Efficacy of a language-concordant community health worker intervention to improve community-to-clinic linkage for dementia care: results of the randomized trial PLAN.

Efficacy of a language‐concordant community health worker intervention to improve community‐to‐clinic linkage for dementia care: results of the randomized trial PLAN - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Alzheimers Dement . 2026 Jun 3;22(6):e71541. doi: 10.1002/alz.71541 Efficacy of a language‐concordant community health worker intervention to improve community‐to‐clinic linkage for dementia care: results of the randomized trial PLAN Hae‐Ra Han 1, 2, ✉ , Nancy Perrin 1 , Ji‐Young Yun 1 , Deborah Min 2, 3 , Simona C Kwon 3 , Jinhui Joo 4 , Ji‐Young Cho 5 , Sara Kim 6 , Hochang Benjamin Lee 7 Author information Article notes Copyright and License information 1 Johns Hopkins School of Nursing, Baltimore, Maryland, USA 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 3 Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA 4 Department of Psychiatry, Massachusetts General Brigham, Harvard Medical School, Boston, Maryland, USA 5 Korean Community Service Center of Greater Washington, Annandale, Virginia, USA 6 Korean Community Services of Metropolitan New York, Inc, New York, New York, USA 7 Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA * Correspondence , Hae‐Ra Han, Johns Hopkins School of Nursing, 525 N. Wolfe St. Baltimore, MD 21205, United States. Email: hhan3@jhu.edu ✉ Corresponding author. Revised 2026 Mar 30; Received 2026 Jan 7; Accepted 2026 Apr 24; Collection date 2026 Jun. © 2026 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. PMC Copyright notice PMCID: PMC13240054  PMID: 42233272 Abstract BACKGROUND Linkage to medical services enables timely diagnosis and treatment, yet racial/ethnic minority older adults with limited English proficiency (LEP) face substantial barriers. We tested Preparing Healthy Aging through Dementia Literacy Education and Navigation (PLAN), a language‐concordant community health worker (CHW)‐led intervention, to improve dementia linkage among Korean American (KA) older adults with undiagnosed probable dementia and to assess caregiver outcomes. METHODS In a community‐based randomized trial, 287 older adult–caregiver dyads were followed for 6 months. Trained Korean‐speaking CHWs delivered a 1‐h dementia literacy education session plus phone navigation. The primary outcome was linkage to medical services, verified through clinic documentation. Secondary outcomes included caregiver psychosocial measures. RESULTS PLAN increased linkage to medical services versus control (16.7% vs 0%, chi‐squared [df = 1] = 24.05, p < 0.001). Caregiver outcomes were largely unchanged, with self‐efficacy favoring control. DISCUSSION This language‐concordant CHW model achieved verified community‐to‐clinic linkage at 6 months. Longer follow‐up and testing across diverse LEP communities are needed to assess diagnosis, treatment initiation, and caregiver trajectories. Keywords: community health worker, dementia, limited English proficiency, linkage to care Highlights The PLAN intervention significantly increased verified linkage to medical services for dementia care among Korean older adults with probable undiagnosed dementia. Caregiver outcomes were largely unchanged, likely reflecting the high functioning of participants and short follow‐up. The language‐concordant CHW model can bridge community‐to‐clinic access for cognitively impaired older adults with limited English proficiency. 1. BACKGROUND In 2022, approximately 58 million Americans were aged 65 and older, representing 17% of the total population. 1 This group is becoming increasingly diverse, with one in four older adults identifying as a member of a racial or ethnic minority group. 2 From 2022 to 2040, the population of older White adults is projected to grow by 19%, compared with increases of 57% for older Black adults and 76% and 118% for older Asian and Hispanic adults. 1 The older immigrant population is also substantial: An estimated 8.6 million immigrants aged 65 and older resided in the United States (US), accounting for roughly 18% of the nation's 48 million immigrants in 2023, the most in US history. 3 Notably, more than half of these older immigrants have LEP, defined as speaking English less than very well, and this proportion appears to be rising. 4 The burden of dementia – a syndrome marked by progressive cognitive decline and impaired daily functioning – is steadily rising across all racial and ethnic groups, including LEP communities. 5 A recent community‐based cohort study 6 estimated a 42% lifetime risk of dementia after age 55. Early detection of dementia offers substantial benefits, including the preservation of cognitive function, improved quality of life for individuals and their caregivers, 7 , 8 and reduced healthcare spending. 9 , 10 An analysis by the Alzheimer's Association in 2018 estimated that early diagnosis could yield $7 trillion in healthcare savings. 11 With the emergence of disease‐modifying therapies for Alzheimer's disease, 12 ensuring timely access to dementia evaluation and care is more critical than ever. While racial and ethnic disparities in dementia care are well documented, particularly among Black and Hispanic Americans, there is underrepresentation of and limited evidence for diverse and immigrant populations in the US. 13 Yet cultural and language barriers – especially in socially isolated immigrant populations – limit access to standard dementia assessments, resulting in delayed diagnoses 14 , 15 , 16 and missed opportunities for intervention. Leveraging community‐based resources, such as CHWs who share patients’ language and culture, offers a promising strategy to bridge these gaps by improving linkage to dementia evaluation and related resources. 17 , 18 , 19 , 20 Linkage to medical services is a critical component of the dementia care continuum and the necessary first step to initiating treatment and developing a comprehensive care plan. 21 Despite national and international recommendations, CHW‐partnered dementia care models remain understudied. 22 To address this gap, we developed Preparing Healthy Aging through Dementia Literacy Education and Navigation (PLAN), a CHW‐led intervention to improve access to formal medical services for undiagnosed KA older adults – one of the fastest growing aging groups in the US. A pilot study demonstrated the intervention's feasibility and acceptability, 23 and we sequentially conducted a randomized trial to rigorously test whether PLAN improved linkage to medical services by a formal healthcare provider at 6 months after randomization compared with a control. 2. METHODS 2.1. Study design Details about the study design and methods have been published elsewhere. 24 Briefly, PLAN was evaluated in a single‐blind, two‐arm, parallel‐group, randomized controlled trial. The primary objective was to determine whether PLAN improved linkage to medical services by a formal healthcare provider among KA older adults with undiagnosed dementia. Secondary objectives assessed caregiver outcomes over 6 months, including dementia literacy, dementia knowledge, self‐efficacy in dementia care and service use, social support, depression, and quality of life. The primary end point was assessed at 6 months after randomization (with interim assessment at 3 months). All participants provided informed consent (or proxy consent when applicable). The Johns Hopkins Medicine Institutional Review Board approved the study, and an external Data and Safety Monitoring Board (DSMB) oversaw trial conduct. Following DSMB approval, enrollment began. In May 2020, the protocol was amended to allow Health Insurance Portability and Accountability Act (HIPAA)‐compliant, Zoom‐based screening, data collection, and intervention delivery in response to COVID‐19; no further amendments were made. 2.2. Study setting and participants The trial was conducted in two US regions: the Greater Washington, DC, area (Maryland, Washington, DC, and Virginia) and the New York metropolitan area (New York and New Jersey). Two long‐standing community‐based organizations – the Korean Community Resource Center of Greater Washington and Korean Community Services of Metropolitan New York, Inc. – served as community sites. Details on community engagement activities will be reported separately. Briefly, these organizations hired and managed CHWs who, after training, supported recruitment, retention, intervention delivery, and data collection under a rigorous quality‐assurance plan. 24 , 25 Desirable qualifications included relevant community‐based experience and interpersonal skills appropriate for working with KA older adults (e.g., community outreach experience, Korean language proficiency, and comfort working with older adult populations), as well as a willingness to learn standardized cognitive screening using Mini‐Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) assessment. Training consisted of 22 h of self‐paced learning with prerecorded videos hosted on the coordinating site's learning management system, supplemented by synchronous, Zoom‐based summary and question and answer (Q&A) sessions and supervised practice. Training videos covered dementia fundamentals and standardized procedures (e.g., MMSE and CDR administration, informed consent, confidentiality, cultural humility, navigation skills, REDCap documentation, and fidelity procedures). A total of 16 CHWs were trained; two withdrew before recruitment began, resulting in 14. CHWs were paid $25/h. The study enrolled dyads consisting of KA older adults with probable undiagnosed dementia and their caregivers. Inclusion criteria for KA older adults were as follows: (1) self‐identified first‐generation KA residing in the target areas; (2) age 65 years or older; (3) having a CDR of 1.0 or higher 26 , 27 ; (4) having a caregiver who lived with the older adult or interacted at least weekly; and (5) providing written consent or having a proxy available for consent. Caregiver inclusion criteria were as follows: (1) age 18 years or older; (2) fluency in reading and speaking Korean; (3) co‐residence, or at least weekly interactions, with the older adult; and (4) written consent to participate and to permit medical record audits for verifying linkage to medical services. Exclusion criteria for KA older adults were as follows: (1) a prior dementia diagnosis; (2) major psychiatric conditions such as schizophrenia; (3) neurological disorders other than Alzheimer's disease that affect cognition (e.g., stroke); and (4) current use of psychotropic medications, including antidepressants and antipsychotics. Caregiver exclusion criteria were as follows: (1) plans to relocate within 6 months and (2) active treatment for a terminal illness or enrollment in hospice care. RESEARCH IN CONTEXT Systematic review : Racial/ethnic minority older adults with LEP face substantial barriers to dementia evaluation and care. CHWs can bridge access gaps, yet randomized trials of CHW‐led interventions are scarce, with limited evidence on linkage to medical services for dementia care and caregiver outcomes. Interpretation : In a randomized trial of 287 KA older adult‐caregiver dyads, PLAN – a Korean‐speaking CHW‐led dementia literacy education plus 6‐month phone navigation – significantly increased verified completion of a medical visit for dementia care at 6 months (16.7% vs 0%; p < 0.001). Caregiver outcomes were largely unchanged, likely reflecting high functioning of participants, ceiling effects, short follow‐up, and limited Korean‐language resources after evaluation. Future directions : Future research should evaluate the scalability and cultural adaptation of PLAN across diverse LEP communities, with extended follow‐up to track diagnosis, treatment initiation, and caregiver trajectories. Assessing reimbursement pathways while integrating CHWs into clinic workflows will be critical for sustainable implementation. 2.3. Recruitment, randomization, and blinding From April 2021 through February 2024, CHWs conducted outreach via Korean language ethnic media, Korean churches, senior centers, adult day care centers, senior apartments, community events, and referrals from community clinics. A two‐tier cognitive screening protocol was implemented: CHWs administered the MMSE to all prospects; those scoring below 24 were further assessed using the CDR to determine eligibility. Our team previously demonstrated that rigorously trained CHWs could achieve high agreement on CDR assessments with gold‐standard physician ratings. 25 We monitored CHW‐conducted CDR assessments using a predefined quality‐control protocol. Specifically, all CHWs were certified as CDR raters through a standardized online training and certification process. The CHWs then recorded their first three CDR assessments, which were reviewed by the study's bilingual geriatric psychiatrist to confirm accuracy. Before conducting CDR assessments independently, each CHW achieved 100% agreement with the psychiatrist's ratings. To maintain rigor, every 10th CDR assessment for each CHW was recorded and reviewed by the psychiatrist. Of 2698 individuals screened with the MMSE, 301 met eligibility criteria. After informed consent and baseline assessments with CHWs, the study recruited 287 dyads and randomized them 1:1 to the intervention ( n = 146) or control ( n = 141) groups. During data cleaning after trial completion, we identified one dyad that enrolled twice. They were initially randomized to the control group and later re‐enrolled and randomized to the intervention group. We retained their data from the original control allocation and excluded all data from the second (intervention) enrollment from the analysis (Figure 1 ). Stratified randomization was used to balance group allocation based on key factors that may impact the primary outcome, including caregiver age, older adult CDR score, and site. Lead investigators and the trial statistician were blinded to treatment allocation and outcome data. Allocation concealment was maintained using a central REDCap system. Outcome assessors (data collecting CHWs) were masked to group assignment and were distinct from intervention‐delivering CHWs. However, due to the nature of the PLAN intervention, CHWs providing the intervention could not be blinded to group allocation. FIGURE 1. Open in a new tab Participant flow in PLAN trial. 2.4. Intervention and interventionists Details about the intervention contents and structure have been published. 24 Briefly, PLAN is a theory‐driven, 28 , 29 community‐delivered program with two core components: (1) a 1‐h dementia literacy education session and (2) monthly phone follow‐up with navigation support for up to 6 months. Dementia literacy – defined as the ability to obtain, process, and understand essential information about dementia – was targeted 30 because limited dementia literacy is a key barrier to timely evaluation and care among racial and ethnic minority older adults, 31 , 32 , 33 , 34 , 35 , 36 , 37 particularly those with LEP such as KAs. 14 , 23 The intervention was developed in partnership with a community advisory board – including a CHW, clinicians, caregivers of KA older adults with dementia, and bilingual researchers – that identified preferred materials, delivery approaches, and outcomes. 23 The culturally tailored, Korean‐language education session covered causes of dementia, diagnostic workups, pathways to obtain formal evaluation, treatment options, and how to work with primary care and geriatric specialists to plan for dementia care after the diagnosis. CHWs facilitated role‐play exercises and problem solving to teach participants how to navigate healthcare processes across settings (e.g., primary care, geriatric specialty clinics, and home) using a picture guidebook featuring bilingual (English/Korean) dialogues and Korean‐language annotations. The education session was delivered via HIPAA‐compliant Zoom (68.6%) or in person (31.4%), with an average session length of 56.7 min (standard deviation [SD] 6.2). During the follow‐up phase, CHWs provided individualized navigation support to address logistical barriers (e.g., appointment scheduling, transportation, interpreter services, paperwork) to help participants obtain cognitive evaluations from healthcare providers. Interventions were delivered from May 2021 to October 2024. An unblinded team member monitored fidelity. One of every 20 education sessions was recorded and reviewed for adherence to content, duration, and participant engagement. A structured fidelity monitoring form was completed by an unblinded team member. The form assessed key domains including educational content, session duration (i.e., a 1‐h session), participant interaction (e.g., Q&A), session order, and use of educational materials (i.e., picture guidebook). For follow‐up calls, CHWs documented session details in REDCap (topics, participant requests, navigation strategies), which were regularly reviewed for consistency and completeness. Participants assigned to the control group were referred to their primary care providers and received a publicly available Korean‐language brochure on dementia signs and treatment ( http://www.alz.org/asian/overview.asp?nL = KO&dL = KO) and a community resource guide that included a list of Korean‐speaking physicians, departments on aging (with contact information for bilingual staff when available), and memory clinics in the study areas. The brochure and the guide were provided to all participants regardless of study arm. 2.5. Measurements The primary outcome was linkage to medical services, defined as completion of a medical clinic visit with a formal health provider by a KA older adult with undiagnosed dementia, 24 determined at 3 and 6 months after randomization. The primary outcome was assessed at 3 and 6 months as part of follow‐up questionnaires, along with other study variables. When participants indicated they had completed a visit, trained study staff collected additional details (clinic name, location, and contact information) and obtained consent to retrieve documentation. A signed medical release form was then sent to the physician's office via secure fax or delivered in person to obtain records. Trained bilingual research staff, blinded to treatment allocation, verified linkage through documentation obtained from the clinic. Secondary outcomes focused on caregivers and were assessed at baseline, 3 months, and 6 months by blinded CHWs using standardized instruments. Dementia literacy was measured by the Dementia Literacy Test, 23 a reading test of 12 words related to dementia such as dementia, plaques, geriatrician, and Alzheimer's disease. A score of 1 is given if the word is pronounced correctly, with possible scores ranging from 0 to 12. Higher scores indicate higher dementia literacy. Dementia knowledge was measured by the Dementia Knowledge Test, 38 which consists of 10 items where each correct response earns 1 point. Possible scores range from 0 to 10, with higher scores indicating higher levels of dementia literacy. The Dementia Self‐Efficacy Scale, 39 comprising 10 Likert‐type items (scored 1 to 10), assesses caregivers' confidence in managing dementia‐related tasks such as arranging services or handling care costs, with higher scores reflecting greater self‐efficacy. Scores can range from 10 to 100. Social support was measured using the Medical Outcomes Study‐Social Support Survey, 40 , 41 which includes eight 5‐point Likert‐scale items (1 = none of the time to 5 = all the time) evaluating the availability of social support in various situations (e.g., meal preparation, emotional support). Higher scores indicate stronger perceived support. Depression was assessed with the Patient Health Questionnaire‐9, 42 , 43 a widely used screening tool with nine 4‐point Likert‐scale items (0 = not at all to 3 = nearly every day) measuring the frequency of depressive symptoms over the past 2 weeks (e.g., lack of interest, feeling down or hopeless). Quality of life was measured using the Quality of Life: Dementia – Caregiver, 44 a 13‐item instrument covering aspects such as physical health, mood, social relationships, and financial well‐being. Caregivers rate their experiences over the past few weeks on a 4‐point Likert scale (1 = poor to 4 = excellent), with higher scores indicating better quality of life. We used a study questionnaire to collect sociodemographic and medical characteristics of the sample (e.g., age, sex, marital status, education, self‐rated physical and mental health, number of chronic conditions). For KA older adults with undiagnosed dementia, we also assessed functional status using the Barthel Index of Activities of Daily Living (ADL) 45 , 46 and the Lawton‐Brody Instrumental ADL (IADL) scale. 47 The Barthel Index is a widely used measure of independence in 10 basic ADLs: bowel control, bladder control, grooming, toilet use, feeding, transfers, mobility, dressing, climbing stairs, and bathing. Total scores range from 0 to 20, with higher scores indicating greater independence 48 ; scores of 8 or lower indicate functional dependence, with 5 to 8 reflecting moderate dependence and 0 to 4 indicating severe dependence. 49 The Lawton‐Brody IADL scale asks an informant to rate the participant's ability across eight instrumental activities: telephone use, shopping, food preparation, housekeeping, laundry, transportation, medication management, and managing finances. Items are scored 1 (independent) or 0 (dependent) and summed to yield a total score of 0 to 8, with higher scores indicating greater independence in IADLs. 47 Scores of 5 or lower indicate some level of dependence in IADLs; scores of 4 to 5 suggest the individual may require assistance with several tasks, and scores below 4 indicate substantial impairment in performing IADLs. 2.6. Data collection Six‐month end‐point data were collected from October 2021 through October 2024. Most assessments were conducted in person via interviewer‐administered questionnaires in quiet, private spaces at community sites. When in‐person visits were not feasible (e.g., due to COVID‐19 or participant preference), data collection interviews were conducted virtually, either via phone or HIPAA‐compliant videoconferencing. All participants were provided printed questionnaires to accompany interviewer prompts, regardless of data collection mode. At 6 months, 270 dyads completed study questionnaires (intervention n = 138 or 94.5% and control n = 132 or 93.6%). 2.7. Sample size calculation With 80% power and a two‐sided alpha of 0.05, the detectable difference in linkage rates at 6 months required 66 participants if 5% of the control group linked to medical services and 236 participants if 10% did so. 18 Effect sizes for caregiver outcomes in the pilot ranged from 0.40 to 0.70 23 ; to account for potential improvements in the control group and reduced effects, the minimum detectable effect size for caregiver outcomes was set at 0.30, requiring 234 participants. Accounting for a conservative 20% dropout rate over 6 months, the target enrollment was about 288 dyads of KAs with probable, undiagnosed dementia and their caregivers. 2.8. Statistical analysis For the primary hypothesis – that PLAN would increase linkage to medical services by a healthcare provider compared with the control – we compared proportions between groups at 6 months using a chi‐squared ( χ 2 ) test. All secondary outcome analyses adhered to the intent‐to‐treat principle. The secondary hypotheses posited that caregivers receiving PLAN would show greater improvements in dementia literacy, dementia knowledge, self‐efficacy in dementia care and service use, social support, depressive symptoms, and quality of life at 6 months in comparison to the control group. Generalized estimating equations were used to model changes over time, incorporating all available observations, including cases with intermittent missing data. Models included fixed effects for group, time, and their interaction. 3. RESULTS 3.1. Sample characteristics Table 1 presents the characteristics of the sample. At baseline, KA older adults had a mean age of 82.5 years (SD 6.1) and were predominantly female (72.5%). Over half (53.1%) had less than a high school level of education. Most were insured by Medicare (94.8%), and two‐thirds had Medicaid (66.9%). A majority rated their physical and mental health as fair or poor (80.8% and 90.9%, respectively). Additionally, KA older adults reported a mean of 1.5 chronic conditions (SD 0.9). Dementia severity was mostly mild: 94.1% had a CDR of 1, 4.9% a CDR of 2, and 1.0% a CDR of 3. Overall functional status in basic ADLs was relatively high, with a mean ADL score of 14.2 (SD 2.4), whereas the mean IADL score was 4.3 (SD 2.0), indicating a need for assistance with some IADLs. TABLE 1. Baseline characteristics of intervention and control arms. Characteristic KA older adults Total ( N = 287) Intervention ( n = 146) Control ( n = 141) Age , mean (SD) (range 67 to 102), years 82.5 (6.1) 82.6 (6.2) 82.3 (6.1) Sex Male 79 (27.5) 37 (25.3) 42 (29.8) Female 208 (72.5) 109 (74.7) 99 (70.2) Marital status Married/partnered 139 (48.4) 72 (49.3) 67 (47.5) Separated/widowed/never married 148 (51.6) 74 (50.7) 74 (52.5) Educational level a Some high school or lower 146 (53.1) 73 (52.5) 73 (53.7) Completed high school 62 (24.4) 34 (24.5) 28 (20.6) Some college or higher 67 (24.4) 32 (23.1) 35 (25.7) Insurance Medicare 272 (94.8) 138 (94.5) 134 (95.0) Medicaid 192 (66.9) 95 (65.1) 97 (68.8) Physical health Excellent/good 55 (19.2) 23 (15.8) 32 (22.7) Fair/poor 232 (80.8) 123 (84.2) 109 (77.3) Mental health Excellent/good 26 (9.1) 12 (8.2) 14 (9.9) Fair/poor 261 (90.9) 134 (91.8) 127 (90.0) No. chronic condition , mean (SD) (range 0 to 4) b 1.5 (0.9) 1.5 (0.9) 1.4 (0.9) CDR 1 270 (94.1) 137 (93.8) 133 (94.3) 2 14 (4.9) 8 (5.5) 6 (4.3) 3 3 (1.0) 1 (0.7) 2 (1.4) ADL , mean (SD) (range 0 to 16) 14.2 (2.4) 14.1 (2.5) 14.3 (2.4) IADL , mean (SD) (range 0 to 8) 4.3 (2.0) 4.3 (2.0) 4.2 (1.9) Characteristic Caregivers Total ( N = 287) Intervention ( n = 146) Control ( n = 141) Age , mean (SD) (range 29 to 96), years 66.9 (13.2) 67.4 (13.2) 66.4 (13.2) Sex Male 87 (30.3) 40 (27.4) 47 (33.3) Female 200 (69.7) 106 (72.6) 94 (66.7) Marital status Married/partnered 237 (82.6) 119 (81.5) 118 (83.7) Separated/widowed/never married 50 (17.4) 27 (18.5) 23 (16.3) Educational level c Some high school or lower 50 (17.5) 20 (13.8) 30 (21.4) Completed high school 77 (27.0) 40 (27.6) 37 (26.4) Some college or higher 158 (55.4) 85 (58.6) 73 (52.1) Born in United States 5 (1.8) 3 (2.1) 2 (1.4) English proficiency d None/little/good 255 (89.5) 129 (89.0) 126 (90.0) Fluent 30 (10.5) 16 (11.0) 14 (10.0) Relationship to older adult Spouse 105 (36.6) 51 (34.9) 54 (38.3) Child 80 (27.8) 42 (28.8) 38 (27.0) Relative 29 (10.1) 13 (8.9) 16 (11.3) Not related 73 (25.4) 40 (27.4) 33 (23.4) Co‐residence with older adult 143 (49.8) 71 (49.3) 72 (51.4) Physical health Excellent/good 180 (62.7) 93 (63.7) 87 (61.7) Fair/poor 107 (37.3) 53 (36.3) 54 (38.3) Mental health Excellent/good 187 (65.2) 98 (67.1) 89 (63.1) Fair/poor 100 (34.8) 48 (32.9) 52 (36.9) No. chronic condition , mean (SD) (range 0 to 3) e 0.7 (0.9) 0.6 (0.8) 0.8 (0.9) Open in a new tab a N = 275. b Multiple choices allowed. Common conditions included hypertension (76.0%), diabetes (42.2%), depression (15.3%), and cardiovascular disease (11.5%). c N = 285. d N = 285. e Multiple choices allowed. Common conditions included hypertension (44.3%), diabetes (18.5%), depression (6.3%), and cardiovascular disease (4.2%). Caregivers had a mean age of 66.9 years (SD 13.2), were mostly female (69.7%), and were married or partnered (82.6%). More than half of the caregivers completed high school or more (82.4%). Nearly all were foreign‐born (98.2%) and had LEP (89.5%). The relationships to the older adults included spouses (36.6%), adult children (27.8%), and other relatives (10.1%); 25.4% were not related to the older adults, comprising 44 paid caregivers and 29 friends. Nearly half (49.8%) co‐resided with the older adult. Most rated their physical and mental health as excellent or good (62.7% and 65.2%, respectively) and reported a mean of 0.7 chronic conditions (SD 0.9). Randomization achieved balance: There were no statistically significant differences in baseline characteristics between intervention and control groups (all p > 0.05). 3.2. Outcomes analyses Primary outcome data were available for 270 of 287 older adults (94.1%; intervention n = 138/146 and control n = 132/141). At 6 months, 16.7% of intervention participants ( n = 23/138) versus 0% of controls ( n = 0/132) were linked to care and completed a medical visit for dementia care ( χ 2 = 24.05, p < 0.001) (Table 2 ). Among intervention participants with primary outcome data ( n = 138), we examined whether linkage by 6 months differed by baseline CDR (1 vs 2+), caregiver age (< 65 vs 65+), caregiver sex, caregiver English proficiency (limited vs proficient), and caregiver education (less than college vs college or more). No subgroup showed a statistically significant difference in the outcome (all p > 0.05); the CDR comparison was not tested due to small cell counts (Table S1 ). TABLE 2. Comparison of primary outcome between intervention and control groups at 6 months. Intervention, n (%) Control, n (%) Difference between groups, % Chi‐squared ( χ 2 ) test ( p value) 23/138 (16.7%) 0/132 (0%) 16.7% 24.05 ( p < 0.001) Open in a new tab Table 3 presents the results for the secondary, caregiver‐focused psychosocial outcomes. In prespecified generalized estimating equation models with group‐by‐time interactions, there were no significant between‐group differences in change from baseline through 6 months for dementia literacy, dementia knowledge, social support, depression, and quality of life (all p > 0.05). Self‐efficacy showed a significant difference in change over time favoring the control group, indicating greater improvement among controls than intervention participants ( p = 0.045). TABLE 3. Change over time in caregiver outcomes. Outcome Intervention, Mean (SD) Control, Mean (SD) Group × Time p value Baseline 3 months 6 months Baseline 3 months 6 months Dementia literacy 4.6 (4.6) 5.4 (4.5) 5.7 (4.4) 4.4 (4.7) 4.9 (4.7) 5.2 (4.8) 0.101 Dementia knowledge 7.1 (1.4) 7.5 (1.4) 7.8 (1.3) 7.0 (1.3) 7.5 (1.4) 7.7 (1.5) 0.503 Self‐efficacy 54.4 (15.1) 56.8 (14.4) 59.7 (15.2) 52.7 (15.6) 58.8 (14.8) 59.8 (15.5) 0.045 Social support 3.7 (1.1) 3.6 (1.1) 3.7 (1.1) 3.7 (1.1) 3.7 (1.1) 3.8 (1.0) 0.693 Depression 1.9 (2.1) 1.7 (1.9) 1.7 (1.9) 1.9 (1.8) 1.8 (2.0) 1.7 (2.1) 0.991 Quality of life 35.3 (5.9) 35.5 (6.1) 35.6 (6.5) 34.5 (6.0) 35.4 (6.4) 35.5 (6.3) 0.250 Open in a new tab 4. DISCUSSION In this randomized trial, we evaluated PLAN, a language‐concordant, CHW‐led, community‐to‐clinic linkage intervention to promote dementia care among KA older adults with probable undiagnosed dementia. Timely access to medical service is increasingly critical, as disease‐modifying therapies for Alzheimer's disease are most effective when initiated early. 12 , 50 Yet older adults with LEP face disproportionate barriers due to low dementia literacy, including limited understanding of the disease and how to access care. 14 , 15 , 16 Our study demonstrated that PLAN was effective in linking participants to formal medical services for dementia care. PLAN targeted language and access barriers common in the KA community, offering a CHW‐led model relevant to other underserved groups. The intervention significantly increased linkage to medical services compared with usual care, underscoring the potential of culturally and linguistically concordant CHW‐led models to advance equitable, timely dementia care. This finding aligns with broader literature that CHWs, embedded within communities and linguistically and culturally concordant with participants, help bridge healthcare access disparities that drive underdiagnosis and delayed treatment. 17 , 18 , 19 , 20 While we could not identify prior dementia care linkage trials for direct comparison, CHW interventions combining education with navigation support – similar to our approach – have resulted in 6% to 33% between‐group differences for outcomes such as cancer screening. 17 Our linkage rate (16.7% in the intervention arm vs 0% in control) likely reflects substantial barriers faced by cognitively impaired older adults and their caregivers with LEP within fragmented healthcare system. Notably, our “usual care” exceeded typical practice. Study procedures included cognitive screening, CDR assessment, and discussion of possible dementia – supports rarely available to older adults with LEP in routine care settings. Nonetheless, despite recommendations to follow up with their primary care physicians (PCPs), no control participants appeared to do so or to pursue specialty care. Recent evidence shows why linkage is challenging. In a US study of patients with mild cognitive impairment or mild dementia, their care partners, and physicians, the median time from symptom onset to the first conversation with a PCP was 15 months, and only one‐third of patients was evaluated and diagnosed by PCPs; the remainder were evaluated by specialists after referral. 51 Prolonged wait time for specialty appointments further delay evaluation by months to over a year. 52 , 53 CHW counseling logs (data not shown) revealed additional reasons for not pursuing formal care: Some caregivers perceived symptoms as manageable or unchanged; competing health priorities (e.g., recent surgery) took precedence, and some participants denied memory problems and declined formal assessment despite caregiver encouragement. Together, these access barriers, coupled with competing priorities and cultural norms, likely made rapid linkage challenging within our follow‐up period. Nonetheless, PLAN's success in initiating medical linkage supports expanding CHW‐led efforts as a scalable strategy to address literacy and navigation barriers and to promote early dementia care access among populations with LEP. One of our goals was to support caregivers of KA older adults. Yet secondary outcomes showed no between‐group differences. Most caregivers scored in the top quartile on dementia literacy and knowledge at baseline, suggesting ceiling effects and limited discriminability of our instruments. Assessing health literacy with a reading test alone may have been insufficient to capture other critical domains – such as comprehension, familiarity with the evaluation process, and system navigation 54 – needed to make informed health decisions and actions. Future studies will employ multidimensional measures of dementia literacy that extend beyond reading ability to include these domains. 54 Applying item response theory to select highly discriminating items may further enhance the measures’ sensitivity to change. 55 , 56 Unexpectedly, self‐efficacy changed in a direction favoring the control group. One possible explanation may be that most KA older adults enrolled had mild dementia (predominantly CDR = 1) with relatively high functional independence; hence, caregivers joined the trial with high baseline psychosocial scores. Another explanation might be that the follow‐up window may have been too short for psychosocial benefits to emerge after linkage. Finally, the intervention may have increased awareness of anticipated care demands without sufficient availability of Korean‐language resources to support them, temporarily reducing self‐efficacy. Future research should elucidate the mechanisms underlying both the observed effects and null findings in this trial. For example, longitudinal research with longer follow‐up is needed to assess whether medical linkage leads to timely diagnosis and treatment initiation. Our sample comprised many older adults with relatively preserved function and few behavioral symptoms, suggesting a “behaviorally stable” subgroup with support systems who were able to manage without engaging formal care, resulting in low caregiver distress and attenuation of the immediate impact of the intervention. A pragmatic next step would prioritize caregivers experiencing higher distress and burden, provide navigation to social services through language‐concordant CHWs, and extend follow‐up beyond 6 months to better capture help‐seeking as symptoms evolve. Qualitative investigations should complement these efforts to understand post dementia evaluation changes such as help‐seeking or resource mobilization. Looking ahead, guided by CHW feedback gathered during post‐trial debriefings (data not shown), we plan to diversify the education delivery format by offering a group option alongside one‐on‐one sessions to foster peer learning and social support, while expanding the picture guidebook with more detailed information on dementia medications to support informed decision‐making. We will also strengthen resource navigation by adding comprehensive, culturally tailored information on social and caregiving supports with step‐by‐step guidance on eligibility and access. These refinements aim to improve uptake and empower caregivers. Our study benefited from long‐standing partnerships with the KA community in the target areas. CHWs played a central role in community outreach, recruitment/retention, intervention delivery, and data collection. They addressed digital literacy issues, offered flexible scheduling, and maintained a presence at recruitment sites 57 – strategies that contributed to strong retention (94% at 6 months). CHWs are increasingly recognized as essential to improving healthcare access for underserved communities like those with LEP. 17 , 18 Recent policy momentum is expanding reimbursement pathways for CHW services, 58 creating opportunities to scale effective models like PLAN. These findings are timely. The aging US population is becoming more racially and ethnically diverse, 1 and the economic burden of dementia is projected to rise from $384 billion in 2025 59 to $1.4 trillion by 2060. 60 Early detection and timely intervention can alter the trajectory of dementia, 7 , 8 , 12 , 50 but only if barriers to dementia care are addressed. CHW‐led culturally and linguistically concordant models can improve access to dementia evaluation and treatment and may yield cost savings. Our findings support integrating CHWs into dementia care pathways, especially for communities with LEP. Policymakers should sustain funding and workforce development for CHWs, including training in dementia literacy and navigation, and continue Medicare reimbursement for CHW services to enhance reach and sustainability. At the practice level, health systems and memory clinics should partner with community‐based organizations to identify and support high‐risk populations and embed navigation support within trusted community settings to reduce logistical barriers that delay evaluation and care. 4.1. Limitations This study has limitations. First, generalizability may be limited due to the focus on linguistically isolated, first‐generation KAs recruited through community‐based organizations in East Coast ethnic enclaves. Second, double blinding was not feasible given the behavioral nature of the intervention; however, outcome assessors were masked. Third, intervention delivery may have varied across CHWs. We mitigated this with a standardized protocol and fidelity monitoring, including periodic session recording review and monthly navigation logs assessed for content and adherence. Fourth, the 6‐month follow‐up was relatively short, likely yielding a conservative estimate of linkage. Because many older adults see their PCPs annually, aligning CHW linkages with patients’ routine visit schedules may improve timely access to dementia care. Finally, baseline data collection occurred either in person or virtually (Zoom). Virtual assessments may have introduced measurement bias due to environmental factors we could not control. In contrast, follow‐ups were conducted entirely by phone, minimizing the risk of technical glitches associated with virtual platforms. Despite these limitations, the trial demonstrates that CHW‐led linkage models like PLAN can measurably improve access and offer a scalable pathway toward more equitable dementia care. 5. CONCLUSION This is the first study testing a language‐concordant CHW intervention to promote access to dementia care and caregiver outcomes. Among KA older adults with probable undiagnosed dementia, a CHW‐led dementia literacy and navigation intervention significantly improved linkage to medical services at 6 months compared with controls. Findings are limited by the short follow‐up, which may underestimate downstream effects, and by a predominantly high‐functioning sample, which may limit generalizability. Community‐dwelling older adults – particularly those with LEP – continue to face significant barriers to timely assessment and diagnosis; closing these disparities is essential to achieving equitable dementia care and optimizing health outcomes across all populations. Future work should investigate longer‐term clinical and caregiver outcomes and test the scalability and cultural adaptability of PLAN across different settings, while refining strategies to strengthen caregiver psychosocial support. CONFLICT OF INTEREST STATEMENT The authors declare no conflicts of interest. Author disclosures are available in the Supporting Information . CONSENT STATEMENT All human subjects provided written informed consent. Supporting information Supporting Information : alz71541‐sup‐0001‐ICMJE.pdf ALZ-22-e71541-s002.pdf (1.3MB, pdf) Supporting Information : alz71541‐sup‐0002‐TableS1.doc ALZ-22-e71541-s001.docx (15.7KB, docx) ACKNOWLEDGMENTS We wish to acknowledge our study participants, community advisory board members, numerous ethnic churches, senior centers, and adult day care centers across the study areas. This study was supported by the National Institutes of Health (NIH) (R01AG062649). The statements presented in this paper are solely the responsibility of the authors and do not necessarily represent the views of the NIH. Han H‐R, Perrin N, Yun J‐Y, et al. Efficacy of a language‐concordant community health worker intervention to improve community‐to‐clinic linkage for dementia care: results of the randomized trial PLAN. Alzheimer's Dement. 2026;22:e71541. 10.1002/alz.71541 Trial Registration: ClinicalTrials.gov Identifier: NCT03909347 REFERENCES 1. Administration for Community Living . 2023 profile of older Americans. Administration for Community Living; 2023. Accessed December 19, 2025. https://acl.gov/sites/default/files/Profile%20of%20OA/ACL_ProfileOlderAmericans2023_508.pdf [ Google Scholar ] 2. Vespa J, Medina L, Armstrong DM. Demographic turning points for the United States: population projections for 2020 to 2060. Current Population Reports; 2020:P25‐1144. Accessed December 19, 2025. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25‐1144.pdf [ Google Scholar ] 3. Batalova J. Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute; 2025. Accessed December 14, 2025. https://www.migrationpolicy.org/sites/default/files/publications/FRS‐PRINT‐2025‐FINAL.pdf [ Google Scholar ] 4. Mizoguchi N, Walker L, Trevelyan E, Ahmed B. The older foreign‐born population in the United States: 2012‐2016. American Community Survey Reports; 2019. ACS‐42. Accessed October 14, 2025. https://www.census.gov/content/dam/Census/library/publications/2019/acs/acs‐42.pdf [ Google Scholar ] 5. Grand JH, Caspar S, Macdonald SW. Clinical features and multidisciplinary approaches to dementia care. J Multidiscip Healthc. 2011;4:125‐147. doi: 10.2147/JMDH.S17773 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Fang M, Hu J, Weiss J, et al. Lifetime risk and projected burden of dementia. Nat Med. 2025;31(3):772‐776. doi: 10.1038/s41591-024-03340-9 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 7. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145(10):713‐726. doi: 10.7326/0003-4819-145-10-200611210-00004 [ DOI ] [ PubMed ] [ Google Scholar ] 8. Rossini PM, Di Iorio R, Vecchio F, et al. Early diagnosis of Alzheimer's disease: the role of biomarkers including advanced EEG signal analysis. Report from the IFCN‐sponsored panel of experts. Clin Neurophysiol. 2020;131(6):1287‐1310. doi: 10.1016/j.clinph.2020.03.003 [ DOI ] [ PubMed ] [ Google Scholar ] 9. White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Medicare expenditures attributable to dementia. Health Serv Res. 2019;54(4):773‐781. doi: 10.1111/1475-6773.13134 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Shore J, Kalafatis C, Stainthorpe A, Modarres MH, Khaligh‐Razavi SM. Health economic analysis of the integrated cognitive assessment tool to aid dementia diagnosis in the United Kingdom. Front Public Health. 2023;11:1240901. doi: 10.3389/fpubh.2023.1240901. Published 2023 Sep 29. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. Alzheimer's Association . 2018 Alzheimer's disease facts and figures. Alzheimers Dement. 2018;14(3):367‐429. doi: 10.1016/j.jalz.2018.02.001 [ DOI ] [ Google Scholar ] 12. Cummings J, Zhou Y, Lee G, Zhong K, Fonseca J, Cheng F, Alzheimer's disease drug development pipeline: 2024. Alzheimers Dement (N Y). 2024;10(2):e12465. doi: 10.1002/trc2.12465 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Hinton L, Tran D, Peak K, Meyer OL, Quiñones AR. Mapping racial and ethnic healthcare disparities for persons living with dementia: a scoping review. Alzheimers Dement. 2024;20(4):3000‐3020. doi: 10.1002/alz.13612 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Lee HB, Han HR, Huh BY, Kim KB, Kim MT. Mental health service utilization among Korean elders in Korean churches: preliminary findings from the Memory and Aging Study of Koreans in Maryland (MASK‐MD). Aging Ment Health. 2014;18(1):102‐109. doi: 10.1080/13607863.2013.814099 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. Lin PJ, Daly AT, Olchanski N, et al. Dementia Diagnosis Disparities by Race and Ethnicity. Med Care. 2021;59(8):679‐686. doi: 10.1097/MLR.0000000000001577 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. White L, Ingraham B, Larson E, Fishman P, Park S, Coe NB. Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia. J Gen Intern Med. 2022;37(12):2957‐2965. doi: 10.1007/s11606-021-07169-7 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Kim K, Choi JS, Choi E, et al. Effects of community‐based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3‐e28. doi: 10.2105/AJPH.2015.302987 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Han HR, McKenna S, Nkimbeng M, et al. A systematic review of community health center based interventions for people with diabetes. J Community Health. 2019;44(6):1253‐1280. doi: 10.1007/s10900-019-00693-y [ DOI ] [ PubMed ] [ Google Scholar ] 19. Berini CR, Bonilha HS, Simpson AN. Impact of community health workers on access to care for rural populations in the United States: a systematic review. J Community Health. 2022;47(3):539‐553. doi: 10.1007/s10900-021-01052-6 [ DOI ] [ PubMed ] [ Google Scholar ] 20. Martinez‐Cruz MS, Namasingh N, Alexopoulos AS, Batch BC, Crowley MJ, Bosworth HB. The forgotten—overcoming challenges in diabetes care for marginalized populations. Expert Rev Endocrinol Metab. 2025;20(5):385‐401. doi: 10.1080/17446651.2025.2526200 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 21. Sadarangani TR, Salcedo V, Chodosh J, Kwon S, Trinh‐Shevrin C, Yi S. Redefining the care continuum to create a pipeline to dementia care for minority populations. J Prim Care Community Health. 2020;11:2150132720921680. doi: 10.1177/2150132720921680 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 22. Johnson E, Lewis M, Nordyke A, et al. Community health workers: developing roles in public health dementia efforts in the United States. Front Public Health. 2025;13:1616404. doi: 10.3389/fpubh.2025.1616404 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Han HR, Choi S, Wang J, Lee HB. Pilot testing of a dementia literacy intervention for Korean American elders with dementia and their caregivers. J Clin Transl Res. 2021;7(6):712‐716. [ PMC free article ] [ PubMed ] [ Google Scholar ] 24. Han HR, Perrin N, Kwon SC, et al. PLAN‐Dementia literacy education and navigation for Korean elders with probable dementia and their caregivers: rationale, methods, and design of a community‐based, randomized, controlled, multi‐site clinical trial. Contemp Clin Trials. 2025;148:107771. doi: 10.1016/j.cct.2024.107771 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Han HR, Park SY, Song H, Kim M, Kim KB, Lee HB. Feasibility and validity of dementia assessment by trained community health workers based on clinical dementia rating. J Am Geriatr Soc. 2013;61(7):1141‐1145. doi: 10.1111/jgs.12309 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412‐2414. doi: 10.1212/wnl.43.11.2412-a [ DOI ] [ PubMed ] [ Google Scholar ] 27. Choi SH, Na DL, Lee BH, et al. Estimating the validity of the Korean version of expanded clinical dementia rating (CDR) scale. J Korean Neurol Assoc. 2001;19(6):585‐591. [ Google Scholar ] 28. Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. 2nd ed.. Mayfield Publishing Co; 1991. [ Google Scholar ] 29. von Wagner C, Steptoe A, Wolf MS, Wardle J. Health literacy and health actions: a review and a framework from health psychology. Health Educ Behav. 2009;36(5):860‐877. doi: 10.1177/1090198108322819 [ DOI ] [ PubMed ] [ Google Scholar ] 30. Sun F, Gao X, Coon DW. Perceived threat of Alzheimer's disease among Chinese American older adults: the role of Alzheimer's disease literacy. J Gerontol B Psychol Sci Soc Sci. 2015;70(2):247‐257. doi: 10.1093/geronb/gbt095 [ DOI ] [ PubMed ] [ Google Scholar ] 31. Chin AL, Negash S, Hamilton R. Diversity and disparity in dementia: the impact of ethnoracial differences in Alzheimer disease. Alzheimer Dis Assoc Disord. 2011;25(3):187‐195. doi: 10.1097/WAD.0b013e318211c6c9 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 32. Diamond AG, Woo BK. Duration of residence and dementia literacy among Chinese Americans. Int J Soc Psychiatry. 2014;60(4):406‐409. doi: 10.1177/0020764013491742 [ DOI ] [ PubMed ] [ Google Scholar ] 33. Joo J, Choi S, Gallo JJ, et al. Intersection of multiple factors shape Korean American caregiver experience in dementia caregiving. Aging Ment Health. 2023;27(10):1975‐1982. doi: 10.1080/13607863.2023.2219625 [ DOI ] [ PubMed ] [ Google Scholar ] 34. Kitchener BA, Jorm AF. Mental health first aid training in a workplace setting: a randomized controlled trial [ISRCTN13249129]. BMC Psychiatry. 2004;4:23. doi: 10.1186/1471-244X-4-23 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Werner P. Knowledge about symptoms of Alzheimer's disease: correlates and relationship to help‐seeking behavior. Int J Geriatr Psychiatry. 2003;18(11):1029‐1036. doi: 10.1002/gps.1011 [ DOI ] [ PubMed ] [ Google Scholar ] 36. Mahoney DF, Cloutterbuck J, Neary S, Zhan L. African American, Chinese, and Latino family caregivers' impressions of the onset and diagnosis of dementia: cross‐cultural similarities and differences. Gerontologist. 2005;45(6):783‐792. doi: 10.1093/geront/45.6.783 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 37. Low LF, Anstey KJ. Dementia literacy: recognition and beliefs on dementia of the Australian public. Alzheimers Dement. 2009;5(1):43‐49. doi: 10.1016/j.jalz.2008.03.011 [ DOI ] [ PubMed ] [ Google Scholar ] 38. Jang Y, Kim G, Chiriboga D. Knowledge of Alzheimer's disease, feelings of shame, and awareness of services among Korean American elders. J Aging Health. 2010;22(4):419‐433. doi: 10.1177/0898264309360672 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 39. Casado BL, Lee SE. Access barriers to and unmet needs for home‐ and community‐based services among older Korean Americans. Home Health Care Serv Q. 2012;31(3):219‐242. doi: 10.1080/01621424.2012.703540 [ DOI ] [ PubMed ] [ Google Scholar ] 40. Moser A, Stuck AE, Silliman RA, Ganz PA, Clough‐Gorr KM. The eight‐item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance. J Clin Epidemiol. 2012;65(10):1107‐1116. doi: 10.1016/j.jclinepi.2012.04.007 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 41. Shin JK, Kim KW, Park JH, et al. Impacts of poor social support on general health status in community‐dwelling korean elderly: the results from the korean longitudinal study on health and aging. Psychiatry Investig. 2008;5(3):155‐162. doi: 10.4306/pi.2008.5.3.155 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 42. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self‐report version of PRIME‐MD: the PHQ primary care study. primary care evaluation of mental disorders. patient health questionnaire. JAMA. 1999;282(18):1737‐1744. doi: 10.1001/jama.282.18.1737 [ DOI ] [ PubMed ] [ Google Scholar ] 43. Han C, Jo SA, Kwak JH, et al. Validation of the patient health questionnaire‐9 korean version in the elderly population: the ansan geriatric study. Compr Psychiatry. 2008;49(2):218‐223. doi: 10.1016/j.comppsych.2007.08.006 [ DOI ] [ PubMed ] [ Google Scholar ] 44. Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002;64(3):510‐519. doi: 10.1097/00006842-200205000-00016 [ DOI ] [ PubMed ] [ Google Scholar ] 45. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61‐65. [ PubMed ] [ Google Scholar ] 46. Sinoff G, Ore L. The Barthel activities of daily living index: self‐reporting versus actual performance in the old‐old (>or = 75 years). J Am Geriatr Soc. 1997;45(7):832‐836. doi: 10.1111/j.1532-5415.1997.tb01510.x [ DOI ] [ PubMed ] [ Google Scholar ] 47. Lawton MP, Brody EM. Assessment of older people: self‐maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179‐186. [ PubMed ] [ Google Scholar ] 48. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61‐63. doi: 10.3109/09638288809164103 [ DOI ] [ PubMed ] [ Google Scholar ] 49. Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs. 2007;2(3):204‐212. doi: 10.1111/j.1748-3743.2007.00074.x [ DOI ] [ PubMed ] [ Google Scholar ] 50. Alzheimer's Association . FDA‐approved treatments for Alzheimer's. Alzheimer's Association; 2026. Accessed January 6, 2026. https://www.alz.org/getmedia/4f4ca289‐a2c6‐4df9‐8cdf‐390365bd477e/alzheimers‐dementia‐fda‐approved‐treatments‐for‐alzheimers‐ts.pdf [ Google Scholar ] 51. Brunton S, Pruzin JJ, Alford S, Hamersky C, Sabharwal A, Gopalakrishna G. Perspectives of patients, care partners, and primary care physicians on management of mild cognitive impairment and mild Alzheimer's disease dementia. Postgrad Med. 2023;135(5):530‐538. doi: 10.1080/00325481.2023.2217025 [ DOI ] [ PubMed ] [ Google Scholar ] 52. Vasileva‐Metodiev SZ, Spargo D, Klein EG, et al. Diagnostic journey and management of patients with mild cognitive impairment and Alzheimer's disease dementia: a multinational, real‐world survey. J Alzheimers Dis. 2025;104(4):1212‐1234. doi: 10.1177/13872877251322978 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 53. Franz CE, Barker JC, Kim K, et al. When help becomes a hindrance: mental health referral systems as barriers to care for primary care physicians treating patients with Alzheimer's disease. Am J Geriatr Psychiatry. 2010;18(7):576‐585. doi: 10.1097/jgp.0b013e3181a76df7 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 54. Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21(8):878‐883. doi: 10.1111/j.1525-1497.2006.00540.x [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 55. Nguyen TH, Paasche‐Orlow MK, Kim MT, Han HR, Chan KS. Modern measurement approaches to health literacy scale development and refinement: overview, current uses, and next steps. J Health Commun. 2015;20(2):112‐115. doi: 10.1080/10810730.2015.1073408 [ DOI ] [ PubMed ] [ Google Scholar ] 56. Nguyen TH, Han HR, Kim MT, Chan KS. An introduction to item response theory for patient‐reported outcome measurement. Patient. 2014;7(1):23‐35. doi: 10.1007/s40271-013-0041-0 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 57. Min D, Yun JY, Parslow C, Jajodia A, Han HR. Online‐based recruitment methods for community‐dwelling older adults: scoping review and lessons learned from the PLAN trial. J Med Internet Res. 2025;27:e55082. doi: 10.2196/55082 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 58. Centers for Medicare & Medicaid Services . Calendar year (CY) 2024 Medicare Physician Fee Schedule final rule. CMS website. Accessed December 2, 2025. https://www.cms.gov/newsroom/fact‐sheets/calendar‐year‐cy‐2024‐medicare‐physician‐fee‐schedule‐final‐rule [ Google Scholar ] 59. Alzheimer's Association . 2025 Alzheimer's disease facts and figures: special report: American perspectives on early detection of Alzheimer's disease in the era of treatment; Alzheimer's Association; 2025. Accessed December 29, 2025. https://www.alz.org/getmedia/ef8f48f9‐ad36‐48ea‐87f9‐b74034635c1e/alzheimers‐facts‐and‐figures.pdf [ Google Scholar ] 60. Nandi A, Counts N, Bröker J, et al. Cost of care for Alzheimer's disease and related dementias in the United States: 2016 to 2060. NPJ Aging. 2024;10(1):13. doi: 10.1038/s41514‐024‐00136‐6 . Published 2024 Feb 8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. 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