Barriers to healthcare access for cognitively impaired older Hispanics.

This study describes the development of the Barriers to Healthcare Access Survey (BHAS) used to evaluate seven barrier factors believed to influence healthcare access for elderly Hispanics with memory or cognitive problems. This study further reports the results of the BHAS applied to a community sample of cognitively impaired older Hispanics and their caregivers. The study includes (1) The BHAS's development and procedures to establish instrument validity and reliability; (2) Interviews with the BHAS on 65 cognitively impaired Hispanics who were undergoing full diagnostic assessment for dementia and their caregivers. The most frequently perceived healthcare barriers reported in our study were related to (1) personal beliefs (38%), (2) language proficiency (33%), and (3) economic status (13%). The BHAS possesses the requisite psychometric properties to be an effective instrument for an initial survey of perceived barriers to access health care for low-education, cognitively impaired, elderly Hispanic patients. The findings suggest that perceptions regarding illness, health consequences of aging, and beliefs about the utility of medicine do, in fact, influence healthcare use by older Hispanic patients with dementia. Language proficiency and economic status remain common barriers among elderly Hispanic subgroups, but when these barriers are experienced by the cognitively impaired, serious healthcare implications ensue, especially delay in early diagnosis and treatment.