Addressing Alzheimer’s in American Indian communities

UW Medicine researchers received an $11.3 million contract to improve the detection and management of Alzheimer’s disease and other dementias among American Indian and Alaska Native elders.

This funding will create training for healthcare providers and support patients’ families in communities that have little access to such specialized care.

Funded by the Indian Health Service, the program will be led by Dr. Dedra Buchwald, a professor of neurological surgery at the University of Washington School of Medicine. She and her team will create and implement instructional programs over the next five years. Her team includes faculty and staff from UW Medicine, along with collaborators Mary Koithan, dean of the College of Nursing at Washington State University, Jordan P. Lewis (Aleut/Sugpiaq, Native Village of Naknek), professor and director of research, College of Indigenous Studies, University of Alaska Fairbanks, and Turner Goins, Distinguished Professor, College of Health and Human Sciences, Western Carolina University. Six American Indian and Alaska Native faculty, staff, and consultants will work on this contract. 

The aim, she said, is to train primary care providers to recognize and improve outcomes.

 “They’ll be trained how to manage dementia locally, talk to families, and identify when certain medications are appropriate,” she noted. “The program will strive to increase the knowledge and competency of primary care providers and staff who work with American Indian and Alaska Native patients and communities.” 

“You might have only a few neuropsychologists or other specialists within the entire healthcare system that serves Native people,” she said. “It may take a year to get an appointment. And most patients are many miles from an MRI facility.” 

The researchers will first develop training modules and then roll them out to primary care providers, nurses and other employees on rural reservations and in urban areas. Trainees will learn to identify early symptoms of dementia and preventative measures, ultimately managing Alzheimer’s and other dementias in under-resourced settings. They will also be offered instruction in screening for conditions that can mimic dementia, such as hearing or vision loss, and in promoting culturally appropriate community outreach.

“The investment in training and support to improve care and services for elders living with dementia, their families and communities has lagged behind other priorities,” said Dr. Jolie Crowder, national elder care consultant with the Indian Health Service. “This commitment to building a partnership with the University of Washington to support the Indian health workforce is a big step toward addressing these gaps.” 

In 2020, an estimated 38,000 American Indian and Alaska Native people aged 65 and older were living with Alzheimer’s disease and other dementias. That number is expected to double by 2030 and quadruple by 2050, according to a study published in August in the Journal of the American Geriatrics Society. Alaska and the eastern United States had the highest rates of diagnosed Alzheimer’s disease and dementia-related diseases, the study noted. 

“This is an incredible investment by the Indian Health Service, and is coming at such a critical time,” said one of the Alaska team members, Jordan P. Lewis. “With the growing recognition of dementia in American Indian and Alaska Native communities, the investment in training of primary care providers, our caregivers and communities will assist in increasing awareness and understanding of dementia.”

Lewis, who is Aleut/Sugpiaq, said the program “will help reduce the fear and stigma that still exists in many of our communities, creating barriers to seeking care and receiving support for the people living with disabilities and their caregivers,” he said. 

Although age is the greatest known risk factor for Alzheimer’s disease and related dementias, American Indian and Alaska Native communities are disproportionately at risk for other risk factors such as diabetes, hypertension, obesity, physical inactivity, social isolation, and greater exposure to air pollution, the report stated. 

The UW Medicine program will collaborate with the Indian Health Service to reach providers working in the healthcare systems that serve all 574 federally recognized tribes across America, as well as the 41 Urban Indian Organizations that serve the healthcare needs of Native people living in U.S. metropolitan areas.