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ZUBAIR MARIA, NORRIS MERIEL. Perspectives on ageing, later life and ethnicity: ageing research in ethnic minority contexts. AGEING & SOCIETY 2015; 35:897-916. [PMID: 25937682 PMCID: PMC4396438 DOI: 10.1017/s0144686x14001536] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of 'ethnicity' (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of 'otherness' within the predominant existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic 'difference'. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and 'otherness' is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly (re)produced, within (and through) research itself - for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à-vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants' ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.
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Affiliation(s)
- MARIA ZUBAIR
- School of Sociology and Social Policy, University
of Nottingham, UK
- Centre for Dementia, Institute of Mental Health,
University of Nottingham, UK
| | - MERIEL NORRIS
- College of Health and Life Sciences, Brunel
University London, UK
- Institute of Healthy Ageing, Brunel University
London, UK
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Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, Schoeman J, Brayne C. Comorbidity and dementia: a scoping review of the literature. BMC Med 2014; 12:192. [PMID: 25358236 PMCID: PMC4229610 DOI: 10.1186/s12916-014-0192-4] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/26/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. METHODS We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014). RESULTS We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia. CONCLUSIONS The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Anne-Marie Burn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
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Liu HY, Wang YN, Huang HL, Hsu WC, Lin YE, Huang TH, Shyu YIL. Psychometric Properties of the Finding a Balance Scale for Family Caregivers of Elders with Dementia in Taiwan. Res Nurs Health 2014; 37:336-46. [DOI: 10.1002/nur.21603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Hsin-Yun Liu
- Postdoctoral Fellow, Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Yu-Nu Wang
- Instructor, Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Huei-Ling Huang
- Associate Professor, Department of Gerontological Care and Management; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Wen-Chuin Hsu
- Assistant Professor and Visiting Staff, Department of Neurology; Chang Gung University and Memorial Hospital; Taoyuan Taiwan
| | - Yueh-E Lin
- Supervisor, Department of Nursing; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Tza-Hsin Huang
- Director, Department of Nursing; Taoyuan Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yea-Ing L. Shyu
- Professor, School of Nursing; and Healthy Aging Research Center; Chang Gung University; 259 Wen-Hwa 1st Road, Kwei-Shan Taoyuan 33302 Taiwan
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Johl N, Patterson T, Pearson L. What do we know about the attitudes, experiences and needs of Black and minority ethnic carers of people with dementia in the United Kingdom? A systematic review of empirical research findings. DEMENTIA 2014; 15:721-42. [DOI: 10.1177/1471301214534424] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper reviews recent literature on the experiences, attitudes and needs of caring for someone with dementia in Black and minority ethnic communities in the United Kingdom. Eight articles, which investigated carer experiences from Black and minority ethnic communities when caring for someone with dementia, were critically appraised. All eight studies used a qualitative methodology. The review identified several themes and issues across the qualitative studies. These included memory loss being viewed as a normal process of ageing, care being perceived as an extension of an existing responsibility, a poor understanding of what support services provide, the influence of migration, the impact of stigma and increased female responsibility. Methodological limitations of the research literature studies are also highlighted and clinically relevant implications are discussed, alongside recommendations for future research in this area.
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Affiliation(s)
- Nicholas Johl
- Health Sciences, Coventry University, Coventry, United Kingdom
| | - Tom Patterson
- Health Sciences, Coventry University, Coventry, United Kingdom
| | - Lesley Pearson
- Health Sciences, Coventry University, Coventry, United Kingdom
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Regan JL. Ethnic minority, young onset, rare dementia type, depression: A case study of a Muslim male accessing UK dementia health and social care services. DEMENTIA 2014; 15:702-20. [PMID: 24858552 DOI: 10.1177/1471301214534423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case study comprised of formal interviews, formal observations and informal discussions investigated the motivations and experiences accessing dementia care health and social care services for a Muslim, Pakistani male with dementia. Motivations derived from 'desperation' and an inability to access support from family or religious community. Experiences of accessing services were mostly negative. Dementia services were ill-informed about how to support persons with young onset dementia, with pre-existing mental health conditions, from an ethnic minority. Education and training to remove barriers to all dementia care services is required for persons with dementia, their families and within dementia services and religious communities.
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Affiliation(s)
- Jemma L Regan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Cowan MM. The lived experiences of the Sikh population of south east England when caring for a dying relative at home. Int J Palliat Nurs 2014; 20:179-86. [DOI: 10.12968/ijpn.2014.20.4.179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Margaret Mary Cowan
- Advanced Nurse Practitioner, Home Care Team and Day Therapy Unit, Ellenor Lions Hospices, Cold Harbour Road, Gravesend DA11 7HQ, England
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Chakrabarti S. Cultural aspects of caregiver burden in psychiatric disorders. World J Psychiatry 2013; 3:85-92. [DOI: 10.5498/wjp.v3.i4.85] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/21/2013] [Accepted: 11/16/2013] [Indexed: 02/05/2023] Open
Abstract
Caring for a mentally ill family member is well known to be mostly a stressful, distressing and burdensome experience. The dominant model for examining the process of caregiving has been the stress-appraisal-coping paradigm, in which interactions between stressors, appraisals, coping, and various mediators produce the eventual outcomes in terms of distress or well-being among caregivers. Ethnic and cultural factors have traditionally received the least research attention as mediators of the caregiving process. However, a large body of accumulated research evidence has clearly demonstrated that culturally-defined values, norms, and roles are among the major determinants of the caregiving experience. This research is based mainly on cross-cultural comparisons between caregivers of minority ethnic groups residing in the West and the native Caucasian population. It has been supplemented, to a limited extent, by research carried out among caregivers belonging to different cultures and residing in their countries of origin. Most of this research has been carried out among caregivers of elderly people with dementia; other psychiatric disorders such as schizophrenia have received much less attention. Results of this research have documented important differences in caregiving experiences and outcomes across cultural and ethnic groups. Cultural factors which could mediate these differences have been identified, and theories, which could provide a coherent framework to understand these differences, proposed. Though limited by methodological difficulties, this research has provided important insights into the impact of cultural and ethnic factors on the whole spectrum of the caregiving experiences. An improved understanding of the area is, nevertheless, required because it will eventually help in devising appropriate ways to reduce burden and distress among caregivers from diverse ethnic and cultural groups.
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58
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Mundia L. Relationship Between Mental Health and Teaching. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2013. [DOI: 10.2753/imh0020-7411420205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Strech D, Mertz M, Knüppel H, Neitzke G, Schmidhuber M. The full spectrum of ethical issues in dementia care: systematic qualitative review. Br J Psychiatry 2013; 202:400-6. [PMID: 23732935 DOI: 10.1192/bjp.bp.112.116335] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Integrating ethical issues in dementia-specific training material, clinical guidelines and national strategy plans requires an unbiased awareness of all the relevant ethical issues. AIMS To determine systematically and transparently the full spectrum of ethical issues in clinical dementia care. METHOD We conducted a systematic review in Medline (restricted to English and German literature published between 2000 and 2011) and Google books (with no restrictions). We applied qualitative text analysis and normative analysis to categorise the spectrum of ethical issues in clinical dementia care. RESULTS The literature review retrieved 92 references that together mentioned a spectrum of 56 ethical issues in clinical dementia care. The spectrum was structured into seven major categories that consist of first- and second-order categories for ethical issues. CONCLUSIONS The systematically derived spectrum of ethical issues in clinical dementia care presented in this paper can be used as training material for healthcare professionals, students and the public for raising awareness and understanding of the complexity of ethical issues in dementia care. It can also be used to identify ethical issues that should be addressed in dementia-specific training programmes, national strategy plans and clinical practice guidelines. Further research should evaluate whether this new genre of systematic reviews can be applied to the identification of ethical issues in other cognitive and somatic diseases. Also, the practical challenges in addressing ethical issues in training material, guidelines and policies need to be evaluated.
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Affiliation(s)
- Daniel Strech
- Hannover Medical School, Institute for History, Ethics and Philosophy in Medicine, CELLS-Centre for Ethics and Law in the Life Sciences, Carl-Neuberg Straße 1, 30625 Hanover, Germany.
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Saltus R, Folkes E. Understanding dignity and care: an exploratory qualitative study on the views of older people of African and African‐Caribbean descent. QUALITY IN AGEING AND OLDER ADULTS 2013. [DOI: 10.1108/14717791311311094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Willis R. Individualism, collectivism and ethnic identity: cultural assumptions in accounting for caregiving behaviour in Britain. J Cross Cult Gerontol 2012; 27:201-16. [PMID: 22869345 DOI: 10.1007/s10823-012-9175-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Britain is experiencing the ageing of a large number of minority ethnic groups for the first time in its history, due to the post-war migration of people from the Caribbean and the Indian subcontinent. Stereotypes about a high level of provision of informal caregiving among minority ethnic groups are common in Britain, as in the US, despite quantitative studies refuting this assumption. This paper reports on a qualitative analysis of in-depth interviews with older people from five different ethnic groups about their conceptualisation of their ethnic identity, and their attributions of motivations of caregiving within their own ethnic group and in other groups. It is argued that ethnic identity becomes salient after migration and becoming a part of an ethnic minority group in the new country. Therefore, White British people who have never migrated do not have a great sense of ethnic identity. Further, a strong sense of ethnic identity is linked with identifying with the collective rather than the individual, which explains why the White British participants gave an individualist account of their motivations for informal care, whereas the minority ethnic participants gave a collectivist account of their motivations of care. Crucially, members of all ethnic groups were providing or receiving informal care, so it was the attribution and not the behaviour which differed.
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Affiliation(s)
- Rosalind Willis
- Centre for Research on Ageing, University of Southampton, Highfield, Southampton, SO17 1BJ, United Kingdom.
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62
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Bunn F, Goodman C, Sworn K, Rait G, Brayne C, Robinson L, McNeilly E, Iliffe S. Psychosocial factors that shape patient and carer experiences of dementia diagnosis and treatment: a systematic review of qualitative studies. PLoS Med 2012; 9:e1001331. [PMID: 23118618 PMCID: PMC3484131 DOI: 10.1371/journal.pmed.1001331] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 09/18/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice. METHODS AND FINDINGS We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis. CONCLUSIONS There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom.
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63
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Development of support networks in informal dementia care: guided, organic, and chance routes through support. Can J Aging 2012; 31:445-55. [PMID: 23021103 DOI: 10.1017/s0714980812000323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Increasing knowledge about factors that shape the development of care networks for people with dementia is imperative in countries with aging populations that are relying increasingly on informal care. This study used a qualitative approach to identify the complex routes through support taken by informal caregivers for people with dementia in the development of their care networks. Interview data were collected from 13 caregivers. Three routes through support were identified: guided routes, organic routes, and chance routes. This article's principal argument is that these routes are the outcomes not only of the resources that caregivers draw upon, but also of their varying expectations regarding the role of the informal caregiver. The identification of the three routes through support provides a potentially valuable framework for examining the experiences of caregivers for individuals with other long-term health conditions.
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Wang YN, Shyu YIL, Tsai WC, Yang PS, Yao G. Exploring conflict between caregiving and work for caregivers of elders with dementia: a cross-sectional, correlational study. J Adv Nurs 2012; 69:1051-62. [DOI: 10.1111/j.1365-2648.2012.06092.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Wen-Che Tsai
- Department of Psychiatry; National Taiwan University Hospital; Taipei; Taiwan
| | - Pei-Shan Yang
- Department of Social Work; National Taiwan University; Taipei; Taiwan
| | - Grace Yao
- Department of Psychology; National Taiwan University; Taipei; Taiwan
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65
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Who cares? Managing obligation and responsibility across the changing landscapes of informal dementia care. AGEING & SOCIETY 2012. [DOI: 10.1017/s0144686x12000311] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
ABSTRACTThis paper explores the different ways in which informal carers for people with dementia negotiate their care-giving role across the changing organisational and spatial landscape of care. In-depth qualitative data are used to argue that the decisions of carers are socially situated and the result of negotiations involving individuals, families and wider cultural expectations. These decisions affect where care occurs. In addressing these issues this paper draws attention to the lack of choice some carers may have in taking on the care-giving role; how and why carers draw upon support; and the different expectations of the care-giver's capabilities across the different sites of care, specifically at home and in nursing homes. It concludes that research and policy attention should focus on how the expectations about the role and abilities of carers are affected by where, and how, care is delivered. In doing so this paper contributes to the emerging health geography literature on care-giving as well as developing the spatial perspective in the established gerontological literature.
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Botsford J, Clarke CL, Gibb CE. Dementia and relationships: experiences of partners in minority ethnic communities. J Adv Nurs 2011; 68:2207-17. [PMID: 22150385 DOI: 10.1111/j.1365-2648.2011.05905.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This article is a report of a study aimed at examining the experiences of partners of people with dementia in two minority ethnic communities. BACKGROUND Cultural background is important in how people perceive the effects of dementia and respond to them. To date there has been little research on the experiences of minority ethnic partners in the U.K. METHOD Using a constructivist grounded theory approach data collection took place in London, England, over an 18-month period between 2007 and 2009. A total of 43 in-depth interviews were conducted with seven Greek Cypriot and six African Caribbean partners of people with dementia. FINDINGS The outcomes of the study revealed partners of people with dementia engaged in an ongoing process of 'redefining relationships'. Greek Cypriot partners tended to emphasize family relationships whilst African Caribbean partners tended to view themselves primarily as an individual or as part of a couple. CONCLUSION Increased understanding of how dementia is experienced by partners of people from specific ethnic groups with dementia can equip nurses to give culturally appropriate advice and support. The study findings suggest that ethnicity alone cannot account for individual responses to dementia in a partner, and therefore awareness of cultural factors needs to be balanced with sensitivity to the unique life experience and relationships of the individuals.
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Affiliation(s)
- Julia Botsford
- Enfield and Haringey Mental Health NHS Trust, London, UK.
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Nielsen TR, Vogel A, Phung TKT, Gade A, Waldemar G. Over- and under-diagnosis of dementia in ethnic minorities: a nationwide register-based study. Int J Geriatr Psychiatry 2011; 26:1128-35. [PMID: 21194100 DOI: 10.1002/gps.2650] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 09/20/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Among dementia professionals in several European countries, it is believed that dementia is under-diagnosed and under-treated to a greater extent among ethnic minorities than in the native population. It is unknown whether this belief holds true. The objective of this study was to compare the prevalence of register-based dementia diagnoses in the largest ethnic minority groups in Denmark with the prevalence of register-based dementia diagnoses in the general Danish population. METHODS By linking the Danish hospital registers with the Danish Civil Registration System, nationwide dementia cases for three main ethnic minorities were identified. Age- and gender-specific prevalence rates for dementia were calculated and compared to previously published data for the general population. RESULTS The study population consisted of 68 219 persons aged 20 and older. A total of 174 dementia cases were identified. The mean age at diagnosis was 57.7 years (SD = 16.2). Compared to the general population, there was a higher prevalence of dementia among those younger than 60 years, and a markedly lower prevalence of dementia among those 60 years and older. CONCLUSIONS Dementia is under-diagnosed to a greater extent among ethnic minorities in the age group 60 years and older but is over-diagnosed in the age group younger than 60 years. Several factors may contribute to this pattern, including cultural differences in help-seeking behaviour, and problems in navigating the health-care system. Furthermore, cross-cultural assessment of dementia can be difficult because of language barriers and cultural differences.
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Affiliation(s)
- T R Nielsen
- Memory Disorders Research Group, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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68
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Botsford J, Clarke CL, Gibb CE. Research and dementia, caring and ethnicity: a review of the literature. J Res Nurs 2011. [DOI: 10.1177/1744987111414531] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the need for services which are culturally appropriate there is a dearth of robust research on the impact of ethnic background on dementia and caregiving. A literature search has revealed a relative lack of published research from the UK, with more US studies available. This paper provides a review of the literature on these topics and includes a critique of ethnicity categorisation and commonly held assumptions. It explores the complexities of the concept of ethnicity and examines its significance in relation to understandings of health and illness in general, and dementia in particular. Ethnic background appears to account for differences in experiences of dementia and caregiving, but other compounding variables, including socio-economic factors and education, also need to be taken into account when considering the experiences of specific ethnic communities. The paper concludes that ethnicity is significant in regard to how people experience dementia and caregiving, but also highlights a continuing need for research which explores the impact of ethnic background in a sensitive and sophisticated manner.
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Affiliation(s)
- Julia Botsford
- Barnet, Enfield and Haringey Mental Health NHS Trust, UK,
| | | | - Catherine E. Gibb
- School of Health, Community and Education Studies, Northumbria University, Newcastle, UK,
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Abstract
BACKGROUND Western policy initiatives prioritize early diagnosis of dementia, but minority ethnic (ME) people currently present later to dementia specialist care than their indigenous counterparts. In order to allow the development of rational interventions, we completed this first study to explore the link between attitudes to help-seeking for dementia and the help-seeking pathway in the ME and indigenous population. METHODS We purposively recruited a maximum variation sample comprising 18 family carers of people with dementia from the major UK ethnic groups. We used semi-structured interviews to determine the barriers to and facilitators of help-seeking, and the pathways to diagnosis. Two researchers independently coded interviews and recruitment continued until theoretical saturation was reached. RESULTS ME carers, in contrast to the indigenous population, tended to delay help-seeking until they could no longer cope or until others commented on the problems. They often thought that families should look after their own elders and a diagnosis alone was purposeless. This appeared to relate to beliefs about the etiology of cognitive impairment, negative beliefs about psychiatry and their sense of familial responsibility. CONCLUSIONS ME carer beliefs were an important barrier to early diagnosis. Further work should explore whether an intervention can modify these attitudes, so that families understand that a diagnosis may allow planning and avoidance of crises; rather than signifying a failure in duty, disloyalty, or relinquishing of the caring role. Further research should focus on developing interventions to tackle barriers to help-seeking in ethnic minorities so that healthcare access can be equitable for all.
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Low LF, Anstey KJ, Lackersteen SMP, Camit M. Help-seeking and service use for dementia in Italian, Greek and Chinese Australians. Aging Ment Health 2011; 15:397-404. [PMID: 21491225 DOI: 10.1080/13607863.2010.536134] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the help-seeking strategies and the acceptance of services among a national sample of Italian, Greek and Chinese compared to third generation Australians. METHODS A cross-sectional telephone survey of 350 Italian, 414 Greek, 437 Chinese and 500 third generation Australians whose households were randomly selected from the national telephone directory was carried out. Participants were asked how they would seek help for a character in a vignette with dementia and what aged care services they would use. RESULTS The most frequently reported sources of help for all participants were general practitioners (55%), community organisations (27%) and family (26%). Significantly more racial minority participants reported that they would seek help from their families (32%) than did third generation Australians (13%). The percentage of participants who reported they would use aged care services were 96% for day activities, 95% for community nursing, 93% for bus outings, 91% for home help with housework, 88% for carer's support groups, 83% for nursing home care, 78% for one-week respite and 67% for Meals-on-Wheels. Racial minorities were equally or more likely to say that they would use some community-based services than third generation Australians and less likely to use residential respite. Italians were less likely to use permanent residential care. Acculturation parameters were inconsistently associated with help-seeking and service acceptability. CONCLUSIONS Racial minority groups have a greater preference for community services than third generation Australians. There are differences between racial minority groups on help-seeking and acceptability of services. Education and outreach to these groups needs to be tailored.
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Affiliation(s)
- Lee-Fay Low
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia.
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Parveen S, Morrison V, Robinson CA. Ethnic variations in the caregiver role: a qualitative study. J Health Psychol 2011; 16:862-72. [PMID: 21415259 DOI: 10.1177/1359105310392416] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.
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Assessment of dementia in ethnic minority patients in Europe: a European Alzheimer's Disease Consortium survey. Int Psychogeriatr 2011; 23:86-95. [PMID: 20602861 DOI: 10.1017/s1041610210000955] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In most European countries the ethnic minority migrant populations are currently reaching an age where dementia becomes an increasingly important issue. There is no European consensus on good clinical practice with these patient groups, who often have special needs and expectations with regard to dementia services. METHODS A survey was conducted in clinical dementia centers in 15 European countries. Questionnaires focusing on different points in the clinical assessment of dementia in ethnic minority patients were mailed to leading dementia experts of the European Alzheimer's Disease Consortium. RESULTS Thirty-six centers from 15 countries responded to the survey. Ethnic minority patients were seen on a regular basis in 69% of these centers. The diagnostic evaluation was in accordance with evidence-based clinical guidelines in 84-100% of the centers, but most centers performed cognitive assessment with instruments that are only validated in Western cultures and frequently relied on family members for interpretation. Diagnostic evaluation of the patients was considered to be challenging in 64% of the centers, mainly because of communication problems and lack of adequate assessment tools. In general, there were few indicators of culturally sensitive dementia services in the centers. CONCLUSIONS Ethnic minority patients are seen on a regular basis in European dementia clinics. Assessment of such patients is difficult for a number of reasons. Results from this study show that the most challenging issues are communication problems and assessment of cognitive function where there is a need to develop specific tests for ethnic minority patients.
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Mukadam N, Cooper C, Livingston G. A systematic review of ethnicity and pathways to care in dementia. Int J Geriatr Psychiatry 2011; 26:12-20. [PMID: 21157846 DOI: 10.1002/gps.2484] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore why people from minority ethnic (ME) groups with dementia present later to specialist diagnostic and therapeutic dementia services. We systematically reviewed the literature exploring how and why ME people with dementia present to specialist services. METHOD We included qualitative and quantitative studies that explored pathways to dementia specialist care in ME groups or determinants of whether ME people with dementia accessed specialist services. Included studies were independently evaluated for quality by two authors. RESULTS We found 3 quantitative and 10 qualitative papers meeting our inclusion criteria. Barriers to accessing specialist help for dementia included: not conceptualizing dementia as an illness; believing dementia was a normal consequence of ageing; thinking dementia had spiritual, psychological, physical health or social causes; feeling that caring for the person with dementia was a personal or family responsibility; experiences of shame and stigma within the community; believing there was nothing that could be done to help; and negative experiences of healthcare services. Recognition of dementia as an illness and knowledge about dementia facilitated accessing help. CONCLUSIONS There are significant barriers to help seeking for dementia in ME groups. These may explain why people from ME groups often presented to therapeutic and diagnostic services at a late stage in their illness. Further study is needed to elucidate the role that ethnicity and culture play in the help-seeking pathway for dementia, and to design and test interventions to improve equity of access to healthcare services.
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Affiliation(s)
- Naaheed Mukadam
- UCL Department of Mental Health Sciences, Archway campus, Highgate Hill, London N19 5NL, UK.
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Lawrence V, Samsi K, Banerjee S, Morgan C, Murray J. Threat to valued elements of life: the experience of dementia across three ethnic groups. THE GERONTOLOGIST 2010; 51:39-50. [PMID: 20724657 DOI: 10.1093/geront/gnq073] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE There is a fundamental knowledge gap regarding the experience of dementia within minority ethnic groups in the United Kingdom and elsewhere. The present study examined the subjective reality of living with dementia from the perspective of people with dementia within the 3 largest ethnic groups in the United Kingdom. DESIGN AND METHODS This was a qualitative study in which in-depth individual interviews were conducted with 11 Black Caribbean, 9 south Asian, and 10 White British older people with dementia. The lack of information in this area prompted the use of a grounded theory approach. RESULTS The main theme to emerge from the interviews with the people with dementia was "threat to valued elements of life." Participants engaged in a process of appraisal in which they assessed the degree to which their condition and support needs interfered with valued elements of life. The analysis revealed that each element of this process was culturally informed. IMPLICATIONS There is potential for modifying beliefs to reduce the perceived threat of dementia and for family and professional carers to promote the roles, relationships, and activities that each person with dementia values. The findings outlined in this paper can inform the development of a culturally sensitive approach.
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Affiliation(s)
- Vanessa Lawrence
- Institute of Psychiatry, King's College London, P026, De Crespigny Park, London SE5 8AF, UK.
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Abstract
BACKGROUND There is a long history of research into the attributes of carers of people with psychosis, but few interventions target their distress or their difficulties. AIMS To describe an empirically based model of the relationships of those caring for people with psychosis to inform clinical and theoretical advances. METHOD We developed a model of informal carer relationships in psychosis, based on an integration of the literature elaborating the concept of expressed emotion. The model accounts for divergent outcomes of three relationship types: positive, overinvolved and critical/hostile relationships. RESULTS Good evidence supports a number of hypotheses concerning the origin and maintenance of these relationship outcomes, which relate to specific differences in carer attributions, illness perceptions, coping behaviour, social support, distress, depression and low self-esteem predicted by our model. We propose that interventions aimed at modifying the specific maintenance factors involved in the different styles of relationships will optimise therapeutic change both for service users with psychosis and for their carers. CONCLUSIONS Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse. It is now time to consider theory-based interventions focused on improving carer outcomes.
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A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. Am J Geriatr Psychiatry 2010; 18:193-203. [PMID: 20224516 DOI: 10.1097/jgp.0b013e3181bf9caf] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of people with dementia from minority ethnic (ME) groups in western countries is projected to rise dramatically, and they may be less able to access dementia services. To compare the use of health and social services, treatments for dementia and dementia research between different ethnic groups. A systematic review of 33 articles fitting predetermined criteria. Compatible results were pooled in a meta-analysis. ME people with dementia were more cognitively impaired, and Hispanic people reported a longer duration of memory loss than non-ME people, at the time of referral to diagnostic dementia services in the United States and Australia {pooled weighted mean difference on Mini-Mental State Examination = 3.48 (95% confidence interval [CI]: 2.87-4.09); z = 11.19, p <0.0001; N = 2,090}. These differences remained after controlling for premorbid level of education. The use of community social services did not vary between ME and non-ME people with dementia, but African Americans were 30% less likely to be prescribed cholinesterase inhibitors {odds ratio (OR) 0.7 [0.6-0.9]; z = -3.1, p = 0.002; N = 175}, and ME groups were underrepresented in U.S. dementia drug trials. ME people with dementia were 40% less likely to enter 24-hour care (pooled hazard ratio 0.59 [95% CI: 0.52-0.69]; z = -7.15, p <0.0001; N = 12,053). The authors found consistent evidence, mostly from the United States, that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement and specific recruitment strategies for ME groups might help address inequalities, and these need to be evaluated. More research is also needed to evaluate ME access to dementia services outside the United States.
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Abstract
SummaryThis review examines the demographic changes, the epidemiology of mental disorders and suicides, the potential risk and protective factors, access to secondary care old age psychiatry services (OAPSs) and the policy context pertaining to older people from ethnic minority groups in the United Kingdom. The number of older people from ethnic minority groups is increasing. The prevalence of mental disorders in older people from ethnic minority groups is either similar to or higher than that in the indigenous population. Therefore, the number of older people from ethnic minority groups with psychiatric morbidity is also increasing. Ethnic minority older people also have inequity of access to secondary care OAPSs. There is an urgent need to develop and implement practical strategies to improve access by older people from ethnic minority groups to OAPSs.
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Abstract
Family caregivers of people with dementia, often called the invisible second patients, are critical to the quality of life of the care recipients. The effects of being a family caregiver, though sometimes positive, are generally negative, with high rates of burden and psychological morbidity as well as social isolation, physical ill-health, and financial hardship. Caregivers vulnerable to adverse effects can be identified, as can factors which ameliorate or exacerbate burden and strain. Psychosocial interventions have been demonstrated to reduce caregiver burden and depression and delay nursing home admission. Comprehensive management of the patient with dementia includes building a partnership between health professionals and family caregivers, referral to Alzheimer's Associations, and psychosocial interventions where indicated.
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Affiliation(s)
- Henry Brodaty
- Primary Dementia Collaborative Research Centre and School of Psychiatry, University of New South Wales, Sydney, Australia.
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Sagrario Espinoza-Salgado F, Reyes-Lagunes I, Velasco-Rojano E, Bravo-González MC, Ramírez Ramírez A. Escala de estrategias de enfrentamento para cuidadores primarios informales de pacientes con cáncer. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.55816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: Analizar propiedades psicométricas de un nuevo instrumento válido y confiable, que evalúa las estrategias de enfrentamiento en cuidadores primarios informales (CPI) de pacientes oncológicos. El Instrumento de Estrategias de Enfrentamiento en Cuidadores Primarios Informales (IEECPI), consta de 2 factores (Dirigido a la emoción) y 3 indicadores (Dirigido al problema). Método: Se evaluó a 20 CPI de pacientes oncológicos mediante un cuestionario de preguntas abiertas, para obtener información sobre la conceptualización de las dimensiones teóricas de las estrategias de enfrentamiento obteniendo 216 indicadores, agrupados en dos categorías (Dirigido a la emoción y al problema), de los cuales se generaron 55 reactivos que se aplicaron a 255 CPI. Una vez obtenidos los datos se siguió el procedimiento propuesto por Nunnally y Bernstein (1994) y el de Reyes-Lagunes, García y Barragán (2008) que consiste en: Análisis de frecuencia de cada reactivo, para conocer el tipo de distribución predominante, discriminación y direccionalidad de los reactivos, confiabilidad inicial, análisis de correlación, análisis factorial y confiabilidad total y por factores. Resultados: Los resultados muestran que de los 55 reactivos iniciales, posterior al análisis estadístico, finalmente se obtuvieron 15 reactivos divididos en 2 factores (Dirigido a la emoción evitativo y Dirigido a la emoción emocional negativo) y 3 indicadores (Dirigido al problema directo, Dirigido al problema revaluación cognitiva positiva y Revaluación cognitiva negativa). Conclusión: El IEECPI, es un instrumento válido, confiable y culturalmente relevante para evaluar estrategias de enfrentamiento en CPI de pacientes oncológicos y detectar necesidades con necesidad de intervención.
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