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Maxson SL, Grini IS, Ueland Ø, Terragni L. Eating preferences and behaviors of older immigrants in Oslo: A qualitative study. Appetite 2024; 200:107531. [PMID: 38815690 DOI: 10.1016/j.appet.2024.107531] [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: 03/19/2024] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
Norway's population of older, first-generation immigrants is expected to almost triple by the year 2060 due to decreased mortality and continued immigration. Studies indicate that older immigrants in Norway have a higher rate of non-communicable disease than older non-immigrants. Eating a health-supporting diet is important for reducing disease risk and maintaining independence in older adults. The purpose of this study was to increase understanding of the eating preferences and behaviors of older, home-dwelling, first-generation immigrants in Oslo, and to identify influences on their eating preferences and behaviors. This qualitative study took a phenomenological approach to understand older immigrants' shared experience of changing eating behaviors with aging. Fourteen home-dwelling, older immigrants were recruited using a combination of purposeful random sampling and snowball sampling. In-depth interviews were conducted then analyzed according to reflexive thematic analysis. Study findings indicate that older immigrants eat a bi-cultural diet pattern. In addition, they seek out information about nutrition, and incorporate many health-supporting eating habits for disease management and prevention. In this way, older immigrants in Oslo share much in common with older non-immigrants. Hopes and worries for the future motivate older immigrants to eat more healthfully in order to maintain independence and cultural identity as long as possible. These results can be useful for designing culturally tailored programs which support eating habits for health maintenance and disease prevention among older immigrants.
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Affiliation(s)
- Stephanie L Maxson
- Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
| | | | | | - Laura Terragni
- Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
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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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Tsai LP, Barr JA. The experiences and perceptions of immigrant informal caregivers about engaging with professional services in the host country: A scoping review. Int J Nurs Pract 2023:e13227. [PMID: 38128928 DOI: 10.1111/ijn.13227] [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: 11/03/2022] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
AIM The inquiry explored immigrant informal caregivers' experiences and perceptions about engaging with professional services in the host country. BACKGROUND The number of informal caregivers is rising, with more people providing home caring. Nurses and other health services are crucial in supporting informal caregivers. Research needs to focus more on immigrants, not just other caregivers. DESIGN This was a scoping review. DATA SOURCES Five databases (January 2017-December 2022) were searched, and 16 articles were included in this inquiry. REVIEW METHODS This scoping review used the Joanna Briggs Institute Scoping Review methodology. This inquiry asked one question: What is the current knowledge about immigrant informal caregivers' experiences and perceptions when engaging mainstream professional services? Themes were identified using a thematic analysis approach. RESULTS Three themes emerged from the review: 'finding cultural bridges: culturally connecting with services'; 'building cultural bridges: addressing "them and us" and "acculturation-sensitive services"'. CONCLUSION Professional service providers are currently not meeting immigrant caregivers' needs. New knowledge is presented, that nurses and health professional services must provide acculturation-sensitive care, commencing with an assessment of the individual's acculturation status. By understanding acculturation status, nurses are more likely to customize person-centred care. Acculturation status refers to the degree that the individual has adapted to the new culture while retaining some traditional cultural beliefs and practices. Acculturation-sensitive care is more likely to provide authentic holistic care that optimizes well-being.
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Affiliation(s)
- Lily P Tsai
- Faculty of Health, Charles Darwin University, Casuarina, Australia
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Xiao L, Gordon S, Ahmad M. Experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries: a systematic review and meta-synthesis. Aging Ment Health 2023; 27:2319-2328. [PMID: 37300492 DOI: 10.1080/13607863.2023.2222078] [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: 03/06/2022] [Accepted: 03/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The cultural and religious beliefs and values of family caregivers of people with dementia have a profound impact on the use of dementia care services in high-income countries. Yet, little is known about how caregivers of people with dementia from a Muslim migrant background in high-income countries perceive their caregiving journey. AIM To synthesise findings from rigorous qualitative studies on the experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries. METHODS Meta-ethnography of qualitative studies was applied to address the aim. Five databases including MEDLINE, CINHAL, PsycINFO, Web of Science and Scopus were searched. Inclusion criteria were qualitative or mixed study design studies on family caregivers of people with dementia from a Muslim migrant background in a home care setting in high-income countries. Studies were excluded if they used a quantitative research design, were not written in English and were not original studies. FINDINGS In total 17 articles met the inclusion criteria and were included in the study. Meta-synthesis of the data revealed three themes from the life course intersectionality perspective: caregiving as both positive and negative experiences; factors affecting caregivers' experiences; and coping strategies used by caregivers. CONCLUSION Caregivers of people with dementia from a Muslim migrant background living in high-income countries have both positive and negative caregiving experiences. However, dementia care services were not tailored to address their care needs and expectations arising from their religious and cultural beliefs.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sue Gordon
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Mahjabeen Ahmad
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Dang TH, Thodis A, Ulapane N, Antoniades J, Gurgone M, Nguyen T, Gilbert A, Wickramasinghe N, Varghese M, Loganathan S, Enticott J, Mortimer D, Dow B, Cooper C, Xiao LD, Brijnath B. 'It's Too nice': Adapting iSupport Lite for Ethnically Diverse Family Carers of a Person with Dementia. Clin Gerontol 2023:1-14. [PMID: 37697628 DOI: 10.1080/07317115.2023.2254296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Resources to support dementia carers from ethnically diverse families are limited. We explored carers' and service providers' views on adapting the World Health Organization's iSupport Lite messages to meet their needs. METHODS Six online workshops were conducted with ethnically diverse family carers and service providers (n = 21) from nine linguistic groups across Australia. Recruitment was via convenience and snowball sampling from existing networks. Data were analyzed using thematic analysis. RESULTS Participants reported that iSupport Lite over-emphasized support from family and friends and made help-seeking sound "too easy". They wanted messages to dispel notions of carers as "superheroes", demonstrate that caring and help-seeking is stressful and time-consuming, and that poor decision-making and relationship breakdown does occur. Feedback was incorporated to co-produce a revised suite of resources. CONCLUSIONS Beyond language translation, cultural adaptation using co-design provided participants the opportunity to develop more culturally relevant care resources that meet their needs. These resources will be evaluated for clinical and cost-effectiveness in future research. CLINICAL IMPLICATIONS By design, multilingual resources for carers must incorporate cultural needs to communicate support messages. If this intervention is effective, it could help to reduce dementia care disparities in ethnically diverse populations in Australia and globally.
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Affiliation(s)
- Thu Ha Dang
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | - Antonia Thodis
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Nalika Ulapane
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Mary Gurgone
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Centre of Capability and Culture, Perth, Australia
- Association of Culturally Appropriate Services (AfCAS), Perth, Australia
- Perth Foundation for Women, Perth, Australia
| | - Tuan Nguyen
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
- Faculty of Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Hanoi, Viet Nam
| | - Andrew Gilbert
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Department of Social Inquiry, La Trobe University, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | | | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Joanne Enticott
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Duncan Mortimer
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Briony Dow
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- School of Social Sciences, University of Western Australia, Perth, Australia
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Brijnath B, Antoniades J, Cavuoto M. Inclusive dementia care for ethnically diverse families. Curr Opin Psychiatry 2023:00001504-990000000-00077. [PMID: 37439594 DOI: 10.1097/yco.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW With population ageing and global migration, rates of dementia are set to rapidly increase in ethnically diverse populations. This narrative review examines recent evidence on what constitutes culturally appropriate models of care. RECENT FINDINGS Barriers to inclusive care continue to prevail, amplifying dementia disparities in ethnically diverse communities. Cultural models that can address these include ensuring health and aged care staff are culturally competent, language supports are available, and cultural practices are integrated into daily care routines. Fundamentally, systems must be reformed to ensure they meet the needs of diverse end-users. More inclusive and widespread ethno-specific services are needed, and governments need to be mindful of demographic transitions in their populations and plan accordingly to meet future demand. Digital media and new technologies offer promising new ways to deliver culturally appropriate care to ethnically diverse groups, but its full potential is yet to be realised. SUMMARY Persistent dementia disparities in ethnically diverse communities can be overcome by operationalising cultural models of care, leveraging the promise of digital media, and systems redesign.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute, Parkville
- School of Population and Global Health, University of Melbourne, Melbourne
- School of Social Sciences, University of Western Australia, Perth
| | - Josefine Antoniades
- National Ageing Research Institute, Parkville
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne
- Department of General Practice, University of Melbourne, Melbourne, Australia
- School of Media, Creative Arts and Social Inquiry, Curtin University, Perth
| | - Marina Cavuoto
- National Ageing Research Institute, Parkville
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
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Hynek K, Gotehus A, Methi F, Nes RB, Skirbekk V, Hansen T. Caregiving + Migrant Background = Double Jeopardy? Associations between Caregiving and Physical and Psychological Health According to Migrant Backgrounds in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105800. [PMID: 37239528 DOI: 10.3390/ijerph20105800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Informal caregiving can have detrimental consequences for physical and psychological health, but the impacts are highly heterogenous. A largely ignored question is whether these impacts differ with migrant backgrounds, and whether caregiving and a migrant background combine to create double jeopardy. We explored these questions using large-scale data that allows stratification by sex, regional background, and types (inside vs. outside of household) of caregivers. We used cross-sectional 2021 data collected from two Norwegian counties as part of the Norwegian Counties Public Health Survey (N = 133,705, RR = 43%, age 18+). The outcomes include subjective health, mental health, and subjective well-being. The findings show that both caregiving, especially in-household caregiving, and a migrant background relate to lower physical-psychological health. In bivariate analysis, non-Western caregivers, women particularly, reported poorer mental health and subjective well-being (but not physical health) than other caregiver groups. After controlling for background characteristics, however, no interaction exists between caregiver status and migrant background status. Although the evidence does not suggest double jeopardy for migrant caregivers, caution is warranted due to the likely underrepresentation of the most vulnerable caregivers of migrant backgrounds. Continued surveillance of caregiver burden and distress among people of migrant backgrounds is critical to develop successful preventive and supportive intervention strategies for this group, yet this aim hinges on a more inclusive representation of minorities in future surveys.
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Affiliation(s)
- Kamila Hynek
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Aslaug Gotehus
- Work Research Institute (AFI), Oslo Metropolitan University, 0130 Oslo, Norway
| | - Fredrik Methi
- Department of Health Services Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Ragnhild Bang Nes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Promenta Research Center, University of Oslo, 0373 Oslo, Norway
- Department of Philosophy, Classics, History of Arts and Ideas, University of Oslo, 0213 Oslo, Norway
| | - Vegard Skirbekk
- Center for Fertility and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Thomas Hansen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Promenta Research Center, University of Oslo, 0373 Oslo, Norway
- Norwegian Social Research (NOVA), Oslo Metropolitan University, 0130 Oslo, Norway
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Knipping D, Garnett A, Jiang BB. Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity. J Appl Gerontol 2023. [PMID: 36866817 DOI: 10.1177/07334648231158490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.
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Affiliation(s)
| | - Anna Garnett
- Nursing, 6221University of Western Ontario, London, ON, Canada
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Gulestø R, Lillekroken D, Halvorsrud L, Bjørge H. Different senses of one's place: Exploring social adjustment to home-based care services among family caregivers from minority ethnic backgrounds who have relatives living with dementia. DEMENTIA 2023; 22:359-377. [PMID: 36594107 DOI: 10.1177/14713012221148528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Western dementia care policies emphasise that family caregivers from minority ethnic backgrounds must become more engaged in healthcare services. However, research exploring experiences of receiving services such as home-based care, and thus adjustment to the service, among family caregivers from minority ethnic backgrounds who have relatives with dementia is still scarce. Therefore, inspired by Pierre Bourdieu's theoretical concepts of field, habitus and capital, we explored how family caregivers from different minority ethnic backgrounds justified decisions about whether to receive home-based care and their social adjustment to the service. Using empirical data from semi-structured interviews with nine family caregivers from different minority ethnic backgrounds, we demonstrated that different mindsets and available social resources gave rise to various actions. Although some family caregivers were optimistic about receiving home-based care, our findings point to tensions between the ideals of care practices and the organisational structures surrounding home-based care as a service. Among those who had experiences with home-based care, we found that organisational limitations, particularly in terms of efficiency demands and time constraints, influenced their behaviours and thus their social adjustments to the service. For some, these limitations eventually resulted in cancellation of the service. However, not all had the same opportunities to make these decisions, indicating that, although family caregivers from minority ethnic backgrounds receive home-based care, this does not necessarily entail a deficiency-free service. Furthermore, we argue that public discourses on this subject can be challenged by encouraging one to look beyond ethnic and cultural labels towards other factors, such as organisational structures, that might largely influence the use of home-based care among these family caregivers.
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Affiliation(s)
- Ragnhild Gulestø
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
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Good practice in needs-based post-diagnostic support for people with young onset dementia: findings from the Angela Project. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.
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Access to Long-Term Care for Minority Populations: A Systematic Review. Can J Aging 2022; 41:577-592. [PMID: 35331343 DOI: 10.1017/s0714980822000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
It has been shown that there is disparity in access to long-term care and other services for minority populations. This study assessed long-term care access among older individuals belonging to minority populations including visible, ethnocultural, linguistic, and sexual minorities. Barriers and facilitators influencing admission were identified and evaluated.A search for articles from 10 databases published between January 2000 and January 2021 was conducted. Included studies evaluated factors affecting minority populations' admission to long-term care, and non-residents' perceptions of future admission. This review was registered with PROSPERO: CRD42018038662. Sixty included quantitative and qualitative studies, ranging in quality from fair to excellent. Findings suggest minority status is associated with reduced admission to long-term care, controlling for confounding variables. Barriers identified include discordant language, fear of discrimination, lack of information, and family obligations. Findings suggest that minority populations experienced barriers accessing long-term care and had unmet cultural and language needs while receiving care in this setting.
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Mendieta MJ, De Geest SM, Goderis G, Yip O, Deschodt M, Dhaini S. A multi-level perspective on perceived unmet needs for home support in home-dwelling older adults in the Swiss context: a secondary data analysis of a population study. BMC Geriatr 2022; 22:833. [PMID: 36329389 PMCID: PMC9635119 DOI: 10.1186/s12877-022-03479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older adults’ quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them. Methods Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support. Results 4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17–2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15–2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06–1.85) or abandoned (OR = 2.60; 95% CI = 1.96–3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49–0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24–0.88) or German (OR = 0.47; 95% CI = 0.24–0.98), having a high level of education [primary (OR = 0.48; 95% CI = 0.24–1.02); secondary (OR = 0.49; 95% CI = 0.25–1.03); tertiary (OR = 0.38; 95% CI = 0.19–0.82); other (OR = 0.31 (0.12–0.75)], having a high score of self-perceived health status [score ≥ 76 (OR = 0.42; 95% CI = 0.20–0.96)] and having informal care (OR = 0.57; 95% CI = 0.45–0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support. Conclusion Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03479-5.
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Affiliation(s)
- Maria Jose Mendieta
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Sabina M De Geest
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium ,grid.6612.30000 0004 1937 0642Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Geert Goderis
- grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Center of General Practice, KU Leuven, Leuven Belgium
| | - Olivia Yip
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Mieke Deschodt
- grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven Belgium ,grid.410569.f0000 0004 0626 3338Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Suzanne Dhaini
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
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Gilbert AS, Antoniades J, Croy S, Thodis A, Adams J, Goeman D, Browning C, Kent M, Ellis K, Brijnath B. The experience of structural burden for culturally and linguistically diverse family carers of people living with dementia in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4492-e4503. [PMID: 35599431 PMCID: PMC10083988 DOI: 10.1111/hsc.13853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 03/27/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Evidence suggests that family carers of culturally and linguistically diverse (CALD) people living with dementia experience higher stress and unmet need than the general Australian population. These disparities are often framed as the result of CALD communities failing to seek formal support. Challenging this, we draw on the concept of 'structural burden' to explore how the complexity of health and aged systems contribute to the burden that CALD carers experience. We conducted semi-structured interviews with 104 family carers for CALD people with dementia in Australia, followed by thematic analysis of transcripts. Additional to structural burdens encountered by the general older population, CALD carers faced challenges understanding Australia's Anglo-centric aged care system, locating culturally appropriate care and were required to translate the languages and operations of health and aged care systems into terms their family members understood. This burden was mitigated by the presence of ethno-specific organisations and other navigation support. Australia's aged care system has moved towards centralised governance and consumer-directed care provision. This system involves a confusing array of different programmes and levels, bureaucratic applications and long waiting times. Carers' encounters with these systems demonstrates how some CALD people are being left behind by the current aged care system. While ethno-specific services can reduce this burden, not all CALD groups are represented. Consequently, improving access to dementia care among CALD populations requires entry point and navigation support that is culturally appropriate and linguistically accessible.
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Affiliation(s)
- Andrew Simon Gilbert
- National Ageing Research InstituteParkvilleVictoriaAustralia
- La Trobe UniversityBundooraVictoriaAustralia
| | - Josefine Antoniades
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Samantha Croy
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Antonia Thodis
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Swinburne University of TechnologyHawthornVictoriaAustralia
| | - Jon Adams
- University of Technology SydneyUltimoNew South WalesAustralia
| | - Dianne Goeman
- University of NewcastleCallaghanNew South WalesAustralia
- Monash UniversityClaytonVictoriaAustralia
| | - Colette Browning
- Federation UniversityMount HelenVictoriaAustralia
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Mike Kent
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Katie Ellis
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Bianca Brijnath
- National Ageing Research InstituteParkvilleVictoriaAustralia
- University of Western AustraliaCrawleyWestern AustraliaAustralia
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Stenberg J, Hjelm K. Migrant informal caregiver perceptions and experiences of caring for a family member with dementia: A systematic review and thematic synthesis. J Clin Nurs 2022; 32:2178-2192. [PMID: 35655377 DOI: 10.1111/jocn.16390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe migrant family caregivers' experiences and perceptions of caring for a family member with dementia. BACKGROUND There are demographic trends of aging populations and increased migration between countries. Age-associated diseases, such as dementia, are expected to increase, with migrants being at significantly increased risk. Knowledge of how dementia care is provided within migrant families is scarce. DESIGN Systematic review and thematic synthesis of qualitative research were performed to inform the development of interventions that can acknowledge and respond to the needs, concerns and preferences of migrant family caregivers. METHODS Searches were performed in PubMed, PsycINFO and CINAHL and reference lists in published articles were reviewed for the period 2000-October 2020. The CASP checklist for qualitative research was used to assess evidence quality, and the ENTREQ framework was used as a guide for study reporting. RESULTS Twenty-six articles from 10 Western countries, including 360 informal migrant caregivers from more than 30 countries of origin, were eligible. Within four areas of construct-perceptions of dementia and initial help-seeking; barriers to accessing and using formal dementia care; caregiver burden and coping and resilience-12 descriptive themes were identified. Several concepts cut across the themes, such as language difficulties; the role of the family in relation to care and support; cultural perceptions of dementia and care; stigma, pride and shame; the importance of religion and the importance of trust. CONCLUSIONS The review revealed commonalities among migrant family caregivers that resulted in reduced understanding of dementia and the importance of diagnosis and treatment. RELEVANCE TO CLINICAL PRACTICE To prevent a negative trajectory in caregiving, with perceived demands causing high levels of stress and strain, several barriers to migrants accessing and using formal care need to be assessed and addressed.
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Affiliation(s)
- Jenny Stenberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Chejor P, Laging B, Whitehead L, Porock D. Experiences of older immigrants living with dementia and their carers: a systematic review and meta-synthesis. BMJ Open 2022; 12:e059783. [PMID: 35613772 PMCID: PMC9125757 DOI: 10.1136/bmjopen-2021-059783] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To systematically review and synthesise evidence on the experiences of older immigrants living with dementia and their carers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Studies exploring the experiences of older immigrants living with dementia and their carers were eligible. Databases were searched including CINAHL, MEDLINE, PsycINFO, PubMed, Embase, Web of Science and Cochrane Library from January 2000 to April 2021. Quality assessment was undertaken using the Critical Appraisal Skills Programme checklist for qualitative studies. Data were then synthesised using the thematic synthesis approach. RESULTS The results of this meta-synthesis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Enhancing transparency in reporting the synthesis of qualitative research statement. A total of 3857 studies were returned from the database search. Eighteen studies were included for meta-synthesis. Five synthesised findings were identified: living with dementia and caregiving; family relationships; barriers to dementia care services; stigma and discrimination; and legal and financial issues. The experiences of living with dementia and caregiving presented multiple challenges for older immigrants living with dementia and their families. However, there seems to be very little difference between the experiences of those who have migrated to a new country and those who were born and aged in the same country, but the ability to access and use the available services is different. CONCLUSION A lack of culturally appropriate dementia services, language barriers and dementia stigma can impede access to dementia care for older immigrants. Strategies to mitigate these barriers are urgently needed to ensure people from culturally and linguistically diverse backgrounds with dementia and their families have the information, education and support to access dementia services, in addition to research that explores the experiences of culturally and linguistically diverse populations. PROSPERO REGISTRATION NUMBER CRD42021277913.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
| | - Bridget Laging
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Davina Porock
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
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Alkhaled T, Rohde G, Lie B, Johannessen B. Navigating the care between two distinct cultures: a qualitative study of the experiences of Arabic-speaking immigrants in Norwegian hospitals. BMC Health Serv Res 2022; 22:400. [PMID: 35346190 PMCID: PMC8959804 DOI: 10.1186/s12913-022-07833-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the past decades, there has been an increase in the number of immigrants to European and Scandinavian countries. This has challenged the health-care systems, which cater to the needs of patients despite their cultural and linguistic barriers, in these countries. Most studies on this topic have focused on the perspectives of health-care providers in delivering their service. The purpose of this qualitative study was to explore how hospitalized Arabic-speaking patients experienced their interaction with the Norwegian health-care system. Methods In-depth interviews with 20 participants and researcher’s participant observation were conducted to explore the idiosyncratic details and ascribed meanings that foreign-born patients attach to their everyday experience of the Norwegian health-care system. Thematic analysis was performed on the transcribed and translated versions of the in-depth interviews. Results The findings of this study indicated three interrelated core themes. Firstly, there exist challenges in understanding and being understood because of linguistic and cultural differences of newly migrated patients. Secondly, some patients missed the holistic and direct care available in their home countries. Finally, patients were satisfied with the Norwegian health-care system because of its compassion, care, and respect toward them as well as advanced health-care equipment. Conclusion Arabic-speaking patients in Norwegian hospitals experienced long waiting times and linguistic problems. Hence, a better and specialized interpreter service may resolve problems emanating from communication within the system and the subsequent delays in treatment. Compassionate care and the feeling of respect and love is the core strength of the Norwegian system as perceived by the patients.
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Gong N, Meng Y, Hu Q, Du Q, Wu X, Zou W, Zhu M, Chen J, Luo L, Cheng Y, Zhang M. Obstacles to access to community care in urban senior-only households: a qualitative study. BMC Geriatr 2022; 22:122. [PMID: 35164708 PMCID: PMC8842867 DOI: 10.1186/s12877-022-02816-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 01/02/2023] Open
Abstract
Background The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care. Methods A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis. Results We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively. Conclusions When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02816-y.
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Affiliation(s)
- Ni Gong
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ya Meng
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Qin Hu
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China
| | - Qianqian Du
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Xiaoyu Wu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Wenjie Zou
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Mengyao Zhu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Jiayan Chen
- Qizhi Social Work Service Center, Tianhe District, Guangzhou, Guangdong, China
| | - Lan Luo
- Hongshan Street Community Health Service Center, Huangpu District, Guangzhou, Guangdong, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China.
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
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Gulestø R, Lillekroken D, Bjørge H, Halvorsrud L. Interactions between healthcare personnel and family caregivers of people with dementia from minority ethnic backgrounds in home-based care-An explorative qualitative study. J Adv Nurs 2021; 78:1389-1401. [PMID: 34806211 DOI: 10.1111/jan.15101] [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: 06/22/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
AIMS To explore how healthcare personnel in home-based care perceive interactions with family caregivers of people with dementia from minority ethnic backgrounds. BACKGROUND Research shows that the organization of home-based care rarely allows opportunities to provide support to family caregivers in practice. However, how these organizational structures influence the way in which healthcare personnel perceive their interactions with family caregivers of people with dementia from minority ethnic backgrounds remains an unexplored area. DESIGN An explorative qualitative study inspired by a critical realist approach using Pierre Bourdieu's theoretical concepts of field, habitus and capital. METHODS Data were collected through individual semi-structured interviews with six nurses and four auxiliary nurses employed in home-based care in Norway. The data were analysed using a thematic analysis approach. The participants were recruited in September and October 2020. FINDINGS 'Family caregivers perceived as facilitators of or barriers to collaborative care' was identified as an overarching theme, supported by two main themes: 'Preconditions for successful collaboration' and 'Challenges for collaborative relationships'. The findings revealed that the participants mainly focused their attention on the dementia patients from minority ethnic backgrounds, while they felt that the family caregivers influenced the way in which they provided healthcare. CONCLUSIONS The findings demonstrate that timesaving strategies have a major influence on healthcare personnel's perceptions of family caregivers from minority ethnic backgrounds. Attention towards the needs of the family caregivers was often replaced by evaluations of their usefulness in the provision of healthcare to the dementia patients. IMPACT This study raises concerns about home-based care as a rigid and inflexible system. It therefore provides opportunities to raise questions on status quo, stimulate debate and encourage fresh thinking with regards to the support and inclusion of family caregivers in the home-based care system for people with dementia from minority ethnic backgrounds.
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Affiliation(s)
- Ragnhild Gulestø
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Jäger SC, Filbert AL, Welchowski T, Weltermann B. Effects of the dementia care toolbox on personnel's self-reported confidence in patient care: a CRT in general practices. BMC FAMILY PRACTICE 2021; 22:231. [PMID: 34789149 PMCID: PMC8597294 DOI: 10.1186/s12875-021-01577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
Background In rapidly aging populations, general practitioners (GPs) are challenged in dementia care of patients with and without migration background. Uncertainties in treating dementia in migrant patients due to language barriers or information deficits are reported. To address these deficits, we developed the Dementia Care Toolbox which was judged helpful by GP practice personnel. This two-armed cluster-randomised trial (CRT) investigated the effects of this toolbox on German GPs’ and practice assistants’ (PrAs) attitudes and confidence in dementia care, especially in patients with migration background. Methods A total of 32 GP practices were recruited and randomised into intervention (toolbox use for 3 months) and waiting-list control (toolbox after follow-up). After 3 months all participating GPs and PrAs received a standardised questionnaire addressing their levels of self-reported confidence in dementia care for patients with and without migration background. A generalized estimating equation model that took practice cluster effects into account was applied to assess GPs and PrAs self-reported confidence in dementia care in patients with and without migration background. Results Overall, the intervention had no significant effect on self-reported confidence in dementia care. However, the use of the dementia care toolbox showed a tendency for a learning effect on knowledge about local support structures for migrant patients with dementia (odds ratio 1.43; 95% CI 0.68-3.03, p = 0.35) and for less communication difficulties with dementia patients in general (odds ratio 0.72; 95% CI 0.33-1.56; p = 0.40). Moreover, intervention practices showed a tendency towards more awareness of own limitations: less self-confidence regarding answering questions (odds ratio 0.82; 95% CI 0.36-1.86, p = 0.64) and providing information for patients with migration background (odds ratio 0.60; 95% CI 0.25-1.45, p = 0.26). Conclusion The Toolbox Dementia Care increased awareness on the respective topic. Given a small sample size, further studies on its effectiveness in primary care are needed. Trial registration German Clinical Trials Register, DRKS00014632. Registered 02/08/2018.
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Affiliation(s)
- Sabine Christine Jäger
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Anna-Liesa Filbert
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Welchowski
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Migrants’ pathways to aged care: the role of local relationships of care in facilitating access for super-diverse older populations. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The literature on older migrants often focuses on identifying the characteristics of ethnic groups that constitute ‘barriers’ for members of these populations to access care. This paper offers an alternative conceptualisation of access to care, by combining relational approaches to place and the notion of super-diversity. From this perspective, ‘access to care’ is perceived as an outcome of an individual's embeddedness in relationships of care in urban places. The objective of the study is to identify relationships of care that facilitate access to aged care for older first-generation migrants. Thirty-two semi-structured interviews were conducted with older migrants who were residents of Nijmegen or The Hague, The Netherlands. All interviewees had accessed home care, home aid and/or day care. Both relationships with minority-specific services and informal relationships of care, particularly those within local minority communities, were found to facilitate access to aged care. Past experiences with health and social care were also found to influence current relationships with formal care providers. This study, therefore, suggests that policy makers and care organisations should build long-term positive relationships with new and incoming migrant groups. In addition, it argues that policy makers and care providers should identify locally relevant shared migration-related (rather than ethnic) identities around which communities can be mobilised and targeted with appropriate services.
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Abstract
OBJECTIVE We assessed long-term incidence and prevalence trends of dementia and parkinsonism across major ethnic and immigrant groups in Ontario. METHODS Linking administrative databases, we established two cohorts (dementia 2001-2014 and parkinsonism 2001-2015) of all residents aged 20 to 100 years with incident diagnosis of dementia (N = 387,937) or parkinsonism (N = 59,617). We calculated age- and sex-standardized incidence and prevalence of dementia and parkinsonism by immigrant status and ethnic groups (Chinese, South Asian, and the General Population). We assessed incidence and prevalence trends using Poisson regression and Cochran-Armitage trend tests. RESULTS Across selected ethnic groups, dementia incidence and prevalence were higher in long-term residents than recent or longer-term immigrants from 2001 to 2014. During this period, age- and sex-standardized incidence of dementia in Chinese, South Asian, and the General Population increased, respectively, among longer-term immigrants (by 41%, 58%, and 42%) and long-term residents (28%, 7%, and 4%), and to a lesser degree among recent immigrants. The small number of cases precluded us from assessing parkinsonism incidence trends. For Chinese, South Asian, and the General Population, respectively, prevalence of dementia and parkinsonism modestly increased over time among recent immigrants but significantly increased among longer-term immigrants (dementia: 134%, 217%, and 117%; parkinsonism: 55%, 54%, and 43%) and long-term residents (dementia: 97%, 132%, and 71%; parkinsonism: 18%, 30%, and 29%). Adjustment for pre-existing conditions did not appear to explain incidence trends, except for stroke and coronary artery disease as potential drivers of dementia incidence. CONCLUSION Recent immigrants across major ethnic groups in Ontario had considerably lower rates of dementia and parkinsonism than long-term residents, but this difference diminished with longer-term immigrants.
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