15.1 % of the total population of the then 301.3 million Americans (State of California 2007a). Locally, in San Diego County Latinos represented 41.7 % of the population while in Imperial County Latinos represented 77.3 % of the total population. Drawing from the 2010 census SANDAG (http://www.sandag.org/resources/demographics_and_ other_data/demographics/census/index.asp) noted much higher concentrations of

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Latinos in several of San Diego County’s individual communities. For instance, in the County’s South Bay area, National City was noted as having 63 % Latino population, followed by Chula Vista at 51 %, and Imperial Beach at 48 %, and two North County cities, Escondido and Vista, had Latino population concentrations of 46 %, and 44 % respectively. Second Step: Sharpening the Profile of the Target Ethnic Population Profile Population projections were obtained from the State of California, Department of Finance’s (CDF), population projections for counties for 2000–2050 (State of California 2007b). The CDF database has a decided advantage not only because it contains local county data but because it also provides ethnically defined baseline population estimates by age, gender and race/ethnicity listing for seven mutually exclusive race/ethnic groups, specifically: Hispanics and non-Hispanic, American Indians, Asians, Blacks, a multirace category, and Pacific Islanders. Additionally the CDF data incorporates several additional California Department of Health key vital statistics essential to handling population projections, especially in the dementing illness arena. These vital statistics include: &

& &

Mortality rates: The CDF mortality rates include female/male survival rates which are constructed separately by race/ethnic groups. Within the CDF formulation the life span estimates for Latino/Hispanic females is 84.2 years and 79.4 years for males. The estimate for White females is placed at 81.1 years, and 76.8 years for males. Age-specific fertility rates (ASFRs): Within this formulation the ASFR for Latinos/Hispanics is 2.33, and that for Whites is 1.83. Migration: CDF calculation of migration uses the 1990 “survived” population compared to the 2000 population, with differences assumed to be migration. The ten-year migration was annualized and divided by the total to derive a proportion. Then a three-year moving average was used to smooth the migration proportions. Additionally, the CDF assumes that people migrate where they choose, and excludes major natural catastrophes. CDF does not distinguish between documented and undocumented immigration status. Estimates of undocumented workers mirror legal immigration, where favorable conditions increase both documented and undocumented migration and unfavorable conditions decrease both types of migration. Based on March 2008 data collected by the Census Bureau, the Center estimates that unauthorized immigrants are 4 % of the nation’s population and 5.4 % of its workforce (Passel and Cohn 2008). However, the CDF data incorporates current and future migration projections, which is an important datum for the Latino communities in southern California.

Formulating the ADAD Prevalence Estimates Third Step, Formulating the Local Latino Population ADAD Prevalence Estimates Utilizing prevalence estimates from Haan et al. (2003) study which included the high rates of diabetes mellitus and stroke as risk factors they concluded that age 60 was

Developing Dementia Prevalence Rates Among Latinos

more appropriate age to record prevalence for ADAD among Latinos. Table 1 illustrates the ADAD prevalence estimates. The earlier Evans (Evans et al. 1989) projections are included for comparative purposes. Feedback to the Community and Study Follow-up The key difference between participatory and conventional methodologies lies in the location of power in the research process. The San Diego/Imperial Chapter commissioned this study. From the request to initiate study, soliciting for funding, sharing the findings with major stakeholders in the Latino health communities, and then to requesting feedback, were all accomplished by the Chapter—attesting to the participatory research context of this study (Cornwall and Jewkes 1995; Chen et al. 2010). The study followed a three-pronged community dissemination format for the study findings. First, the results of the prevalence rates were disseminated both electronically and in hard copies throughout the ADAD provider community network in both San Diego and Imperial Counties. Second, focus group sessions were held in both counties. Third, there was a 36-month observational window to track how the prevalence study findings might be incorporated into the rationale components of grants, service planning efforts, and community education undertakings. Human Subjects Considerations The study was conducted under the auspices of the Chapter’s Medical and Scientific Advisory Board. The development of the ADAD prevalence projections employed secondary data analysis wherein no individual human subjects could be identified. The focus group participants signed consent forms but individuals were not identified in the reports. Table 1 Prevalence algorithm by age cohort estimates

Age

Male

Female

Haan et al. (2003) Latino ADAD Prevalence Estimates of Fully Evaluated Cases by percent. 60–69

1.31

0.61

70–79

4.66

4.71

80–84

10.00

9.46

85+

23.33

17.65

All

4.05

3.75

Total combined=3.65 % Male and Female combined Evans et al. (1989) General Population ADAD Prevalence Estimates.

Table 3 (p173): Fully evaluated cases Source: Haan, et al. (2003; p173); Evans, et al (1989; p2554).

65–74

3.9

75–84

16.4

85 +

47.55

Total

11.3 %

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Results Latino 60+ Aging-in-Projected Population Growth The methods generated prevalence estimates over the five-decade study time period with the year 2000 serving as the baseline and 2050 as the endpoint. Tables 2 and 3 summarize the estimated growth of the Latino age 60+ population in both San Diego and Imperial counties over five decades. As can be seen in Tables 2 & 3, even when taking mortality into account, as well as not being able to account for the full scope of Latino immigration patterns, there is a projected 344 % growth in the Latino age 60+ cohort at the 2030 midpoint. And there is a projected doubling of growth at 652 % in the Latino 60+ population in the San Diego County at the endpoint of 2050. The estimates for the Imperial County are higher. Specifically there is a projected 363 % Latino age 60+ population growth by 2030, nearly doubling to 689 % in 2050. While in comparison, the estimated growth for the White San Diego 60+ population will be 101 % by 2030 and 107 % for 2050, The estimates for the Imperial Valley White population growth are 5 % as of 2030 and a minus -6 % by 2050 indicating a decline in the White population in this region by 2050. Tables 2 and 3 summarize these data. Latino ADAD Prevalence Growth Estimates Tables 4 and 5 summarize the point-prevalence ADAD estimates for the general population and the Latino populations in San Diego and Imperial counties. It is important to note that the Haan et al. (2003) prevalence estimate formulation yields a relatively conservative 3.65 % overall ADAD prevalence rate for the age 60+ Latino cohort. Nonetheless, as can be noted in Tables 4 & 5 there is a pronounced growth in the estimated ADAD prevalence rates for the Latino cohort. This increased prevalence primarily reflects primarily the growth and the aging of the Latino population. San Diego ADAD projections indicate a 1,133 % increase between the baseline year of 2000 and the endpoint year of 2050. The projected increase in Imperial Valley is even higher reaching an increase of 1,213 %. As the projections indicate, White ADAD-impacted persons in San Diego County will grow in real numbers, from an estimated 16,592 in 2000 to 48,152 in 2050. However, when proportional prevalence percentages are calculated, White will increase by 190 % as against the noted 1,133 % for San Diego Latinos. The proportional ADAD prevalence growth picture is more pronounced in Imperial County with Table 2 San Diego Latino 60+ Aging-in-Place Estimates 2000– 2050

Tables 2 and 3 Source: State of California (2007)

Year

Latino 60 + White 60+ Percentage increase from 2000 Latino 60 +

White 60+

2000 48,299

306,947

–

–

2010 80,180

348,243

66 %

13 %

2030 214,426

618,244

344 %

101 %

2050 363,372

636,145

652 %

107 %

Developing Dementia Prevalence Rates Among Latinos

Table 3 Imperial Valley Latino 60+ Aging-in-Place Estimates 2000–2050

Tables 2 and 3 Source: State of California (2007).

Year

Latino 60 + White 60+ Percentage increase from 2000 Latino 60 +

White 60+

2000 10,589

7,423

–

–

2010 18,146

7,376

71 %

−1 %

2030 48,993

7,782

363 %

5%

2050 83,527

6,999

689 %

−6 %

a projected 39 % increase among the White mainstream population as of 2050 in contrast to the Latino 1,213 %, more than thirty fold increase. Tables 4 and 5 summarize these data. Another factor to take into account is the expected increase of the ADAD care burden for the Latino community. As of 2010 The U.S. Bureau of the Census estimated the average number of persons-in-the-household for Latinos is 4.0 compared to 2.59 for the White population (US Bureau of the Census 2007). Calculating a crude impact of this statistical difference—where one ADAD member impacts their whole household—in 2000 for the Latino cohort in San Diego there can be an estimated 7,556 impacted family members rising to a 93,156 persons by 2050. The outlook estimate for the Imperial Valley care burden rises from an estimated 1,644 impacted family members in 2000, to 21,580 potentially impacted persons by 2050. Tables 6 and 7 summarize these data. Immediate Community Dissemination of the Findings Short of implementing a prevalence study in order to be able to corroborate the estimates developed in this study—which was not feasible given the economic and time constraints of this commissioned work—the project endeavored to gain “facevalidity” of the Latino aging-in-place and ADAD prevalence estimates through direct feedback from the Chapter’s dementia care network provider and researcher stakeholders. Three focus groups were convened. The first of the feedback groups was composed of the area’s ADAD researchers who reviewed the methodology employed as well as the findings obtained. The other two focus sessions involved ADAD service providers. One was held in San Diego and the other in Imperial Valley. Both of these focus groups where established to examine whether the study’s

Table 4 Latino Age 60+ San Diego ADAD Prevalence Projections 2000–2050

Year

Latino 60 + White 60+ Percentage increase from 2000 Latino 60 +

White 60+

2000 1,889

16,592

–

–

2010 3,267

18,025

73 %

9%

2030 8,815

29,019

367 %

74 %

2050 23,289

48,152

1,133 %

190 %

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Table 5 Latino Age 60+ Imperial Valley ADAD Prevalence Projections 2000–2050

Year

Latino 60 + White 60+ Percentage increase from 2000 Latino 60 +

White 60+

2000 411

372

–

–

2010 838

418

104 %

12 %

2030 2,251

469

448 %

26 %

2050 5,395

517

1,213 %

39 %

ADAD projections coincided with what professionals and providers were experiencing with their Latino clientele. The Focus Group tackled three major questions: & & &

Did the study’s prevalence estimates—which highlight a present and increase ADAD crisis for the Latino community—match what focus group participants were seeing in their daily work? How can the estimates be used in terms of service planning? What kinds of interventions are needed to deal with the emerging ADAD care crisis among Latinos? (These reports are available from the primary author.)

Only the first question concerns this study. Fifty-five persons attended three focus groups, 25 of whom were researchers and/or managers of ADAD research, and 30 were ADAD service providers and clinical service administrators. Although it is likely that service providers are more prone to overestimate their service population in order to make proposals for funding more attractive, the reaction to the prevalence rates that were presented was one of accuracy. Service providers who work in the community also reported that the specific figures, when further disaggregated by smaller geographies—which the researchers shared—were in line with what they were seeing. The Follow-up 36 Month Observation Period Results The ADAD prevalence results from this study were distributed widely to all clinical and social service agencies in the two counties. In conjunction with this activity, project staff implemented a 36-month observation period to track what use, if any, was made by the areas ADAD-engaged providers and investigators. Service Planning Results from this study were relatively quickly incorporated into two major community stakeholder planning efforts. In the first example, the findings Table 6 San Diego Latino ADAD Care-Burden Projections 2000–2050

Year Latinos with ADAD

Potential caregivers per household

Percent increase stays constant

2000 1,889

7,556

–

2010 3,267

13,068

73 %

2030 8,815

35,260

367 %

2050 23,289

93,156

1,133 %

Developing Dementia Prevalence Rates Among Latinos

Table 7 Imperial Valley Latino ADAD Care-Burden Projections 2000–2050

Year Latinos with ADAD

Potential caregivers per household

Percent increase stays constant

2000 411

1,644

–

2010 838

3,352

104 %

2030 2,251

9,004

448 %

2050 5,395

21,580

1,213 %

were included in the “community input” phase leading to the development of the County of San Diego Mental Health Services Act recommendations. The Applied Community Dementia Prevalence study findings were then incorporated within the Mental Health Services Act (MHSA), of the Three-Year Program and Expenditure Plan, Fiscal Years 07–08 and 08–09, by County of San Diego. This report was in turn submitted to the State of California as the Older Adult Component for the MHSA plan for the County of San Diego. In the second example, the results from this study featured in a San Diego Latino ADAD Caregiver focused community forum held in June 2010. The forum included a wide range of Latino caregiver stakeholders giving voice to their needs, and identified barriers to services that have previously been highlighted in the ethnocultural ADAD literature (Pinquart and Sörensen 2005) directly to the State of California Alzheimer’s Disease Planning Task Force. The prevalence data from this project featured prominently in this discussion. Grant Development The findings were also used as a core rationale element in the preparation of, and the subsequent securing of two Latino dementia caregiver intervention grants with a combined award of $1.5 million. The purpose of the grants was to enhance caregiver coping capabilities using the REACH OUT methodology (Burgio et al. 2009). The grants were projected to include 425 Latino ADAD caregivers over a three year period. Community Education The findings were also used to support the Development Community Education Grants with a combined award of $300,000 to develop ADAD information for low literacy Latino audiences. The products of these grants are to make use of an innovative low text and pictorial communication health education product called “fotonovelas” which are very popular with Latino community audiences. Fotonovelas, are pictorial, magazine-like small booklets which provide information in story and easy to read formats and using photographs and short narrative (Rogers 2004; Harvey and Fleming 2005; Valle et al. 2006; Lanning and Doyle 2010). The prevalence rates from this study have also been incorporated into the health education curriculum of Latino caregiver support groups. A more recent example is the training of promotoras in a National Council of La Raza program. Promotoras are indigenous lay community outreach and health information aides who are most often attached to community health and mental health centers and clinics and who function as link persons between formal and informal services (Balcázar 2009).

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Additional Follow-up Dissemination Within the 36 month observational period, the prevalence results were presented in a variety of venues including; several national and regional conferences on aging; At the Alzheimer’s Association regular annual conference for practitioners and researchers; In two regularly conducted webinar conferences conducted under the auspice of two private foundations supporting innovative service grants for ADAD Caregivers populations; and in ongoing gerontology courses on diversity at San Diego State University.

Discussion Service providers and researchers affirmed that the reported prevalence estimates reflected what they were encountering on the ground in both San Diego and Imperial Valley counties. They also confirmed that in concert with the Haan et al. findings (Haan et al. 2003), they were seeing younger under age 65 Latinos with a dementing illness. Additionally, the providers and researchers alike said they were seeing increasing numbers of cases of diabetes, along with heart and vascular diseases among Latinos. The providers expressed satisfaction with the reported prevalence results stating that they reflected their experience with increased demands. Overall, this applied community dementia prevalence study produced several tangible outcomes. First, the approach resulted in a better understanding of where and how the Latino populations were geographically distributed among the two counties. This in turn facilitated a more focused outreach and program implementation effort. And, as an added feature of this study, once the data was consolidated, the researchers could disaggregate the results to finer detail within specific census tracts where specific services or studies were situated. Second, the prevalence data stimulated a great deal of discussion among both the local researchers and providers. It soon became evident that the discussions extended well beyond the immediate feedback sessions themselves. Provider and researcher interest continued throughout the 36-month observational period. As examples, the prevalence results made their appearance in the content of letters of intent and in proposals submitted and subsequently funded. The prevalence results also appeared in the local community-based conferences and forums with Latino caregiver convened throughout the study’s observational period. Moreover, even at present it is not unusual to find the ADAD prevalence data still being quoted in the local newspapers whenever key service administrators or researchers are interviewed (Cannon 2011; Graham 2011). Third, this effort demonstrated the utility of a relatively flexible, replicable, and cost-contained methodology by which existing large publically accessible databases could be applied to define projections of prevalence of any chronic disease for any ethnic group or locality. These secondary databases continue to be available in many web accessible formats, as well as in many public domain organizational and policy reports. Although clinically-based prevalence studies are the ideal, extrapolating prevalence rates for local areas is methodologically feasible. Extrapolated prevalence rates are necessary to local service agencies in order for them to understand the hidden size of the ADAD epidemic in their communities. This

Developing Dementia Prevalence Rates Among Latinos

type of information is also invaluable for these local service organizations when submitting proposal for funding. Fourth, the application of the results occurred during the 36 month observational period moved along the participatory research lines suggested by Chen et al. (2010) who urged that dissemination of findings be made directly available to potential “on the spot users” in order to build community capacity to make “meaningful changes.” During this time the researchers were frequently called upon to review and present these findings, and where appropriate, refined the analyses based on major events such as the 2010 Census which occurred 24 months into our study. Limitations The study recognizes a central limitation to our study. Prevalence estimates are drawn from and reflect the present reality as it is understood. No study can account for breakthrough in new treatments that will prevent or cure ADAD. There is no way to control for what has come to be known as the “black swan effect” (Nassim 2010; Popper 1959), namely the chance introduction of a single new factor which can invalidate a generally held observation. Moreover, another limitation is that the study did not have the capability to provide clinical validation of the prevalence estimates reported here, such as the Haan et al. group was able to do (Haan et al. 2003). Closing Observations These findings support the fact that ADAD impacts diverse groups such as Latinos, differentially. The same is likely to be true for other ethnic groups. More than two decades ago Evans (1992) followed by Martin & Kukull (Martin and Kukull 1996) have suggested that the study of different ethnocultural groups could contribute to a better understanding of the etiology of Alzheimer’s disease—or at least as the Hendrie research group (Hendrie et al. 2004) have argued—that an awareness of the varying presentation of dementing illness has to be taken into account when engaging the culturally diverse population. This demographic data-based study provides support of this possibility. Examples include ADAD prevalence studies of Japanese Americans by White et al. (1996) who point to differences of higher vascular-related dementing illness rates among the Japanese Americans residing in Hawaii, who are a few generations removed from their Japanese counterparts residing in Japan. Hendrie et al. (1995, 2001) in their research found considerable differences in ADAD prevalence between populations such as Nigerian Africans and Indianapolis African Americans living in quite different environments. And more specifically with reference to the African American ethnocultural group, there are a range of ADAD prevalence studies extending back to the 1980’s (Schoenberg et al. 1985) through to the present (Fillenbaum et al. 1998; Gurland et al. 1999). Currently intensive studies are taking place in the Columbian region of Antioquia to trace a distinctly observable strain of familial Alzheimer’s disease (Lopera et al. 1997; Belluck 2010). The investigators there are examining villagers who are experiencing unusually high levels of familial Alzheimer’s disease—as high as 50 % in some kindred groups, along with an earlier, age 50 or even younger, onset of the disease within this specific Latin American region.

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Researchers can also turn to more global perspectives where there is cross-cultural ADAD prevalence literature (Ferri et al. 2005). Additionally there are recent studies of prevalence studies within specific national populations in England/Wales (Brayne et al. 2006); among Italian populations (Cristina et al. 2001; Togoni et al. 2005); in France (Dartigues 2004); in Asia, Korea, China and Japan (Suh and Shah 2001); with Koreans specifically (Suh et al. 2003; Lee et al. 2002); and in Australia (Anstey et al. 2010). And, while the body of these and other prevalence studies of different ethnocultural groups report somewhat varying ADAD prevalence rates, they have also strengthened the diagnosis across cultural boundaries (Prince et al. 2003). This approach presents a workable method for establishing local ADAD prevalence rates for a culturally diverse, and often, underserved population. This expectation holds even where the ADAD data pool may be extremely sparse such as among American Indian and Alaska Native populations (White et al. 2005). The researchers recognize that not everyone can obtain funding sufficient to undertake a full blown case-confirming prevalence study. This is precisely why the more cost effective approach undertaken here could therefore serve as an alternative practical approach. Alzheimer’s Association Chapters, and other ADAD-focused service providers can have another way to sharpen their local service planning and implementation efforts relative to the needs of the specific populations they engage (Silverman et al. 1992). There is an even stronger certainty that such efforts can proceed within a complimentary participatory research strategy (Cornwall and Jewkes 1995; Chen et al. 2010). Targeting of services to a specific population is not enough. The approach has to be tailored. This approach provides an outline of how to do so. The approach offered in this study can also assist in not just “targeting” a specific population group but in “tailoring” the outreach and service programs (Noar et al. 2007; Hawkins et al. 2008) in order to address the more unique local ADAD needs of the Latino populations in culturally appropriate ways (Archer et al. 2008; Gelman 2010; Rodriguez 2011). Focusing on local data allows for an awareness of how territorial and cultural environments impact disease and different responses to seeking help, as well as by extension, to the expression of genetic risk factors (Hendrie et al. 2004; Mayeux et al. 1993; Mendez 1998). In closing, this study reports on a relatively modest effort. However, there is one salient finding; that there is mounting evidence that a large portion of the U.S. Latino community is being hit earlier and harder by Alzheimer’s disease and dementing illnesses than the general White population with similar aging-in-place populations. It is not just that there will be a projected increase in dementia impacted individuals within the two counties studied, but that that there will be an equal increase in caregiving burden for the Latino community, as well as increased cost in real service dollars (Fox et al. 2001). This finding requires our immediate collective attention.

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This research was sponsored by the Alzheimer’s Association San Diego/Imperial Chapter and Funded by the Bravo Foundation of San Diego.