How is migration background considered in the treatment and care of people? A comparison of national dementia care guidelines in Europe

[Linguistic portrait of a Russian-German speaking woman with dementia : Longitudinal observations from a German language nursing home]

BACKGROUND

The advantages of an individual use of the linguistic resources of multilingual persons in need of care are obvious, but quite often an implementation is hardly possible. This leads to a reduction of the linguistic abilities of those concerned.

OBJECTIVE

This case study shows the differences in the abilities of a Russian-German bilingual woman suffering from dementia in expressing herself in two languages and traces the longitudinal changes.

MATERIAL AND METHODS

Data material from 4 years of observation (including conversation recordings, linguistic tests and interviews with nursing personnel) was used to create the linguistic portrait.

RESULTS

The expression abilities and changes in the languages were different. In German, the receptive abilities at word level and sentence level and productive abilities at word level remained unchanged over the entire period. In Russian, the situation was less stable; at the beginning, she was an interested interlocutor who could express herself fluently at all levels. Over time, her syntactic complexity and willingness to interact decreased; nevertheless, better and productive Russian skills remained.

CONCLUSION

The asymmetrical distribution of the two languages entails the danger of a one-sided assessment of the general abilities of the person concerned. This underlines the need for a differentiated view of the languages.

Intersectionality and its relevance for research in dementia care of people with a migration background

BACKGROUND

Despite the care and support needs of migrants affected by dementia differing from the population of the country where they live now, most European countries do not provide specific strategies to address migration in their national dementia plans. The concept of intersectionality provides an innovative approach to dementia care perspectives and methodologies.

OBJECTIVE

The aim is to define intersectionality and to provide examples of applying the concept to dementia care research, focusing on people with a migration background.

METHODS

This article was conceptualized and discussed during virtual INTERDEM taskforce meetings in 2020/2021, while discussing identified literature on intersectionality, migration, and dementia care research.

RESULTS

Using an intersectionality framework allows understanding of a person's lived experience by considering the dimensionality, co-occurrence and interlocking of factors (e.g., sex/gender, socioeconomic status, ethnicity, migration status, geographic location/place).

CONCLUSION

Intersectionality can be applied as a conceptual and methodological approach to identify and address gaps in perspectives and in (dementia care) research to overcome the threat of ignorance, exclusion and discrimination.

Socio-Economic Disparities in Access to Diagnostic Neuroimaging Services in the United Kingdom: A Systematic Review

Socio-economic factors affecting health care can lead to delays in diagnosis of neurological conditions, consequentially affecting treatment and morbidity rates. This inequality in health care can leave patients from lower socio-economic backgrounds more vulnerable to a poorer quality of care from health care providers in the United Kingdom (U.K.). Aims: In this systematic review, we assess the impact of socio-economic status on the use of diagnostic neuroimaging in the U.K., measured by the timeliness, accessibility and appropriate use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, electroencephalography (EEG) and single-photon emission computed tomography (SPECT). We specifically evaluate the non-surgical use of neuroimaging techniques as this relies on the judgment of primary care-givers (e.g., doctors and radiologists), where health disparities are most common. This study includes the analysis of diagnostic imaging used for dementia, minor head injury, stroke, cancer, epilepsy, chronic inflammatory demyelinating polyneuropathy and Parkinson’s disease. With this study, we aim to assess the health inequalities at disease diagnosis. Methods: Using Medline (via Ovid), PubMed and Web of Science databases as sources of information, we critically appraise existing studies on neuroimaging use in the U.K. health care system, published between January 2010 and February 2021. Findings: A total of 18 studies were included in this research, revealing that there was an increase in patients of Black and Asian communities diagnosed with dementia and at an earlier age. There was little evidence to suggest that a lack of access to diagnostic imaging is associated with socio-economic status. However, there are data to suggest that people of a lower socio-economic background require more specialist services with diagnostic neuroimaging tools. In addition, there is evidence to suggest that diagnostic neuroimaging techniques could be utilised more effectively by health care workers to prevent unnecessary delays in diagnosis for patients in lower socio-economic areas.