# Understanding and Improving Inequities in Palliative Care for Older Adults with Advanced Dementia and Limited-English Proficiency: A Mixed-Methods Evaluation

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2022 · $635,602

## Abstract

PROJECT SUMMARY
Older adults with Alzheimer's Disease and Related Dementias and limited-English proficiency (LEP) are at
high risk of receiving suboptimal, goal-discordant care because of language and cultural barriers to effective
communication about goals of care. Palliative care provides a way to improve quality of life and facilitate goal-
concordant care by supporting effective person-family-clinician communication, but is under-utilized by older
adults with Dementia and LEP and their families. No studies have sought to identify targets for intervention to
address barriers to palliative care at multiple levels (i.e., patient/family, clinician, system, and community-
levels) for this vulnerable population. Addressing this gap will be essential for the development of effective
interventions to improve the quality of care for older adults with Dementia and LEP. The long-term goal of this
work is to develop, evaluate, and disseminate interventions to facilitate culturally-sensitive palliative care for
older adults with Dementia and LEP and their families. The rationale for this study is that before effective
culturally- and linguistically-appropriate interventions to improve palliative care for older adults with Dementia
and LEP can be developed, quantitative and qualitative data is needed to evaluate the scope of existing
inequities and identify modifiable multi-level barriers to the delivery of high-quality palliative care for this
population. Aim 1 utilizes quantitative methods to compare the quality of care received by decedents with
advanced Dementia and LEP to those with English proficiency in four key palliative care domains (utilization of
care, documentation of patient goals and preferences, symptom assessment, and circumstances of death)
using EHR-based quality metrics and novel machine learning methods. Aim 2 utilizes qualitative interviews
with key stakeholders (older adults with Dementia and LEP and their family members, caseworker-cultural
mediators and interpreters, and clinicians and administrators) to identify modifiable targets for intervention
across multiple levels. Aim 3 utilizes qualitative interviews with leaders of community-based organizations to
assess community-level resources and capacity to support high quality palliative care for older adults with
Dementia and LEP. Our interdisciplinary team is experienced in Alzheimer's Disease and Related Dementia
research, community engagement with LEP populations, and quantitative and qualitative methods. The
proposal is innovative because it evaluates multi-level barriers to palliative care across three diverse LEP
populations (Latinx, Chinese, and Vietnamese), and uses machine learning methods to evaluate the quality of
care across several palliative care domains in a large health system. The proposed research is significant
because these data will enable the identification and prioritization of multi-level targets for the development of
culturally and linguistically-appropria...

## Key facts

- **NIH application ID:** 10468791
- **Project number:** 5R01AG074253-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Rashmi Kumar Sharma
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $635,602
- **Award type:** 5
- **Project period:** 2021-08-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10468791

## Citation

> US National Institutes of Health, RePORTER application 10468791, Understanding and Improving Inequities in Palliative Care for Older Adults with Advanced Dementia and Limited-English Proficiency: A Mixed-Methods Evaluation (5R01AG074253-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10468791. Licensed CC0.

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