Appropriation and dementia in India

Negotiating a sociophysical space for elders with dementia in Shanghai

Dementia, which used to be a private issue due to the stigma and cultural expectations of family-based support in China, has been transformed into a social concern due to its increasing number in recent years. As a response, advocates have introduced the dementia-friendly initiative to deal with related challenges. Yet, as a project mainly proposed by developed countries, we know little about its localisation in developing countries. Based on 20-month ethnographic research in Shanghai, this article explores the localisation process of this global project. While many stakeholders who advocate on behalf of people with dementia and their family caregivers have made remarkable progress in terms of embracing the global concepts and practices, one project - community-based dementia care units - generates a lot of resistance from nearby residents due to the feng shui damage, a specific scheme in traditional Chinese culture. These findings reveal an important source of obstacle - the cultural context that shapes the public understanding of dementia and the ways of arranging dementia care - that may prevent the dementia-friendly initiative from further localisation in China. Through this ethnographic analysis, I call attention to the significance of cultural contexts in the design and implementation of dementia-friendly projects globally.

Dementia Knowledge and Attitudes of the General Public among the Bangladeshi Community in England: A Focus Group Study

BACKGROUND

Increasing life expectancy worldwide means more people will develop dementia. Despite the rapid growth in older Bangladeshi immigrants living in the UK, there is little evidence of how community members understand and view the process of ageing and dementia. However, Bangladeshis have a higher risk of developing type 2 diabetes and heart disease, both of which are important indicators of dementia development in old age. This study aimed to explore and analyse the perception and knowledge of, and attitudes towards, ageing and dementia among the Bangladeshi community.

METHODS

A qualitative research approach guided two separate focus group discussions held with Bangladeshi adults in Portsmouth, UK. A topic guide was used alongside two vignettes depicting either early- or late-stage dementia to stimulate discussion. The data were recorded, transcribed, and analysed thematically using NVivo qualitative software.

RESULTS

Three main themes emerged: (1) knowledge and perceptions of dementia; (2) perceived causes of dementia; and (3) perceptions of stigma about dementia. Lack of knowledge and understanding of dementia was evident, but the stigma about dementia was non-existent. This study fills a research gap by providing qualitative research examining knowledge about and attitudes towards dementia among a Bangladeshi community in England.

CONCLUSION

Future research must highlight the importance of raising dementia awareness among, and providing information about dementia caregiving to, Bangladeshi community members, as well as providing religiously sensitive healthcare services.

Understandings of dementia in low and middle income countries and amongst indigenous peoples: a systematic review and qualitative meta-synthesis

Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia.Methods: A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out.Findings: Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving.Conclusions: There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.

Dementia in the Bangladeshi diaspora in England: A qualitative study of the myths and stigmas about dementia

RATIONALE, AIMS AND OBJECTIVES

Although Bangladeshis are three times more likely to be carers than White British, Bangladeshi family carers are the most deprived, neglected, and effectively a hidden group in the United Kingdom.¹ There is a paucity of research within the Bangladeshi community that is capable of explaining and predicting the experiences and concerns of Bangladeshi family carers providing care for their relatives with dementia. The purpose of this study is to explore the perspectives of Bangladeshi family carers' knowledge and day-to-day experiences living in England.

METHODS

This is a qualitative study involving semistructured face-to-face interviews with six Bangladeshi family carers living in London and Portsmouth. Interviews were recorded with the consent and transcribed verbatim. Data were managed by using NVivo software, and thematic analysis was performed.

RESULTS

This paper explores that most carers have a lack of knowledge and awareness of the symptoms of dementia. The results of this study are in contrast to previous studies, where South Asian carers perceived dementia as being possessed by evil spirits or God's punishment for previous life's sins; this study reveals that Bangladeshi family carers believed dementia was a medical condition. Unlike earlier South Asian studies, however, all family carers in this study also believed that there was no stigma attached to dementia.

CONCLUSIONS

Further research is warranted to investigate the religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi family carers negotiate and construct their caregiving roles for their relatives with dementia.

Awareness and understanding of dementia in South Asians: A synthesis of qualitative evidence

Background

Despite a growing elderly South Asian population, little is known about the experience of diagnosis and care for those living with dementia. There have been a number of individual qualitative studies exploring the experiences of South Asian people living with dementia and their carers across different contexts. There has also been a growing interest in synthesizing qualitative research to systematically integrate qualitative evidence from multiple studies to tell us more about a topic at a more abstract level than single studies alone. The aim of this qualitative synthesis was to clearly identify the gaps in the literature and produce new insights regarding the knowledge and understanding of the attitudes, perceptions, and beliefs of the South Asian community about dementia.

Methods

Following a systematic search of the literature, included qualitative studies were assessed by two independent reviewers for methodological quality. Data were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Findings were synthesized using the Joanna Briggs Institute approach to qualitative synthesis by meta-aggregation.

Results

Seventeen papers were critically appraised, with 13 meeting the inclusion criteria. Participants were mostly of South Asians of Indian background; followed by Pakistani with a few Sri Lankans. Missing South Asian countries from the current evidence base included those from Bangladesh, Bhutan, Maldives, and Nepal. Three meta-synthesis themes emerged from the analysis: (1) a poor awareness and understanding of dementia, (2) the experience of caregiving, and (3) the attitudes toward dementia care provision.

Conclusions

A consistent message from this qualitative synthesis was the limited knowledge and understanding of dementia amongst the South Asians. Whilst symptoms of dementia such as ‘memory loss’ were believed to be a part of a normal ageing process, some South Asian carers viewed dementia as demons or God’s punishments. Most studies reported that many South Asians were explicit in associating stigmas with dementia.

Dementia Care Work in Singapore: Embodied Relations and Power Dynamics

Based on research at a dementia day-care center in Singapore, I discuss how embodied care relations proceed amidst cultural expectations on aging, dementia, and care work. Engaging with approaches that conceptualize "care" as either empathy or control, I argue that care between older people with dementia, their families, and care workers can be understood as a reiterative, dialogic process whereby care participants strive to keep pace with each other, however briefly, due to cognitive decline, care workers' own limitations, and particular family difficulties. Care vacillates between practices of control, surveillance, and recognition, and comprises dynamic rather than enduring power relations.