Discovery 2018: Dementia Care in Rural Areas


By Dr. Kristen Childress and Dr. Jonathan Medina

The prevalence of Americans living with dementia is expected to increase by 40 percent from 2016 to 2025. This dramatic increase in prevalence will greatly impact our rural communities, as we see an influx of elders living longer in rural communities across the United States.

Currently, persons who live in rural communities account for half of un-diagnosed dementia cases in the US, and rural residents are more likely to remain unaware of their diagnosis than their urban counterparts. Many rural providers face challenges with dementia management due to lack of resources, while urban providers can typically access those resources necessary for optimal management without significant difficulty. There are multiple known barriers to diagnosing and managing care for persons with dementia. These can include diagnostic uncertainty, stigma, denial of signs and symptoms by the patient, and the time constraints placed on primary care providers by health systems. These barriers are inflated in rural areas where health resources are limited and the general health of communities is often poorer.  

A 2015 survey of providers in Washington State conducted by the Alzheimer’s Disease Working Group (ADWG) showed that only 34 percent of providers felt “very prepared” to screen and make a diagnosis of dementia and only 40 percent of health systems had guidelines that directed management of care for persons diagnosed with dementia. The cumulative effect of infrequent visits and reluctance to discuss symptoms, along with provider insecurity and lack of guidelines add to the problem of mismanaged care for persons with dementia.

How do we best prepare general practitioners for this expected increase in persons with dementia in rural communities? What tools and resources are available to rural practitioners in the Northwest, and how can we access them to best care for our patients with dementia and their carers?

Though these are complex questions, there are viable answers. For example, targeted interventions for rural providers can increase provider confidence in managing care for persons with dementia. These may include using a care pathway or template, identifying local resources for persons with dementia and their carers, and collaborating with community partners to reduce stigma surrounding dementia.

MedineDr. Jonathan Medina recently completed a Doctor of Nursing Practice project to address some of these barriers, and created a care pathway designed to help facilitate the diagnosis and management of persons with dementia who live in rural areas. He has also collaborated with Dr. Morgane Le Guennec to complete a scoping review on stigma reduction interventions surrounding dementia.


ChildressDr. Kristen Childress is a Family Nurse Practitioner and a Clinical Assistant Professor at the University of Washington School of Nursing. She provides community-based primary care to elders, and has a passion for providing excellent care to those with dementia while supporting their families through the process. Her doctoral work was focused on interventions for caregivers of persons with dementia, she is dedicated to educating primary care providers so they can confidently deliver high-quality care to their patients with dementia.

Come join Drs. Childress and Medina at the Alzheimer’s Association’s 2018 Discovery Conference in April. They will be leading a workshop entitled, “Enhancing Dementia Management and Caregiver Support in Rural Areas.” Click here for more information or to register today!

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