# Causes and Consequences of Healthcare Inequity in Alzheimer's Disease and Related Dementias

> **NIH NIH P01** · DARTMOUTH COLLEGE · 2024 · $3,251,295

## Abstract

ABSTRACT
Motivated by soaring spending and stagnating life expectancy, the first 20 years of this Program Project Grant
(PPG) has focused on the causes and consequences of healthcare efficiency in the U.S. This work has
advanced fundamental scientific knowledge regarding sources of inefficiency and has motivated significant
changes in healthcare policy and delivery for millions of Americans. This competitive renewal responds to the
NIA’s prioritization of Alzheimer’s disease and related dementia (ADRD)-related research and to eliminating
health disparities by shifting the focus of this PPG to inequities in healthcare services and delivery for persons
with ADRD and with a lens on racial inequities. This is a new framework from the work to-date produced by
this PPG. Inequity is a particularly egregious form of healthcare inefficiency. Recent PPG research showed
excess mortality among older adults with ADRD, especially for Asian, Black, and Hispanic populations and
people living in nursing homes, even in areas with low COVID-19 prevalence. Intersectional inequities in
ADRD care delivery run the gamut from differential exposure to the modifiable risks that contribute to
development of ADRD, initial diagnosis and referral, ongoing treatment and support, and throughout later
stages, including end-of-life care. Conceptually, the determinants of individual health outcomes will be
documented among persons with ADRD from the social ecological perspective which recognizes nested
‘systems’ that interact with one another (individual, interpersonal, organizational, structural, community, and
policy) and their attendant social determinants of health. This PPG renewal, therefore, proposes projects
focusing on each concentric circle of this model and their interactions. Project 1 will explore state-level policy
heterogeneity and its influence on access to home and community-based services for nursing home eligible
adults with ADRD. Project 2 will test the hypothesis that having resident service coordinators for adults who
live in affordable senior housing decreases adverse health care service use and increases home and
community-based service use for low- income residents with ADRD. Project 3 will explore trends in the quality
of primary care for people with ADRD and to identify modifiable policy-, system- and practice-level factors that
contribute to better outcomes. Finally, Project 4 will develop a novel measure of bias in provider diagnostic
test ordering in the acute care setting and explore the impact of diagnosis on the trajectory of patients with
ADRD. Projects achieve synergy by using the social ecological model to examine how interactions among the
key variables examined in each project could operate together to improve outcomes and reduce inequities,
and by relying on shared administrative, data and analysis, and methodology cores.

## Key facts

- **NIH application ID:** 10898877
- **Project number:** 5P01AG019783-22
- **Recipient organization:** DARTMOUTH COLLEGE
- **Principal Investigator:** AMBER E BARNATO
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $3,251,295
- **Award type:** 5
- **Project period:** 2001-08-01 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10898877

## Citation

> US National Institutes of Health, RePORTER application 10898877, Causes and Consequences of Healthcare Inequity in Alzheimer's Disease and Related Dementias (5P01AG019783-22). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/10898877. Licensed CC0.

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