Dementia and Ethnic Minorities

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Dementia and Ethnic Minorities

• A workshop to promote multicultural health care
• By Charity Brooks

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Review What is Dementia?

• Dementia- loss of intellectual functions (such as
  thinking, remembering, and reasoning) of
  sufficient severity to interfere with a persons
  daily functioning
• Dementia is not a disease itself but rather a
  group of symptoms that may accompany certain
  diseases or conditions, such as Alzheimers
  Disease
• Symptoms include a change in personality, mood,
  and behavior
• www.alz.org

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Demographics of Minorities in the U.S.

• African-American- 12.3
• Asian- 3.6
• American Indian/Alaska Native- 0.9
• Hispanic/Latino- 12.5
• Other- 5.5
• Total 34.8
• The impact of dementia on minorities, and the
  response of health care workers to them, is
  significant due to the implications of the
  minority population
• www.census.gov

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How does Dementia Affect Ethnic Minorities?

• The Double Jeopardy Hypothesis? Social Handicap
  Age Race
• Triple jeopardy Age Race Dementia

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Factors Influencing the Hypotheses

• Institutional Racism- discrimination that exists
  in social structures and institutional practices,
  placing racism in a historical, cultural,
  socio-economic, and political context
• Color-blindness- treats minorities in the same
  way that majority whites are treated, denying
  cultural differences and negating the various
  experiences of minorities
• Not always intentional racism, but it ignores the
  structural inequalities present in the system

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Factors Influencing the Hypotheses

• Lack of Cultural Awareness- it is difficult to
  diagnose dementia when patients have different
  cultures and languages than the practitioner
• It is important for psychiatrists and
  practitioners to be aware of the culture and
  racism of their profession and the overall social
  climate
• Cultural values should be respected, but should
  not be used to justify lack of services

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Factors Influencing the Hypotheses

• Most services available for dementia are focused
  towards white, English-speaking clients, causing
  minority ethnic patients with dementia to remain
  underserved this reinforces the message that
  these mainstream agencies do not belong for
  minority groups
• Because specific minority ethnic organizations
  may not be aware of the implications of dementia,
  minority ethnic families can be isolated due to a
  lack of support rather than choice

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Factors Influencing the Hypotheses

• Linguicism- a form of prejudice that involves
  making judgments about one's wealth, education,
  social status, and other traits based on their
  use of language
• Miscommunication- if there is a language barrier
  that exists between native speakers and
  non-native speakers of English (health care
  workers and patients, for example),
  miscommunication can occur, hindering effective
  care- the result of limited English proficiency
  (LEP)

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Factors Influencing the Hypotheses

• Stereotypes- the myth that all minority families
  look after their extended family, including
  health care and dementia symptoms
• Minority groups tend to be viewed as a homogenous
  groups with easily identifiable characteristics
• Although minority families from different ethnic
  groups may traditionally have extended family
  living with them, it should not be seen as the
  norm

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• Traditional Views of Ethnic Minority Immigrants
  in the U.S.
• Although these views may still be in place and it
  is important to be aware of them, they should not
  be viewed as the cultural norm and cause cultural
  stereotypes.

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Traditional Latino Views of Family and
Alzheimers

• The family unit is extremely important in the
  Hispanic/Latino community, being the center of
  activity and support.
• Care for elders may be provided by the extended
  family who may reside in the same home.
• Adult children and grandchildren can help bring
  knowledge to older family members and support
  them in accessing health care services.
• Doctors are respected and viewed as authority
  figures.
• Latinos may receive health care information from
  Spanish language media, including newspapers,
  radio and television.
• Language barriers may prevent access to health
  care information and other services.
• Particularly in the early stage, Alzheimers
  disease is viewed as normal aging.
• Families may not seek out services because they
  do not wish to bring shame upon the family.

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Traditional Asian Views of Family and Alzheimers

• Family is the foundation of daily living
• Family members have a strong sense of duty to
  care for each other.
• Elders are highly respected and obeyed.
• Multigenerational family ties exist, with
  families often living together.
• Families may oppose long term care, believing it
  is shameful to place loved ones in residential
  care.
• Strong internal cultural mechanisms help shape
  their support system, which includes having
  values that address the care and support of
  elderly family members.
• Language barriers may prevent access to health
  care information and other services.
• Alzheimers disease and other forms of dementia
  may be perceived as forms of mental illness with
  shame attached, and this sense of shame may
  extend beyond the diagnosed individual to the
  entire family.
• The behavioral symptoms of dementia may be seen
  as a natural consequence of aging.

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Recommendations for Improving the Healthcare of
Elderly Minorities

• Providing trained and licensed translators and
  interpreters for patients and their families so
  that they can effectively communicate with health
  care workers
• Making translated information concerning dementia
  available to health care agencies and minorities
  suffering from dementia

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Recommendations for Improving the Healthcare of
Elderly Minorities

• Cultural training needs to be provided for
  practitioners so that the they can support
  minorities with dementia and their families in
  culturally sensitive ways
• By working to achieve racial equality in
  employment through training and awareness,
  organizations can evaluate the management,
  recruitment procedures, and qualification
  requirements that affect the ways in which
  minorities are served

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Recommendations for Improving the Healthcare of
Elderly Minorities

• Outreach work can serve the purpose of educating
  community organizations and areas that are
  frequented by elderly minorities about dementia,
  as well as encouraging practitioners to create
  partnerships with these organizations
• Further research is important to improve the
  services to minorities with dementia
• In the U.S., research focusing on ethnic
  minorities has been termed ethnogeriatric
  research

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Group Work

• Case Studies
• In groups, read the sample case studies and
  discuss them
• Underline all of the examples and factors that
  relate to what has been discussed about dementia
  and ethnic minorities

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Group Work

• Case Study Questions
• What are the ways in which the culture of the
  patients was addressed? What are ways in which it
  was not addressed?
• Were there examples of racism in your case study?
  If so, in what ways?
• How was language addressed in the case study?
  Were translators or interpreters used?
• How were the services of the minority elders
  affected due to their ethnicity?
• Did the families respond in the way you expected?
  Did their cultural background determine the way
  they responded to the care of their families?
• How did knowledge or lack of knowledge of
  dementia affect the subject in the case study?
• How would you respond as a health care worker in
  your specific situation?

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Group Work

• Have a class discussion pertaining to your
  specific case studies
• Explain the context of your groups case study,
  and allow for feedback from other group members

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References

• Brownlie, J. (1991) A Hidden Problem? Dementia
  Amongst Minority Ethnic Groups. Stirling
  University of Stirling.
• Case studies used in this presentation were
  modified based upon Browlies case studies in her
  research
• Cultural Competency
• www.alz.org/Resources/Diversity/downloads/GEN_EDU-
  10steps.pdf
• Alzheimers Association
• www.alz.org
• Wikipedia- The Free Encyclopedia
• http//en.wikipedia.org