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Hurley S, Turnbull S, Calia C. Barriers and facilitators to diagnosing dementia in migrant populations: A systematic review of European health professionals' perspectives. Int J Geriatr Psychiatry 2024; 39:e6118. [PMID: 38944812 DOI: 10.1002/gps.6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/17/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Rates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and facilitators to accessing dementia care have been explored from the viewpoint of migrants and caregivers, however, no review has synthesised the literature pertaining to clinicians' viewpoints. This review aimed to explore clinician perspectives as to the barriers and facilitators in assessing and diagnosing dementia in migrant populations. METHODS A systematic review of the literature was conducted. Databases included EMBASE, CINAHL, PsycINFO, MEDLINE and ProQuest. Qualitative studies from the perspective of European clinicians were included. The methodological quality of each study was assessed using the Critical Appraisals Programme Tool (CASP). The analysis adopted a thematic synthesis approach. RESULTS The review included 11 qualitative studies relating to the diagnosis of dementia in migrants. The quality of the studies was generally high, although few studies reported on the relationship between the researcher and the participants. The data related more to the barriers in diagnosing dementia, and few facilitators were found. Four themes were constructed: (1) service access (2) perceptions of migrant beliefs (3) relationships and (4) quality of the diagnostic process. CONCLUSIONS The review is limited by the small number of studies available. The findings highlight significant clinical concerns in the diagnosis of migrants, in particular the underrepresentation of migrants within services and the barriers to access they may face. The quality of the diagnostic process was often thought to be undermined by a lack of culturally sensitive assessment tools. Further research on the use of an interpreter in diagnosing dementia is needed.
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Affiliation(s)
- Siobhan Hurley
- Midlothian Psychological Therapies, NHS Lothian, Dalkeith, UK
| | - Sue Turnbull
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Clara Calia
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Kiadarbandsari A, Lemalu MT, Wilson S, Fa'alau F. Dementia among Minority Populations: A Scoping Review of Meaning, Language, and Translation. Dement Geriatr Cogn Disord 2024:1-11. [PMID: 38776886 DOI: 10.1159/000539446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dementia as a neurocognitive disorder is becoming increasingly common worldwide, and minority groups are more vulnerable than the general population. Many factors may contribute to their vulnerability such as misconceptions, language barriers, cultural factors, invalid assessment tools, lack of knowledge, or assigning spiritual beliefs to dementia symptoms. Therefore, this scoping literature review aimed to clarify how empirical studies reflect the meaning of dementia, language, and translation among minority ethnic groups. SUMMARY The PRISMA extension for the scoping review protocol was used. Thirty-eight studies published in English were reviewed and analysed. The findings revealed that lack of knowledge about dementia and attributing the disease to the normal ageing process were frequent among minority groups. Furthermore, their cultural-specific perspectives and worldviews of wellness and well-being can impact the way dementia is perceived, consequent help-seeking behaviours, or caregiving. Facilitating educational programs to enhance the knowledge and experiences of ethnic communities might be beneficial. Moreover, language is shown to be an important aspect in dementia assessment and participants' educational level could significantly impact their functional capacity when responding to cognitive measures. Even though there are some useful screening tests, diagnosis barriers might be eased by assessment tool development, modifications, and accurate translations for ethnic communities. KEY MESSAGES A promising pathway to support ethnically diverse communities regarding dementia can be raising awareness, providing ethnic-specific services, developing cultural-specific tools to assess dementia or any cognitive impairment by considering perceptions, language, and culture among ethnic groups. Cultural and spiritual considerations could also encourage engagement during assessment.
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Affiliation(s)
- Atefeh Kiadarbandsari
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Miraneta Tafue Lemalu
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sharyn Wilson
- Counselling Service, Soul Talk, Auckland, New Zealand
| | - Fuafiva Fa'alau
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Hoang MT, Kåreholt I, Lindgren E, von Koch L, Xu H, Tan EC, Johnell K, Nägga K, Eriksdotter M, Garcia-Ptacek S. Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden. SSM Popul Health 2024; 25:101573. [PMID: 38162224 PMCID: PMC10755485 DOI: 10.1016/j.ssmph.2023.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/08/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
•Compared to Swedish-born people, foreign-born people were less likely to receive dementia diagnostic tests.•Being born in Africa or Europe was associated with lower chance of receiving cholinesterase inhibitors.•Asian-born people had higher chance of receiving cholinesterase inhibitors, but were less likely to receive memantine.•Disparities existed in dementia diagnostics and treatment between Swedish-born and foreign-born people, but were not consistent after adjusting for MMSE scores.
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Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Emma Lindgren
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C.K. Tan
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Amano T, Halvorsen CJ, Kim S, Reynolds A, Scher C, Jia Y. An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. Alzheimers Dement 2024; 20:1614-1626. [PMID: 38053452 PMCID: PMC10984499 DOI: 10.1002/alz.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity. METHODS Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity. RESULTS A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity. DISCUSSION Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.
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Affiliation(s)
- Takashi Amano
- Department of Social WorkSchool of Arts and SciencesRutgers University NewarkNewarkUSA
| | | | - Seoyoun Kim
- Department of SociologyTexas State UniversitySan MarcosUSA
| | - Addam Reynolds
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesUSA
| | - Clara Scher
- School of Social WorkRutgers UniversityNew BrunswickUSA
| | - Yuane Jia
- Department of Interdisciplinary StudiesSchool of Health ProfessionsRutgers Biomedical and Health SciencesNewarkUSA
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Torkpoor R, Frolich K, Londos E, Nielsen TR. Diagnostic Accuracy of the Swedish Version of the Multicultural Cognitive Examination for Cognitive Assessment in Swedish Memory Clinics. J Alzheimers Dis 2024; 97:715-726. [PMID: 38143364 PMCID: PMC10836550 DOI: 10.3233/jad-230998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Cognitive assessment for foreign-born individuals is suboptimal. The Multicultural Cognitive Examination (MCE) was developed for use in culturally, linguistically and educationally diverse populations. The MCE includes the Rowland Universal Dementia Assessment Scale (RUDAS) and performs assessment of memory, verbal fluency, and visuospatial function. OBJECTIVE To compare the psychometric properties of the Swedish version of the Multicultural Cognitive Examination (MCE-S) with the Swedish versions of the RUDAS (RUDAS-S), the Mini-Mental State Examination (MMSE-SR), and the Clock Drawing Test (CDT), and to explore the ability of the MCE-S test to differentiate patients with and without dementia in a multicultural population. METHODS 117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment. RESULTS Significant differences between patients with and without dementia were observed for all MCE-S components. There were significant differences between foreign-born and Swedish-born patients in the MMSE-SR, but not in the MCE-S or the RUDAS-S. The MCE-S, had good diagnostic performance for detecting dementia (AUC, 0.82), and was at least as good as the RUDAS-S alone (AUC, 0.79). The MCE-S also distinguished Alzheimer's disease (AD) from non-AD dementia. Contrary to expectations, the MCE-S was also at least as good as the MMSE-SR among the Swedish-born patients. CONCLUSIONS The MCE-S is adequate for detecting dementia in both foreign-born and Swedish-born populations. Based on the cultural diversity of general society, adapted cognitive tests that can be used for everyone are practical and beneficial for both patients and health-care professionals. Further studies are needed within primary care.
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Affiliation(s)
- Rozita Torkpoor
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skane University Hospital, Malmö, Sweden
| | - Kristin Frolich
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - T. Rune Nielsen
- Danish Dementia Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Lynnerup C, Rossing C, Sodemann M, Ryg J, Pottegård A, Nielsen D. Perspectives on medication safety from vulnerable older migrants and their relatives-A qualitative explorative study. Basic Clin Pharmacol Toxicol 2023; 132:392-402. [PMID: 36750434 DOI: 10.1111/bcpt.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Little is known about the combined effect of several risk factors occurring simultaneously, and the perspectives of patients with language barriers or dementia are lacking because these patients are often excluded as research participants. This study aimed at investigating medication safety among older migrants with cognitive disorders who use five or more medications daily from the perspective of older patients and their relatives. Eight semi-structured interviews with patients and relatives were conducted in their homes. The study adopted an inductive hermeneutic phenomenological approach and used both "Analyzing the present" and "Systematic text condensation" as inspiration for the analysis. Three main themes were identified: (i) potential medication safety and threats, (ii) communication and missing medication information and (iii) everyday life with medication. Threats to medication safety included medication perceptions, health perceptions, and cognitive impairment of the patient as well as miscommunication among departments, wrong diagnosis and medication, and unlocked medication cabinets. However, most families expressed having no problems concerning medication, which could be a result of limited engagement of the patient and relatives in the medical treatment and limited medication information provided to the families by healthcare professionals.
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Affiliation(s)
- Camilla Lynnerup
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense, Denmark
| | | | - Morten Sodemann
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Tran AGTT, Eustice KL, Mintert JS, Lam CK, Holzapfel J. Perceptions of peer mental health: impact of race and student-athlete status. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:626-638. [PMID: 33830892 DOI: 10.1080/07448481.2021.1903477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
Objective: This study used a multi-faceted methodological approach to examine if peer perceptions of stereotyped student groups' mental health needs varied by target race and student-athlete status.Participants: In Study 1, 502 university students completed an online experiment. Study 2 data were drawn from the American College Health Association (ACHA)-National College Health Assessment (N = 65,167) and Healthy Minds Study (N = 43,487).Methods: Study 1 participants rated the severity of various mental health concerns for Black non-student-athletes, White non-student-athletes, Black student-athletes, or White student-athletes. Study 2 conceptualized peer perceptions vis-à-vis mental health patterns in national data.Results: Study 1 generally revealed lower perceived severity of mental health concerns for Black non-student-athletes. In contrast, Study 2 patterns revealed more variations across student status groups, including that Black non-student-athletes exhibited relatively high prevalence rates of numerous mental health concerns.Conclusions: Results may suggest mental health under-/over-pathologizing, with implications for training and peer-to-peer mental health interventions.
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Affiliation(s)
- Alisia G T T Tran
- College of Integrated Sciences and Arts, Arizona State University, Tempe, Arizona, USA
| | - Kristi L Eustice
- College of Integrated Sciences and Arts, Arizona State University, Tempe, Arizona, USA
| | - Jeffrey S Mintert
- College of Integrated Sciences and Arts, Arizona State University, Tempe, Arizona, USA
| | - Christina K Lam
- College of Integrated Sciences and Arts, Arizona State University, Tempe, Arizona, USA
| | - Jenny Holzapfel
- College of Integrated Sciences and Arts, Arizona State University, Tempe, Arizona, USA
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Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
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Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Exploring the factors that influence equitable access to and social participation in dementia care programs by foreign-born population living in Toronto and Durham region. Aging Clin Exp Res 2022; 34:2231-2235. [PMID: 35534763 DOI: 10.1007/s40520-022-02136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
Abstract
This paper reports the findings of a qualitative study conducted in Ontario, Canada with the purpose of identifying the barriers and facilitating factors of access to dementia care by foreign-born individuals, including immigrants and refugees. Interview data revealed seven overarching themes related to access and participation in dementia care programs by migrants, including structural, process, and outcome barriers. Our study findings suggest that incorporating culturally inclusive activity components in recreational dementia care programs will promote program participation by individuals from ethno-cultural backgrounds. It is essential to train health care providers to assist with building competence in working with people from different cultural and linguistic backgrounds. To prevent normalization of symptoms of dementia and promote timely access to dementia care, it is important to focus on generating awareness and acknowledgement of dementia as an illness rather than as a normal part of aging or a condition associated with stigmatization.
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Gove D, Nielsen TR, Smits C, Plejert C, Rauf MA, Parveen S, Jaakson S, Golan‐Shemesh D, Lahav D, Kaur R, Herz MK, Monsees J, Thyrian JR, Georges J. The challenges of achieving timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups in Europe. Int J Geriatr Psychiatry 2021; 36:1823-1828. [PMID: 34378237 PMCID: PMC9291493 DOI: 10.1002/gps.5614] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a just society, everyone should have equal access to healthcare in terms of prevention, assessment, diagnosis, treatment and care. Europe is a multicultural society made up of people who identify with a wide range of ethnic groups. Many older people from minority ethnic groups also have a direct migration background. Several studies have shown that there is a lack of equity in relation to dementia diagnoses and care because equal opportunities do not necessarily translate into equal outcomes. An expert ethics working group led by Alzheimer Europe has produced an extensive report on this issue, a policy brief and a guide for health and social care workers. In this brief summary, the authors/members of the expert working group present some of the key challenges and recommendations for healthcare clinicians striving to provide timely diagnosis and good quality care and treatment to people with dementia from all ethnic groups.
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Affiliation(s)
| | - Thomas Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreCopenhagen University HospitalKobenhavnDenmark
| | - Carolien Smits
- Pharos Dutch Centre of Expertise on Health DisparitiesUtrechtthe Netherlands
| | - Charlotta Plejert
- Department of Biomedical and Clinical SciencesDivision of Sensory Organs and CommunicationLinköping UniversityLinköpingSweden
| | | | - Sahdia Parveen
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Siiri Jaakson
- Multicultural Memory Centre ‐ the Finnish Society for Memory WorkVantaaFinland
| | | | - Debi Lahav
- Emda Alzheimer's AssociationKefar SabaIsrael
| | | | | | - Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
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The issue of dementia in migrants and ethnic minorities: the perspective of National Dementia Plans. Aging Clin Exp Res 2021; 33:2703-2708. [PMID: 31494911 DOI: 10.1007/s40520-019-01340-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The occurrence of dementia among individuals with a migration background and composing ethnic minorities is being recognized as a global public health issue. AIMS In the present study, we sought to explore if and how this phenomenon is mentioned and addressed by the existing National Dementia Plans (NDPs). METHODS The 32 NDPs listed on the Alzheimer's Disease International (ADI)'s website were considered for the present analysis. First, the plans mentioning the issue of dementia among migrants and/or ethnic minorities were identified. Subsequently, the sections addressing this topic and the pertaining proposed actions were analyzed and their contents were unbundled in descriptive categories. RESULTS Overall, nine NDPs (28.1% of the total), namely those promulgated by Australia, Austria, England, Israel, Norway, Switzerland, Taiwan, United States, and Wales, mentioned the issue of dementia among migrants and/or ethnic minorities and only eight proposed targeted actions to tackle this issue. With few exceptions, the proposed strategies were only marginally dashed within NDPs and crucial information on their objectives, timeline, conduction, and monitoring was missing. DISCUSSION AND CONCLUSIONS To our knowledge, this is the first attempt to describe and discuss how the issue of dementia among migrants and ethnic minority groups is addressed within NDPs. The issue of dementia in migrants and ethnic minorities is assuming a growing relevance under a of global health perspective. The timely identification and implementation of dedicated policies at the national and international level are fundamental to limit its future clinical and socioeconomic burden.
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Fletcher JR. Black knowledges matter: How the suppression of non-white understandings of dementia harms us all and how we can combat it. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1818-1825. [PMID: 34002398 DOI: 10.1111/1467-9566.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/06/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
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Hendriks S, Peetoom K, Bakker C, van der Flier WM, Papma JM, Koopmans R, Verhey FRJ, de Vugt M, Köhler S. Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:1080-1090. [PMID: 34279544 PMCID: PMC8290331 DOI: 10.1001/jamaneurol.2021.2161] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/24/2021] [Indexed: 12/22/2022]
Abstract
Importance Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. Objective To determine the global prevalence of YOD. Data Sources The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. Study Selection Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. Data Extraction and Synthesis Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. Main Outcomes and Measures Prevalence estimates of YOD for 5-year age bands. Results A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women, 293.1 per 100 000 population), whereas prevalence was lower in high-income countries (crude estimate, 663.9 per 100 000 population) compared with upper-middle-income (crude estimate, 1873.6 per 100 000 population) and lower-middle-income (crude estimate, 764.2 per 100 000 population) countries. Meta-regression showed that age range (P < .001), sample size (P < .001), and study methodology (P = .02) significantly influenced heterogeneity between studies. Conclusions and Relevance This systematic review and meta-analysis found an age-standardized prevalence of YOD of 119.0 per 100 000 population, although estimates of the prevalence in low-income countries and younger age ranges remain scarce. These results should help policy makers organize sufficient health care for this subgroup of individuals with dementia. Study Registration PROSPERO CRD42019119288.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC (University Medical Center), Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
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14
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Nielsen TR, Nielsen DS, Waldemar G. Barriers in access to dementia care in minority ethnic groups in Denmark: a qualitative study. Aging Ment Health 2021; 25:1424-1432. [PMID: 32619352 DOI: 10.1080/13607863.2020.1787336] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore barriers in access to dementia care in Turkish, Pakistani and Arabic speaking minority ethnic groups in Denmark. METHOD Semi-structured qualitative individual- and group interviews with minority ethnic family carers, primary care dementia coordinators, staff in elderly daycare, and multicultural link workers. Hermeneutic phenomenology was used as theoretical framework. RESULTS A total of 21 individual- and 6 group interviews were conducted, including a total of 35 participants. On the service user side, barriers in access to dementia care were related to lacking language proficiency and strong cultural norms, including familial responsibility for the care of older family members and stigma associated with mental illness and dementia. On the care provider side, the available formal services were rarely tailored to the specific needs of minority ethnic service users and were often considered inadequate or unacceptable. CONCLUSION Care practices and perceived consequences of dementia in minority ethnic communities were heavily influenced by cultural factors leading to a number of persisting barriers to accessing dementia care services. There is a simultaneous need to raise awareness about dementia and the existence of dementia care services in minority ethnic groups, to reduce stigma, and to develop culturally appropriate dementia care options.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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15
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Islamoska S, Hansen ÅM, Ishtiak-Ahmed K, Garde AH, Andersen PK, Garde E, Taudorf L, Waldemar G, Nabe-Nielsen K. Stress diagnoses in midlife and risk of dementia: a register-based follow-up study. Aging Ment Health 2021; 25:1151-1160. [PMID: 32233797 DOI: 10.1080/13607863.2020.1742656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Previous studies indicated that stress diagnoses increase the risk of dementia. However, previous results may be biased by confounding, reverse causation and misclassification. Therefore, the main aim of this study was to investigate the association between clinically diagnosed stress in midlife and later dementia risk, while addressing limitations of previous studies. METHODS The study population was selected from all individuals in Denmark born 1935-1956. Individuals diagnosed with stress in midlife (aged 37-58 years) were matched (1:5) with individuals without stress diagnoses based on sex and birthdate (N = 103,484). Data were retrieved from national registers. Cox regression models were adjusted for socio-demographic factors and different morbidities. RESULTS We found a 2.20 (95% CI: 1.93-2.50) times higher rate of dementia among individuals with any stress diagnosis registered in midlife compared with no stress diagnosis. Hazard rate ratios of dementia were 1.73 (95% CI: 1.13-2.65) among individuals with acute stress reactions, 2.37 (95% CI: 2.05-2.74) among individuals with adjustment disorders, and 2.20 (95% CI: 1.73-2.80) among individuals with unspecified stress reactions. Individuals with PTSD and other stress reactions had non-significantly elevated rates of dementia. Adjustment for confounding only slightly attenuated the association, and reverse causation did not appear to bias the results substantially. CONCLUSION Our results support the hypothesis that severe stress in midlife is an important risk factor for dementia. This finding emphasizes the importance of identifying and treating severe stress in midlife to reduce potential detrimental consequences for brain health in later life.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lærke Taudorf
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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16
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Brijnath B, Gilbert AS, Kent M, Ellis K, Browning C, Goeman D, Adams J, Antoniades J. Beyond crisis: Enacted sense-making among ethnic minority carers of people with dementia in Australia. DEMENTIA 2020; 20:1910-1924. [DOI: 10.1177/1471301220975641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ‘family crisis’ narrative is frequently used in dementia studies to explain ethnic minority families’ pathways to health and aged care and why there is delayed dementia diagnoses in ethnic minority communities. Such narratives may obscure the family carers’ agency in negotiating services and managing personal, social and structural burdens in the lead up to diagnosis. To illuminate agency, this article describes ethnic minority families’ pathways to a dementia diagnosis using the concept of sense-making. Three case studies were drawn from 56 video interviews with family carers of older adults with dementia from Chinese, Arab and Indian backgrounds. Interviews were conducted across Australia from February to August 2018, then translated, transcribed and thematically analysed. Findings suggest families did not enter into formal care because of a crisis, instead navigating fragmented systems and conflicting advice to obtain a dementia diagnosis and access to relevant care. This experience was driven by sense-making (a search for plausible explanations) that involved family carers interpreting discrepant cues in changes to the behaviour of the person with dementia over time, managing conflicting (medical) advice about these discrepancies and reinterpreting their relationships with hindsight. The sense-making concept offers a more constructive hermeneutic than the ‘family crisis’ narrative as it illuminates the agency of carers’ in understanding changed behaviours, negotiating services and managing personal, social and structural barriers pre-diagnosis. The concept also demonstrates the need for a multimodal approach to promoting timely diagnosis of dementia in ethnic minority communities through dementia awareness and literacy campaigns as well as initiatives that address structural inequities.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute, Australia; School of Occupational Therapy and Social Work, Curtin University, Australia; Department of General Practice, Monash University, Australia
| | - Andrew Simon Gilbert
- National Ageing Research Institute, Australia; Department of Social Inquiry, La Trobe University, Australia
| | - Mike Kent
- Centre for Culture and Technology, Curtin University, Australia
| | - Katie Ellis
- Centre for Culture and Technology, Curtin University, Australia
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Australia; Centre for Research on Ageing, Health and Wellbeing, Australian National University, Australia
| | - Dianne Goeman
- School of Medicine and Public Health, University of Newcastle, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jon Adams
- Discipline of Public Health, Faculty of Health, University of Technology Sydney, Australia
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17
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Czapka EA, Sagbakken M. "It is always me against the Norwegian system." barriers and facilitators in accessing and using dementia care by minority ethnic groups in Norway: a qualitative study. BMC Health Serv Res 2020; 20:954. [PMID: 33059685 PMCID: PMC7565363 DOI: 10.1186/s12913-020-05801-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is one of the greatest health challenges in the contemporary world. Due to several barriers to accessing health care services, elderly immigrants constitute a group that poses special challenges in dementia diagnosis and treatment. The aim of this study was to explore the barriers and facilitators in accessing and using dementia care services by minority ethnic groups in Norway. METHODS The study utilised a qualitative design. The participants included family caregivers of individuals from minority ethnic groups living with dementia, representatives of immigrant communities, and representatives of health and care personnel working with people living with dementia. Individual semi-structured in-depth interviews were carried out in 2018 and 2019 in Oslo and Akershus. Interviews were analysed using thematic analyses. RESULTS Several barriers and facilitators in accessing and using dementia care services were identified, the most important of which were related to lack of knowledge of dementia, lack of awareness of dementia care services, lack of language skills, culturally based differences, the organisation of Norwegian dementia care services, and immigrants' socio-economic status. According to the study participants, having health care personnel in the family and further adaptation of dementia services to the needs of people with different cultural and linguistic backgrounds facilitate access to dementia services. CONCLUSIONS The study shows the need to develop inclusive policies that promote a patient-centred approach to ensure that individuals from minority ethnic groups receive appropriate dementia care.
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Affiliation(s)
- Elżbieta Anna Czapka
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0130, Oslo, Norway.
| | - Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0130, Oslo, Norway
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18
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Islamoska S, Hansen ÅM, Wang HX, Garde AH, Andersen PK, Garde E, Hansen JM, Waldemar G, Nabe-Nielsen K. Mid- to late-life migraine diagnoses and risk of dementia: a national register-based follow-up study. J Headache Pain 2020; 21:98. [PMID: 32762715 PMCID: PMC7410151 DOI: 10.1186/s10194-020-01166-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previous studies found an association between migraine and dementia, which are two leading causes of disability. However, these studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Additionally, we explored potential differences in dementia risk for migraine with and without aura. METHODS We obtained data on birth cohorts born between 1935 and 1956 (n = 1,657,890) from Danish national registers. Individuals registered with migraine before age 59 (n = 18,135) were matched (1:5) on sex and birthdate with individuals without migraine (n = 1,378,346). Migraine was defined by International Classification of Diseases (ICD) diagnoses and dementia was defined by ICD diagnoses and anti-dementia medication. After matching, 62,578 individuals were eligible for analysis. For the statistical analyses, we used Cox regression models and adjusted for socio-demographic factors and several psychiatric and somatic morbidities. RESULTS During a median follow-up time of 6.9 (IQR: 3.6-11.2) years, 207 individuals with migraine developed dementia. Compared with individuals without migraine, we found a 50% higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28-1.76). Individuals without aura had a 19% higher rate of dementia (HR = 1.19; 95% CI: 0.84-1.70), and individuals with aura had a two times higher rate of dementia (HR = 2.11; 95% CI: 1.48-3.00). CONCLUSIONS Our findings support the hypothesis that migraine is a midlife risk factor for dementia in later life. The higher rate of dementia in individuals with a hospital-based diagnosis of migraine with aura emphasizes the need for studies on pathological mechanisms and potential preventative measures. Furthermore, given that only hospital-based migraine diagnoses were included in this study, future research should also investigate migraine cases derived from the primary healthcare system to include less severe migraine cases.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Hui-Xin Wang
- Stress Research Institute, Stockholm University, Frescati Hagväg 16A, 114 19, Stockholm, Sweden
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Ellen Garde
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Jakob Møller Hansen
- Danish Headache Center, Rigshospitalet - Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.,Danish Headache Knowledge Center, Rigshospitalet - Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922, Juliane Mariesvej 28, 2100, Copenhagen, Denmark
| | - Kirsten Nabe-Nielsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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19
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Monsees J, Schmachtenberg T, Hoffmann W, Kind A, Gilmore-Bykovskyi A, Kim AJ, Thyrian JR. Dementia in People with a Turkish Migration Background: Experiences and Utilization of Healthcare Services. J Alzheimers Dis 2020; 77:865-875. [PMID: 32741814 PMCID: PMC7508884 DOI: 10.3233/jad-200184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As the proportion of older people with migration background (PwM) increases, the proportion of older PwM with dementia might also increase. Dementia is underdiagnosed in this group and a large proportion of PwM with dementia and family caregivers are not properly supported. Healthcare utilization is lower among older migrant populations. Thus, a better understanding of how PwM and family caregivers perceive their situation and how they experience healthcare services is needed to improve utilization of the healthcare system. OBJECTIVE Analyze how family caregivers of PwM with dementia experience their situation, why healthcare services are utilized less often, and what can be done to reverse this. METHODS Eight semi-structured interviews were conducted with people with Turkish migration background caring for PwM with dementia. Qualitative content analysis was used for data analysis. RESULTS Daily care was performed by one family member with the support of others. Healthcare services were used by most participants. Participants identified a need for better access to relevant information and incorporation of Turkish culture into healthcare services. CONCLUSION PwM face similar challenges in taking care of persons with dementia as those without migration background. There is a willingness to use services, and services embracing Turkish culture would help to reduce hesitance and make affected people feel more comfortable, thereby increasing utilization and satisfaction. A limitation of this study is that participants were already connected to health services, which may not reflect the help-seeking behavior of those in the Turkish community who are not involved in healthcare.
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Affiliation(s)
- Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Tim Schmachtenberg
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Amy Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Andrea Gilmore-Bykovskyi
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA.,University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Alice J Kim
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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20
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Environmental, Health and Sociodemographic Determinants Related to Common Mental Disorders in Adults: A Spanish Country-Wide Population-Based Study (2006-2017). J Clin Med 2020; 9:jcm9072199. [PMID: 32664638 PMCID: PMC7408656 DOI: 10.3390/jcm9072199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Common mental disorders (CMD) represent a serious, growing public health concern, especially in women. The aims of this study were to report the prevalence of CMD among the adult population in Spain, to analyze the time trends from 2006 to 2017 and to explore the associations between CMD and gender, in relation to the perceived environmental and sociodemographic problems and clinical factors. A nationwide cross-sectional study was conducted including 48,505 participants aged 16 to 64 years old who had participated in the Spanish National Health Surveys in 2006, 2011/2012 and 2017. A logistic regression analysis was performed to identify the variables associated with CMD by gender. The prevalence of CMD was 20.4% in 2006, 20.8% in 2011/2012 and 16.9% in 2017 (p = 0.36). In women, the probability of having a CMD was higher in widowed or separated/divorced compared with single individuals and as the perception of distressing noise levels from outside the home increased. The probability of CMD was lower as the level of education increased in men. Foreigners and those with limitations due to health problems, chronic conditions and worse perceived health were more likely to suffer from a CMD in both women and men.
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21
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Fletcher JR. Positioning ethnicity in dementia awareness research: does the use of senility risk ascribing racialised knowledge deficits to minority groups? SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:705-723. [PMID: 31965599 DOI: 10.1111/1467-9566.13054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over recent decades, the importance of increasing dementia awareness has been promoted by charities, researchers and governments. In response, a large body of research has emerged that evaluates the awareness of different populations. One such population are minority ethnic communities. Associated studies typically conclude that minority ethnic groups have a poor awareness of dementia and that interventions should be developed to better educate them. Operationalisations of awareness almost always reference senility - the traditional notion that dementia is a natural outcome of ageing - a widely held belief among many populations. Senility is considered incorrect knowledge in the research literature, and those participants who identify with it are deemed to have poor awareness. Despite the researchers' claims that senility is false, the scientific evidence is inconclusive, and the concept is contested. As such, a large body of research repeatedly positions minority ethnic communities as inferior and in need of re-education based on researchers' questionable assumptions. This issue is bound up with a racialised deficit-model of science communication and wider critiques of psychiatric colonialism. In response, researchers of dementia and ethnicity should reflect on their own awareness and the ways in which they position others in relation to it.
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Affiliation(s)
- James R Fletcher
- Department of Global Health and Social Medicine, King's College London, London, UK
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22
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Ogliari G, Turner Z, Khalique J, Gordon AL, Gladman JRF, Chadborn NH. Ethnic disparity in access to the memory assessment service between South Asian and white British older adults in the United Kingdom: A cohort study. Int J Geriatr Psychiatry 2020; 35:507-515. [PMID: 31943347 DOI: 10.1002/gps.5263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Equality of access to memory assessment services by older adults from ethnic minorities is both an ethical imperative and a public health priority. OBJECTIVE To investigate whether timeliness of access to memory assessment service differs between older people of white British and South Asian ethnicity. DESIGN Longitudinal cohort. SETTING Nottingham Memory Study; outpatient secondary mental healthcare. SUBJECTS Our cohort comprised 3654 white British and 32 South Asian older outpatients. METHODS The criterion for timely access to memory assessment service was set at 90 days from referral. Relationships between ethnicity and likelihood of timely access to memory assessment service were analysed using binary logistic regression. Analyses were adjusted for socio-demographic factors, deprivation and previous access to rapid response mental health services. RESULTS Among white British outpatients, 2272 people (62.2%) achieved timely access to memory assessment service. Among South Asian outpatients, fourteen people (43.8%) achieved timely access to memory assessment service. After full adjustment, South Asian outpatients had a 0.47-fold reduced likelihood of timely access, compared to white British outpatients (odds ratio 0.47, 95% confidence interval 0.23-0.95, P value = .035). The difference became non-significant when restricting analyses to outpatients reporting British nationality or English as first language. Older age, lower index of deprivation and previous access to rapid response mental health services were associated with reduced likelihood of timely access, while gender was not. CONCLUSIONS In a UK mental healthcare service, older South Asian outpatients are less likely to access dementia diagnostic services in a timely way, compared to white British outpatients.
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Affiliation(s)
- Giulia Ogliari
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,Clinical Development Unit, Medical Directorate, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Zoë Turner
- Clinical Development Unit, Medical Directorate, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Javid Khalique
- Independent Community Engagement Consultant, Nottingham, UK
| | - Adam L Gordon
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Neil H Chadborn
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
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Petersen MS, Lophaven SN, Weihe P, Lynge E. High incidence of dementia in Faroese-born female residents in Denmark. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12022. [PMID: 32346600 PMCID: PMC7185209 DOI: 10.1002/trc2.12022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To assess whether the incidence of dementia among immigrants in Denmark from the Faroe Islands is similar to that of the inhabitants of their new country. METHODS Data on Faroese-born immigrants in Denmark were retrieved from the Danish Central Population Register. Incident dementia cases were identified from the Danish National Patient Register. Standardized incidence ratios (SIRs) were used to compare the dementia incidence in immigrants with the general Danish population. RESULTS Female, first-generation Faroese immigrants had double the risk of dementia compared with Danes (SIR 2.1, 95% confidence interval [CI] 1.8-2.5); the excess risk prevailed even beyond 10 years in Denmark, and it affected all sub-types of dementia. In male immigrants, only a modest, statistically non-significant excess risk was seen (SIR 1.2, 95% CI 0.9-1.6). DISCUSSION The observation of an excess risk of dementia in women only but not in men of Faroese origin living in Denmark underscores the complexity of the etiology of dementia.
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Affiliation(s)
- Maria Skaalum Petersen
- Department of Occupational Medicine and Public HealthThe Faroese Hospital SystemTórshavnFaroe Islands
- Faculty of Health SciencesCentre of Health ScienceUniversity of the Faroe IslandsTórshavnFaroe Islands
| | | | - Pál Weihe
- Department of Occupational Medicine and Public HealthThe Faroese Hospital SystemTórshavnFaroe Islands
- Faculty of Health SciencesCentre of Health ScienceUniversity of the Faroe IslandsTórshavnFaroe Islands
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenCopenhagenDenmark
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24
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Brini S, Sohrabi HR, Hebert JJ, Forrest MRL, Laine M, Hämäläinen H, Karrasch M, Peiffer JJ, Martins RN, Fairchild TJ. Bilingualism Is Associated with a Delayed Onset of Dementia but Not with a Lower Risk of Developing it: a Systematic Review with Meta-Analyses. Neuropsychol Rev 2020; 30:1-24. [PMID: 32036490 PMCID: PMC7089902 DOI: 10.1007/s11065-020-09426-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
Some studies have linked bilingualism with a later onset of dementia, Alzheimer's disease (AD), and mild cognitive impairment (MCI). Not all studies have observed such relationships, however. Differences in study outcomes may be due to methodological limitations and the presence of confounding factors within studies such as immigration status and level of education. We conducted the first systematic review with meta-analysis combining cross-sectional studies to explore if bilingualism might delay symptom onset and diagnosis of dementia, AD, and MCI. Primary outcomes included the age of symptom onset, the age at diagnosis of MCI or dementia, and the risk of developing MCI or dementia. A secondary outcome included the degree of disease severity at dementia diagnosis. There was no difference in the age of MCI diagnosis between monolinguals and bilinguals [mean difference: 3.2; 95% confidence intervals (CI): -3.4, 9.7]. Bilinguals vs. monolinguals reported experiencing AD symptoms 4.7 years (95% CI: 3.3, 6.1) later. Bilinguals vs. monolinguals were diagnosed with dementia 3.3 years (95% CI: 1.7, 4.9) later. Here, 95% prediction intervals showed a large dispersion of effect sizes (-1.9 to 8.5). We investigated this dispersion with a subgroup meta-analysis comparing studies that had recruited participants with dementia to studies that had recruited participants with AD on the age of dementia and AD diagnosis between mono- and bilinguals. Results showed that bilinguals vs. monolinguals were 1.9 years (95% CI: -0.9, 4.7) and 4.2 (95% CI: 2.0, 6.4) older than monolinguals at the time of dementia and AD diagnosis, respectively. The mean difference between the two subgroups was not significant. There was no significant risk reduction (odds ratio: 0.89; 95% CI: 0.68-1.16) in developing dementia among bilinguals vs. monolinguals. Also, there was no significant difference (Hedges' g = 0.05; 95% CI: -0.13, 0.24) in disease severity at dementia diagnosis between bilinguals and monolinguals, despite bilinguals being significantly older. The majority of studies had adjusted for level of education suggesting that education might not have played a role in the observed delay in dementia among bilinguals vs. monolinguals. Although findings indicated that bilingualism was on average related to a delayed onset of dementia, the magnitude of this relationship varied across different settings. This variation may be due to unexplained heterogeneity and different sources of bias in the included studies. Registration: PROSPERO CRD42015019100.
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Affiliation(s)
- Stefano Brini
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia.
- Turku Brain and Mind Center, Turku, Finland.
- Health Services Research and Management School of Health Sciences, City, University of London, London, UK.
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.
| | - Hamid R Sohrabi
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Biomedical Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jeffrey J Hebert
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Mitchell R L Forrest
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
| | - Matti Laine
- Turku Brain and Mind Center, Turku, Finland
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Heikki Hämäläinen
- Turku Brain and Mind Center, Turku, Finland
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Jeremiah J Peiffer
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
| | - Ralph N Martins
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Biomedical Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Alzheimer's Research Foundation, Perth, Western Australia, Australia
| | - Timothy J Fairchild
- Discipline of Psychology, Exercise Science, Chiropractic and Counselling, Murdoch University, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Western Australia, Australia
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Shiekh SI, Forbes H, Mathur R, Smeeth L, Pearce N, Warren-Gash C. Ethnicity and risk of diagnosed dementia after stroke: a cohort study using the Clinical Practice Research Datalink. J Epidemiol Community Health 2020; 74:114-119. [PMID: 31699799 PMCID: PMC6993022 DOI: 10.1136/jech-2019-212825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The UK has over 1.2 million stroke survivors. Stroke is a major risk factor for dementia, and along with other risk factors such as hypertension and diabetes, is more common among Black, Asian and other ethnic minorities (BAME). We aimed to explore whether diagnosed dementia differed by ethnicity among adult stroke survivors. METHODOLOGY Using the UK Clinical Practice Research Datalink and linked hospital data, we conducted a cohort study among patients aged ≥40 years who had an incident stroke between 2005 and 2016. We fitted multivariable Cox proportional hazard models to estimate ethnic differences in the risk of poststroke dementia, adjusting for major clinical and social confounders. RESULTS Our cohort comprised 45 474 stroke survivors (mean age 72.6 years, 49% female), of whom 95.7% were White, 2.0% South Asian, 1.2% Black and 1.1% of Mixed/Other ethnicity. Of these, 4624 (10.2%) were diagnosed with poststroke dementia over a median follow-up of 3.26 years. Compared with the White ethnic group, those of Black ethnicity were 42% more likely to be diagnosed with dementia (adjusted HR 1.42, 95% CI 1.05 to 1.93). There was no association between any other ethnic group and poststroke dementia diagnosis. DISCUSSION There was good evidence that those of Black ethnicity had higher risk of diagnosed dementia poststroke. Further understanding of the mechanisms of this relationship could help target interventions at communities most at risk of dementia poststroke.
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Affiliation(s)
- Suhail Ismail Shiekh
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Harriet Forbes
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Begum M, Lewison G, Wölbert E, Berg Brigham K, Darlington M, Durand-Zaleski I, Sullivan R. Mental health disorders research in Europe, 2001-2018. EVIDENCE-BASED MENTAL HEALTH 2020; 23:15-20. [PMID: 32046988 PMCID: PMC10231506 DOI: 10.1136/ebmental-2019-300130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The burden of mental health disorders in Europe is well above the world average and has increased from 11.5% to 13.9% of the total disease burden in 2000 and 2015. That from dementia has increased rapidly, and overtaken that from depression as the leading component. There have been no analyses of the research activity in Europe to combat this burden. METHODOLOGY We identified research papers in the Web of Science (WoS) with a complex mental health disorders filter based on title words and journal names in the years 2001-18, and downloaded their details for analysis. RESULTS European mental health disorders research represented less than 6% of the total biomedical research. We estimate that research expenditure in Europe on mental health disorders amounted to about €5.4 billion in 2018. The Scandinavian countries, with Croatia and Estonia, published the most relative to their wealth, but the outputs of France and Romania were less than half the amounts expected. DISCUSSION AND CONCLUSIONS The burden from mental health disorders is increasing rapidly in Europe, but research was only half what would have been proportional. Suicide & self-harm, and alcohol misuse, were also neglected by researchers, particularly since the latter also causes many physical burdens, such as foetal alcohol syndrome, interpersonal violence, and road traffic accidents. Other relatively neglected subjects are sexual disorders, obsessive compulsive disorder, post-traumatic stress disorder, attention-deficit hyperactivity and sleep disorders. There is an increasing volume of research on alternative (non-drug) therapies, particularly for post-traumatic stress and eating disorders, notably in Germany.
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Affiliation(s)
- Mursheda Begum
- Business Studies, Queen Mary University of London, London, UK
| | - Grant Lewison
- Cancer Policy Unit, Guy's Hospital, King's College London, London, UK
| | | | | | - Meryl Darlington
- URC ECO, AP-HP, Paris, France
- UPEC, Creteil, Île-de-France, France
| | | | - Richard Sullivan
- Cancer Policy Unit, Guy's Hospital, King's College London, London, UK
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Goudsmit M, van Campen J, Franzen S, van den Berg E, Schilt T, Schmand B. Dementia detection with a combination of informant-based and performance-based measures in low-educated and illiterate elderly migrants. Clin Neuropsychol 2020; 35:660-678. [PMID: 31951511 DOI: 10.1080/13854046.2020.1711967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Detecting dementia in people who are illiterate or have a low level of education is complicated because many cognitive screening tests are not suitable for these persons. Caregiver or informant-based judgment of cognitive status may aid diagnosis. Our goal was to investigate the diagnostic accuracy of the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) in a population of elderly non-Western migrants with a high illiteracy rate. Second, we wanted to investigate the diagnostic accuracy of IQCODE and Rowland Universal Dementia Screening (RUDAS) combined. METHOD 109 geriatric outpatients and 20 community controls were included. Geriatricians provided a research diagnosis of intact cognition (n = 27), mild cognitive impairment (MCI; n = 33) or dementia (n = 49). Diagnostic accuracy was calculated for the clinical sample (n = 109). ROC curves for prediction of group status for IQCODE, RUDAS and the combination of both were created. RESULTS Predictive validity was high for both IQCODE and RUDAS and was highest for the combination (Area Under the Curve .91). Sensitivity, specificity, Youden index, predictive value, and likelihood ratio for IQCODE and RUDAS are reported. CONCLUSIONS In this study in non-Western elderly migrants, half of whom were illiterate, the IQCODE proved to be a valid instrument for dementia detection, and adding the RUDAS increased accuracy. Combining performance-based and informant-based data is recommended to enhance diagnostic precision.
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Affiliation(s)
- Miriam Goudsmit
- Department of Psychiatry and Medical psychology, OLVG, Amsterdam, The Netherlands
| | - Jos van Campen
- Department of Geriatrics, OLVG, Amsterdam, The Netherlands
| | - Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thelma Schilt
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben Schmand
- Department of Medical Psychology, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
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Franzen S, van den Berg E, Kalkisim Y, van de Wiel L, Harkes M, van Bruchem-Visser RL, de Jong FJ, Jiskoot LC, Papma JM. Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test. Dement Geriatr Cogn Disord 2019; 47:345-354. [PMID: 31319408 PMCID: PMC6878732 DOI: 10.1159/000501151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied. OBJECTIVES The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT). METHOD Both the original VAT and the mVAT were administered to non-Western immigrants (n = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (n = 14) with low education levels (32 and 29% illiterate, respectively). RESULTS Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77-0.88; mVAT, 0.85-0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (Z = -3.35, p = 0.001). CONCLUSIONS The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yuled Kalkisim
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Lotte van de Wiel
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Marleen Harkes
- Department of Geriatric Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C. Jiskoot
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Nielsen TR, Segers K, Vanderaspoilden V, Beinhoff U, Minthon L, Pissiota A, Bekkhus-Wetterberg P, Bjørkløf GH, Tsolaki M, Gkioka M, Waldemar G. Validation of a brief Multicultural Cognitive Examination (MCE) for evaluation of dementia. Int J Geriatr Psychiatry 2019; 34:982-989. [PMID: 30901493 DOI: 10.1002/gps.5099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/17/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aims of this study were to present the psychometric properties of a newly designed cognitive screening instrument, the Multicultural Cognitive Examination (MCE), and to compare it with the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural population. METHODS The study was a Western European cross-sectional multicenter study. The MCE consists of four components evaluating separate cognitive functions and was constructed by adding measures of memory, verbal fluency, and visuospatial function to the RUDAS to create a scale with 0 to 100 points. RESULTS A total of 66 patients with dementia and 123 cognitively intact participants were included across six memory clinics; 96 had minority ethnic background, and 93 had majority ethnic background. Moderate to large differences were present between patients with dementia and control participants on all MCE components. The MCE significantly improved diagnostic accuracy compared with using the RUDAS alone, with area under the curves of .918, .984, and .991 for the RUDAS, MCE composite, and demographically corrected composite scores, respectively. Diagnostic accuracy of the MCE did not significantly differ between minority and majority ethnic groups. Across MCE subcomponents, patients with Alzheimer's disease (AD) dementia performed significantly poorer on the memory component compared with those with non-AD dementia. CONCLUSIONS The MCE is a brief cross-cultural cognitive screening instrument that expands evaluation of the cognitive functions covered by the RUDAS, does not require any specialized training, and may be useful for classification of mild dementia or dementia subtypes.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Berlin, Germany
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål and Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Magda Tsolaki
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Nielsen TR, Nielsen DS, Waldemar G. Barriers to post-diagnostic care and support in minority ethnic communities: A survey of Danish primary care dementia coordinators. DEMENTIA 2019; 19:2702-2713. [PMID: 31167555 PMCID: PMC7925439 DOI: 10.1177/1471301219853945] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background People from minority ethnic groups are under-represented in dementia diagnosis, treatment, and care. The aim of this study was to examine barriers to accessing post-diagnostic care and support in minority ethnic communities from the perspective of primary care dementia coordinators in Denmark. Method A survey questionnaire investigating issues related to provision of care and support services in minority ethnic communities was conducted among 41 primary care dementia coordinators representing all Danish geographic regions. Responses were primarily based on five-point Likert scales. Results from geographic regions with different rates of people from minority ethnic communities with dementia were compared. Results Among the surveyed dementia coordinators, 95% generally thought that providing dementia care and support services to minority ethnic service users was challenging. Strategies for overcoming cultural and linguistic barriers were generally sparse. Uptake of most post-diagnostic services was perceived to be influenced by service users’ minority ethnic background. Communication difficulties, poor knowledge about dementia among minority ethnic service users, inadequate cultural sensitivity of care workers, and a lack of suitable dementia services for minority ethnic communities were highlighted as some of the main barriers. Not surprisingly, 97% generally found minority ethnic families to be more involved in provision of personal care and support compared to ethnic Danish families. Conclusion There is a need to develop methods and models for post-diagnostic care and support that include cultural awareness and diversity for interacting with different cultural communities.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Centre for Global Health, University of Southern Denmark, Odense, Denmark; Health Sciences Research Center, University College Lillebælt, Odense, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Akarsu NE, Prince MJ, Lawrence VC, Das-Munshi J. Depression in carers of people with dementia from a minority ethnic background: Systematic review and meta-analysis of randomised controlled trials of psychosocial interventions. Int J Geriatr Psychiatry 2019; 34:790-806. [PMID: 30714226 DOI: 10.1002/gps.5070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Systematic review and meta-analysis to determine the effectiveness of interventions in reducing depressive symptoms in ethnic minority carers of people with dementia. METHODS We systematically searched EMBASE, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Applied Social Sciences Index and Abstracts (ASSIA), The Cochrane Central Register of Controlled Trials (CENTRAL), and Sociological Abstracts and Social Policy and Practices databases from 1990 to 2015, supplemented by a grey literature search, hand searches of bibliographies, and contacting authors. Study quality was assessed independently by two researchers using The Effective Public Health Practice Project Quality Assessment Tool, with an inter-rater reliability of Cohen's kappa of 0.72 (95% CI, 0.42-1.01). Narrative synthesis and meta-analysis were used to assess intervention effectiveness. Meta-regression was used to assess whether factors such as intervention type, peer support, and ethnicity accounted for hetereogeneity. RESULTS Thirteen studies were eligible for inclusion, with 1076 participants in control groups and 980 participants in intervention groups; 12 studies provided estimates for meta-analysis. All studies were from the United States. Interventions were associated with an overall mean reduction in depression in caregivers (SMD -0.17 (95% CI, -0.29 to -0.05; P = 0.005). Meta-regression did not indicate any potential sources of heterogeneity, although narrative synthesis suggested that interventions developed with the target ethnic minority group's preferred mode of engagement in mind alongside cultural adaptations may have enhanced effectiveness. CONCLUSIONS Psychosocial interventions for depression in ethnic minority carers of people with dementia are effective and could be enhanced through cultural adaptations. High-quality studies targeting minority ethnic groups outside of the United States are needed.
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Affiliation(s)
- Nazire E Akarsu
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin J Prince
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vanessa C Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Trust, London, UK
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Nabe-Nielsen K, Hansen ÅM, Ishtiak-Ahmed K, Grynderup MB, Gyntelberg F, Islamoska S, Mortensen EL, Phung TKT, Rod NH, Waldemar G, Westendorp RGJ, Garde AH. Night shift work, long working hours and dementia: a longitudinal study of the Danish Work Environment Cohort Study. BMJ Open 2019; 9:e027027. [PMID: 31129586 PMCID: PMC6538206 DOI: 10.1136/bmjopen-2018-027027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Shift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia. DESIGN A longitudinal study. SETTING Denmark. PARTICIPANTS 3435 occupationally active men and women from the general working population. METHODS Work schedule covered day work (reference) and shift schedules without/with night work. Working hours covered <27, 28-36, 37 (reference), 38-44, and ≥45 hours/week. As the primary outcome, we used register-based information about dementia, and estimated incidence rate ratios (IRR) and 95% CI. Estimates were adjusted for gender, age, psychosocial work factors and cardiovascular risk factors. RESULTS We identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38-44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working <37 hours/week or ≥45 hours/week. CONCLUSION We did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard.
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Affiliation(s)
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Finn Gyntelberg
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Canevelli M, Lacorte E, Cova I, Zaccaria V, Valletta M, Raganato R, Bruno G, Bargagli AM, Pomati S, Pantoni L, Vanacore N. Estimating dementia cases amongst migrants living in Europe. Eur J Neurol 2019; 26:1191-1199. [PMID: 30968532 DOI: 10.1111/ene.13964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The phenomenon of dementia amongst migrants and ethnic minorities represents an emerging concern for European healthcare systems, posing additional challenges in terms of clinical approach, access to care and resource utilization. The aim of the present study was to estimate the cases of dementia amongst immigrant older subjects living in Europe and in each European country. METHODS The estimated cases of dementia amongst older (i.e. 65+) migrants living in the European Union (EU-28) and European Free Trade Association member states were calculated by multiplying the number of migrants (obtained through the data provided by Eurostat) with the age- and sex-specific prevalence rates (derived by a recent meta-analysis). RESULTS Overall, 6 507 360 older migrants lived in Europe in 2017. In addition, 1 204 671 migrants were registered in Germany in 2010. Nearly 475 000 dementia cases (329 028 women, 147 410 men) were estimated in this population by applying age- and sex-specific prevalence rates. When considering each European country, the number of estimated cases ranged from 108 (Iceland) to 119 161 (France). In parallel, the proportion of dementia cases occurring in migrants ranged from 0.9% (Czech Republic) to 51.2% (Liechtenstein). CONCLUSIONS The issue of dementia in migrants and ethnic minorities is emerging but already relevant for European healthcare systems. The magnitude of this phenomenon and its complexities reinforce the need for coordinated initiatives both at a national and continental level. These epidemiological data should ideally be integrated with those coming from 'real world' services in order to better calibrate these actions.
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Affiliation(s)
- M Canevelli
- Department of Human Neuroscience, 'Sapienza' University, Rome, Italy.,National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - E Lacorte
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - I Cova
- Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' University Hospital, Milan, Italy
| | - V Zaccaria
- Department of Human Neuroscience, 'Sapienza' University, Rome, Italy
| | - M Valletta
- Department of Human Neuroscience, 'Sapienza' University, Rome, Italy
| | - R Raganato
- Department of Human Neuroscience, 'Sapienza' University, Rome, Italy
| | - G Bruno
- Department of Human Neuroscience, 'Sapienza' University, Rome, Italy
| | - A M Bargagli
- Department of Epidemiology, Regional Health Service, Rome, Italy
| | - S Pomati
- Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' University Hospital, Milan, Italy
| | - L Pantoni
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - N Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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Tillmann J, Just J, Schnakenberg R, Weckbecker K, Weltermann B, Münster E. Challenges in diagnosing dementia in patients with a migrant background - a cross-sectional study among German general practitioners. BMC FAMILY PRACTICE 2019; 20:34. [PMID: 30803438 PMCID: PMC6388491 DOI: 10.1186/s12875-019-0920-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022]
Abstract
Background Diagnosing dementia, a syndrome affecting 35.6 million people worldwide, can be challenging, especially in patients with a migrant background. Language barriers and language-based diagnostic tools, cultural differences in the perception of the syndrome as well as restricted access to healthcare can influence medical care. For the first time in Germany, this study investigates whether German general practitioners (GPs) feel prepared to meet the diagnostic needs of these patient groups and whether there are challenges and support needs. Methods A cross-sectional study among a random sample of 982 general practitioners in Germany was conducted from October 2017 to January 2018 (response rate: 34.5%). A self-developed, written, standardised questionnaire was used. Descriptive statistics as well as multiple logistic regression analyses were performed using data of 326 GPs. Results Ninety-six percent of GPs reported having experienced barriers at least once. Uncertainties in diagnosing dementia in patients with a migrant background were indicated by 70.9%. There was no significant association between uncertainties in diagnosing dementia and GPs’ sociodemographic characteristics. The most frequently reported barriers were language barriers that affected or prevented diagnostics (89.3%) and information deficits in patients with a migrant background (59.2%). Shameful interaction or lack of acceptance of the syndrome was also common (55.5%). A demand for more information about the topic was expressed by 70.6% of GPs. Conclusions Public health measures supporting GPs in their interaction with patients with a migrant background as well as information and services for dementia patients are needed. Efforts to facilitate access to interpreting services and to focus on people with a migrant background in healthcare are necessary. Trial registration German Clinical Trials Register: DRKS00012503, date of registration: 05/09/2017 (German Institute of Medical Documentation and Information. German Clinical Trials Register (DRKS) 2017). Clinical register of the study coordination office of the University hospital of Bonn: ID530, date of registration: 05/09/2017 (Universitätsklinikum Bonn. Studienzentrum. UKB-Studienregister 2017).
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Affiliation(s)
- Judith Tillmann
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany.
| | - Johannes Just
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Rieke Schnakenberg
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany.,Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
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Islamoska S, Ishtiak-Ahmed K, Hansen ÅM, Grynderup MB, Mortensen EL, Garde AH, Gyntelberg F, Prescott EIB, Török E, Waldemar G, Nabe-Nielsen K. Vital Exhaustion and Incidence of Dementia: Results from the Copenhagen City Heart Study. J Alzheimers Dis 2019; 67:369-379. [PMID: 30584138 PMCID: PMC6398840 DOI: 10.3233/jad-180478] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychological distress is potentially linked to the risk of dementia through neurologic and cardiovascular mechanisms. Vital exhaustion (VE) is a mental state of psychological distress, which could be a risk factor for dementia. OBJECTIVE To investigate whether VE is a risk factor for dementia in later life. METHODS We used data from 6,807 participants attending the third survey of the Copenhagen City Heart Study in 1991-1994. VE was assessed by 17 symptoms (score: 0-17) from the Maastricht Questionnaire. Information on dementia was obtained from national registers. Risk time for dementia was counted from five years after VE assessment for participants > 55 years at the time of VE assessment. For younger participants, risk time for dementia was counted from the year they turned 60 years and onwards. Participants were followed until 2016. We used Poisson regression to calculate incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS During an average follow-up of 10 years, 872 participants were registered with dementia. We found a dose-response relation between the number of VE symptoms and the incidence of dementia. For every additional VE symptom, the dementia incidence increased by 2% (IRR = 1.024; 95% CI: 1.004-1.043). Adjustment for socio-demographic and health-related factors did not change the results substantially. Neither did stratification by age, sex, educational level, and marital status. CONCLUSION We found evidence that VE is a risk factor for dementia. Our sensitivity analyses supported that this association was not only due to VE being a potential prodromal sign of dementia.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Eszter Török
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Migrants seeking help for cognitive disturbances: exploratory data from an Italian memory clinic. Neurol Sci 2018; 40:857-859. [PMID: 30511346 DOI: 10.1007/s10072-018-3663-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The phenomenon of dementia occurring in migrants and minority groups constitutes an emerging issue for Western countries. Nevertheless, it has been poorly explored from the perspective of "real-world" clinical services. We aimed to quantify the number of migrants from LMIC attending an Italian university memory clinic and to document its modifications over time. METHODS All the subjects undergoing a first neurological and cognitive assessment between 2001 and 2017 were considered for the present analyses. RESULTS The proportion of subjects from LMIC performing a first cognitive evaluation was found to remain substantially stable between 2001 and 2017. No statistically significant difference was found between "HIC" and "LMIC" individuals with regard to sociodemographic and clinical characteristics. CONCLUSION These findings seem to indicate that cognitive disorders in LMIC migrants still constitute a marginal public health issues for Italian dementia services. Nevertheless, the identification of eventual sociocultural and healthcare barriers may help to understand the real magnitude and relevance of this phenomenon.
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Sagbakken M, Spilker RS, Nielsen TR. Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia. BMC Health Serv Res 2018; 18:910. [PMID: 30497459 PMCID: PMC6267848 DOI: 10.1186/s12913-018-3720-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/15/2018] [Indexed: 01/12/2023] Open
Abstract
Background Along with the ageing of the general population, Europe’s migrant populations are also ageing, thus posing new challenges for dementia care services, particularly if the services are to be adjusted to persons with different linguistic and cultural backgrounds. From the perspective of health professionals, this study aims to explore challenges involved in identifying, assessing and diagnosing people with cognitive impairment/dementia who have different linguistic and cultural backgrounds. Methods Research on health professionals experiences regarding the management of dementia among immigrants is scarce and qualitative methods was used to address the objective of the study. Using qualitative in-depth interviews and focus-group discussions, we sought to gather participants’ experiences regarding the diagnostic process for immigrants with dementia. The material was analysed and interpreted based on Kvale and Brinkmann’s descriptions of three different contexts of interpretation: self-understanding, critical common-sense understanding, and theoretical understanding. Results Health professionals described how families could attribute symptoms of dementia to processes of normal ageing, while others saw the symptoms as something shameful; both instances delayed or hindered help-seeking. Many clinicians had limited experience with older immigrants suffering from dementia, and general practitioners (GPs) in particular experienced difficulties assessing dementia due to language barriers and difficulties related to the involvement of the family or an interpreter. The findings illustrate challenges in assessment, such as unfamiliarity with test situations among those being assessed and lack of knowledge regarding appropriate diagnostic tools among health professionals. Lack of continuity and poor information exchange in the chain of care seem to reinforce many of these challenges. Conclusions Detection, treatment and care may be improved if primary care professionals strengthen their cross-cultural competences. Training in communication skills and in the use of cross-cultural assessment tools may help build competence and confidence when assessing and caring for people with different cultural and linguistic backgrounds. Closer collaboration among families, nurses in home-based services, dementia teams, and GPs may facilitate close monitoring of a patient over time. Such collaboration requires sufficient information exchange during transitions in the chain of care, continuity among health professionals, and a shared understanding of the goals for treatment and care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3720-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Pilestredet 32, 0130, Oslo, Norway.
| | - Ragnhild Storstein Spilker
- Norwegian Center for Migration and Minority Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213, Oslo, Norway
| | - T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922 Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Barriers in providing primary care for immigrant patients with dementia: GPs' perspectives. BJGP Open 2018; 2:bjgpopen18X101610. [PMID: 30723796 PMCID: PMC6348325 DOI: 10.3399/bjgpopen18x101610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background Dementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention. Aim To describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs. Design & setting A mixed-method study, consisting of an online survey and focus groups. Method An online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care. Results GPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education. Conclusion Important barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.
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Diaz E, Kumar BN, Engedal K. Immigrant patients with dementia and memory impairment in primary health care in Norway: a national registry study. Dement Geriatr Cogn Disord 2015; 39:321-31. [PMID: 25823461 DOI: 10.1159/000375526] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immigrants comprise a growing proportion of the elderly population. However, knowledge about the diagnosis and management of dementia and memory impairment among immigrants is scarce in Norway and elsewhere. AIMS To compare proportions of Norwegians and immigrants aged ≥50 years with a diagnosis of dementia or memory impairment in primary health care and to study the demographic characteristics, utilization of primary health care services and pharmacological treatment of Norwegians and immigrants with either of the two diagnoses in 2008. METHOD This is a registry-based study using linked data at the individual level from 4 national Norwegian registers. RESULTS A significantly lower proportion of immigrants, especially those from other than high-income countries, had a diagnosis of dementia or memory impairment. Among patients with such diagnoses, anti-dementia medication was purchased 20-50% more often by Norwegians than by immigrants, although the differences remained significant only for immigrants from other than high-income countries after adjustment for several variables. CONCLUSION The lower proportions of immigrants with a dementia diagnosis and lower proportions of patients receiving treatment might indicate a lower prevalence or milder forms of dementia among immigrants. However, the cultural validity of the assessment tools, linguistic barriers and challenges for general practitioners should be further investigated.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Tuerk R, Sauer J. Dementia in a Black and minority ethnic population: characteristics of presentation to an inner London memory service. BJPsych Bull 2015; 39:162-6. [PMID: 26755947 PMCID: PMC4706140 DOI: 10.1192/pb.bp.114.047753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To examine data on referrals to an inner-city London memory service to explore any differences in referral rates, cognitive assessments and stages of dementia at presentation between ethnic groups. Results African-Caribbean patients were well represented in the memory service. They were diagnosed with dementia on average 4.5 years younger than their White British counterparts and were more likely to be diagnosed with a vascular or mixed type dementia. However, scores on initial cognitive testing were significantly lower in the African-Caribbean group, possibly representing more advanced disease at presentation. Clinical implications Initiatives to access Black and minority ethnic populations earlier in the course of their illness should be considered. Professionals need to consider the potential for cultural bias in memory testing and diagnosing dementia in these populations, and the importance of cultural competency in assessments.
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Affiliation(s)
- Rosalyn Tuerk
- South London and Maudsley NHS Foundation Trust, London UK
| | - Justin Sauer
- South London and Maudsley NHS Foundation Trust, London UK; Institute of Psychiatry, King's College London
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Jensen NK, Norredam M, Priebe S, Krasnik A. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark. BMC FAMILY PRACTICE 2013; 14:17. [PMID: 23356401 PMCID: PMC3568406 DOI: 10.1186/1471-2296-14-17] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
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Affiliation(s)
- Natasja Koitzsch Jensen
- The Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
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