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Influence of care network characteristics on physician visit experiences for Black, White, and Hispanic older adults with dementia.

OBJECTIVES
Most older adults with dementia are assisted by multiple caregivers, but the relationship of care network structure with healthcare access and quality is underexamined. We sought to test the associations of care network characteristics with the physician visit experience for older adults with dementia across diverse racial/ethnic groups.


METHODS
We used data on Medicare beneficiaries (ages 65+) with dementia from the National Health and Aging Trends Study (2015-2019) to fit logistic regression models to test associations between physician visit outcomes and 1) size of the potential care network and 2) proportion of potential care network members (PCNMs) currently helping with daily functioning tasks. We also tested for modifications by race/ethnicity.


RESULTS
Hispanic respondents had the largest potential care networks (M = 6.89, SD 3.58) and the smallest proportion of PCNMs providing help with daily functioning (M = 29.89%, SD 22.29). In models adjusted for demographics and dementia classification, both network size and proportional involvement of PCNMs were positively associated with presence of a PCNM and assistance during the visit. Associations remained significant at four-year follow-up for presence of PCNM at the visit and were robust to further adjustments for insurance type, income, and health factors. Associations were not modified by race/ethnicity.


DISCUSSION
Larger networks and higher proportion of PCNMs providing assistance predicted caregiver presence and assistance at the physician visit but not access to care. Findings suggest that strengthening care networks early in the disease may support improved healthcare outcomes for persons with dementia across diverse populations.