Social isolation and delayed dementia diagnosis among us older adults

Abstract Delayed dementia diagnosis may exacerbate dementia symptoms and reduce opportunities for care arrangements, further harming older adults’ health and well-being. Social isolation may increase the risk of delayed dementia diagnosis via a lack of support that prevents seeking help and accessing primary and specialty care for diagnosis. We investigated the association between social isolation and missed/delayed dementia diagnosis using the Health and Retirement Study (2004-2018) linked with the Medicare Claims record. We defined social isolation as having 3 or more affirmative responses to 6 questions about living arrangements, family/friend contact, and social participation. We defined missed/delayed diagnosis as having no clinical diagnosis documented in Medicare in the presence of an algorithm-defined dementia diagnosis in the survey; or having dementia diagnosed more than 3 years after meeting the survey-based algorithmic criterion for dementia. We fitted logistic regression models, adjusting for sociodemographic and health characteristics. Among 2,417 people in our sample (mean age 82.4(SD 5.85); 60% women), 54.7% of older adults experienced social isolation at the time of survey-based dementia onset, 41.5% had missed/delayed diagnosis, and 22.1% died with no dementia diagnosis in their Medicare record. Preliminary results indicate that social isolation was not associated with increased odds of missed/delayed diagnosis (OR 1.09 95% CI 0.90, 1.32). Our findings suggest that social isolation may not be a major driver of healthcare access and system factors pertinent to clinical documentation of dementia. To corroborate findings, we plan to refine our models (e.g., accounting for attrition and selection).