Intercultural care for people of migrant origin with dementia

Abstract

Background

Close to 12 million people of migrant origin who are 65 years or older live in different European countries. In the European Union (EU) and the European Free Trade Association (EFTA) countries, approximately half a million are estimated to have dementia. This rate is expected to increase in the coming decades. People of migrant origin who develop dementia and their families face challenges people without migration backgrounds do, but due to cultural differences, additional challenges may arise. There is an increasing need for interculturally sensitive care. There is research on certain aspects of intercultural care and this study will be a comprehensive summary of current topics in intercultural care.

Research question

What factors of intercultural care for people of migrant origin with dementia can be identified? What requirements and aspects are necessary to ensure intercultural care?

Method

A systematic literature analysis in the databases PubMed, PsycInfo and Psychology and Behavioural Sciences Collection was conducted.

Findings

Thirty-nine articles were eligible for analysis. Enhancement in the areas diagnostics, education and information, healthcare services and healthcare professionals to ensure intercultural care is needed.

Discussion

Current evidence supports the need for (a) thorough education of people of migrant origin with dementia, their families and healthcare professionals, (b) collaborations among everyone involved, (c) embracing different cultures in healthcare services, (d) the implementation of a care navigator functioning as a contact person and connecting all relevant parties with one another and (e) dementia testing suitable to the target group to ensure culturally sensitive and appropriate care for people of migrant origin with dementia and their families.

Keywords

dementia healthcare intercultural care migration ethnicity culturally sensitive care

Introduction

The Migration Data Portal shows that in 2019, 82.3 million people of migrant origin lived in different European countries. A total of 14.4% of this population is older than 65 years, which amounts to approximately 11,851,200 people (International Organization for Migration, 2020). Due to demographic changes, this number will increase in the future. With it, there will be an increase in age-associated illnesses, such as dementia. A recent analysis of EU and EFTA countries shows that of 7,633,718 people of migrant origin 65+, approximately 480,000 people are expected to have dementia (Canevelli et al., 2019). Estimations suggest that the number of people of migrant origin with dementia will increase over the coming decades (APPGD, 2013; Nielsen et al., 2015; Schouler-Ocak, Aichberger, Penka, Kluge, & Heinz, 2015). People of migrant origin with dementia and their families face challenges similar to those of the population without migration background (Bowes & Wilkinson, 2003; Monsees et al., 2020), for instance increasing isolation, feelings of burden and strain due to caregiving (Bowes & Wilkinson, 2003; Hossain, Stores, Hakak, & Dewey, 2019; Lawrence, Murray, Samsi, & Banerjee, 2008; Mackenzie, 2006; Parveen, Peltier, & Oyebode, 2017). There have been reports of additional or increased challenges associated with migration background or culture. For example people of migrant origin with dementia experience language problems because of a language barrier (Berdai-Chaouni & de Donder, 2019; Sagbakken, Spilker, & Ingebretsen, 2018; Tillmann et al., 2019) and when they develop dementia, people start to revert to their primary language and use the acquired language of the destination country less (McMurtray, Saito, & Nakamoto, 2009; Mendez, Perryman, Pontón, & Cummings, 1999). In addition, there is a lack of knowledge among people of migrant origin about dementia (Parveen et al., 2017; Purandare, Luthra, Swarbrick, & Burns, 2007; van Wezel et al., 2018) and which healthcare services are available and can help (Bowes & Wilkinson, 2003; Kenning, Daker-White, Blakemore, Panagioti, & Waheed, 2017; Mukadam, Waugh, Cooper, & Livingston, 2015). There are also challenges on the structural level, like obtaining a timely and appropriate diagnosis and/or access healthcare services, which result in less utilisation (Bowes & Wilkinson, 2003; Diaz, Kumar, & Engedal, 2015; Kenning et al., 2017; Nielsen et al., 2015; Pham et al., 2018). Existing tests are often unsuitable for assessing people of migrant origin as they are developed to test the majority population (Teng & Manly, 2005) and there is a lack of culturally sensitive and adequately suited healthcare services (Beattie, Daker-White, Gilliard, & Means, 2005; Mukadam et al., 2015; Nielsen et al., 2015). This indicates that people of migrant origin with dementia and their families are not optimally educated about the healthcare system, its services and the help they could get and are not receiving optimal support.

In view of these challenges and the increasing number of people affected, interculturally sensitive care is all the more important. To provide such care, health systems and healthcare providers should respond appropriately to this population by integrating them more efficiently into the help and support system and be more responsive to the needs of culturally diverse populations. The aim of this paper is to identify aspects of intercultural care for people of migrant origin with dementia and point out requirements and factors necessary to ensure intercultural care. Identifying these factors and aspects could help healthcare professionals and providers gain more confidence in their interactions with people of migrant origin with dementia and tailor their services to this vulnerable population. This is in line with a study that provides a broad overview of different aspects of caring for people of migrant origin with dementia, such as awareness-raising in migrant communities, access to healthcare, culturally sensitive care and calls for action in these areas (Schmachtenberg, Monsees, & Thyrian, 2021).

Methods

A systematic literature analysis was conducted by consulting the databases PubMed, APA PsycInfo and Psychology and Behavioural Sciences Research to find relevant literature. The search was conducted on 14 May 2020, and search terms included ‘dementia’ and ‘care’ in combination with ‘migration’ or ‘immigrant’ or ‘ethnic minority’. These search terms were used to ensure a wide range of articles that focus on healthcare for people of migrant origin with dementia. Three different terms for people of migrant origin were used because in the international literature, different terms are used, and searching with these different terms ensured that fewer articles that refer to this population would be missed. The search was restricted to the titles and abstracts of the articles. Exclusion criteria were publication date before 01.01.2000, language other than English or German, reviews and articles that were not original research and articles that did not address care-related improvements for people of migrant origin with dementia. These exclusion criteria aimed to ensure that only articles that could contribute to the aim of this study would be included in the final analysis. The articles that were chosen for the final analysis were read in their entirety, and text elements were coded. Inductive coding was performed based on Mayring (2014). That means categories for the category system were derived from the articles that are included in this analysis. For this purpose, half of the articles were read to identify categories and subcategories. When no new categories or subcategories could be found, all of the articles were read and coded according to the category system (see Figure 1). The categories that initially emerged were basic conditions, understanding of culture, food preferences, bicultural/bilingual workers, trust, cultural preferences, cultural competence, language, support, missing/improvable healthcare services, cultural music, newspapers and television, diagnostic tools, translator/interpreter, testing, training/education for healthcare professionals, educating the family, educating people of migrant origin with dementia, information, collaboration with families, collaborations with other professionals and avoiding stereotypes. Those categories were then merged into four main categories: (a) diagnostics; (b) education/information; (c) healthcare professionals and (d) healthcare services. The basic category conditions were so diverse that they could be subordinated to three of the four main categories. Healthcare services involved in inpatient care (e.g. nursing homes), outpatient care (e.g. mobile nursing service), support groups, information offers and similar services. The group of healthcare professionals included GPs, nurses, professional caregivers and other professionals who work in healthcare services.

Figure 1.

Category system.

Literature search

The initial literature search yielded 233 findings. After excluding duplicates, 147 articles remained. The abstract and title screening eliminated 93 articles. Those were articles that were published before 2000, were written in a language other than English or German or did not focus on people with dementia, people of migrant origin or healthcare in people of migrant origin with dementia. Therefore, 54 articles were included in the full text screening in which another 15 articles did not meet the inclusion criteria, making 39 articles eligible for analysis.

Findings

Diagnostic

With increased dementia screening and referrals to acute care comes timelier diagnosis and treatment (McCleary et al., 2013; Vissenberg, Uysal, Goudsmit, van Campen, & Buurman-van Es, 2018; Xiao, Habel, & de Bellis, 2015). A timely dementia diagnosis can lead to earlier intervention, which can help to prevent comorbidities, prolong admission to residential care and minimise hospitalisation (La Fontaine, Ahuja, Bradbury, Phillips, & Oyebode, 2007). There is a need for culturally sensitive tests that include language- and culture-independent validated diagnostic tools (Berdai-Chaouni & de Donder, 2019; Tillmann et al., 2019; Vissenberg et al., 2018). Borson et al. (2006) point out that sociodemographic factors influence the recognition of cognitive impairments and suggest the Mini-Cog as a tool that is mainly free of bias from demographic variations and false-positive classifications. Sagbakken, Spilker and Nielsen (2018) on the other hand, recommend using the Rowland Universal Dementia Assessment Scale (RUDAS), as it diminishes the ‘effects of cultural learning and language diversity when assessing general cognitive functioning’. Different studies point out the presence of an interpreter or an intercultural mediator as a useful help (Berdai-Chaouni & de Donder, 2019; Tillmann et al., 2019). Morgan & Crowder (2003) observed that it would be helpful to test bilingual patients in both languages, and the better test result should be regarded as reliable. When in contact with older adults with migration backgrounds, it might be helpful for healthcare professionals to be extra wary of dementia. In addition to the individuals themselves, family members should be interviewed discreetly about any changes that they have noticed when they are talking to the patient and family caregivers (McCleary et al., 2012).

Education and information

Knowledge, training and awareness about dementia and the need for care for people of migrant origin must be enhanced (Berdai-Chaouni & de Donder, 2019; Hossain & Khan, 2020; McCleary et al., 2012; Mogar & von Kutzleben, 2015; Vissenberg et al., 2018; Xiao et al., 2015), and it is crucial to educate healthcare professionals and dementia services (Hossain & Khan, 2020; La Fontaine et al., 2007; S. E. Lee, Casado, & Hong, 2018; Regan, 2016; Vissenberg et al., 2018; Xiao et al., 2015).

People of migrant origin and family caregivers.

The families of people of migrant origin with dementia need to have early access to education, information and resources, that come from trusted sources and are culturally appropriate (Gillespie, Harrison, & Mullan, 2015; Lawrence et al., 2008; McCleary et al., 2012). Xiao et al. (2015) showed in their study of Vietnamese family caregivers that culturally and linguistically appropriate dementia education programmes improve caregivers’ dementia health literacy and therefore their self-efficacy, skills in handling dementia and deploying healthcare services. The educational needs of people of migrant origin with dementia and their family caregivers include information about dementia, including its etiology, the condition, the course of the disease, the prognosis (Nielsen & Waldemar, 2016; Regan, 2016; Vissenberg et al., 2018), symptom and stress management, its treatment, medication and medication management and nutritional requirements (Casado, Lee, Hong, & Hong, 2015; Gillespie et al., 2015; Regan, 2016). The ‘importance and urgency of receiving timely clinical assessments and appropriate treatments’ (Casado et al., 2015) should be highlighted, as should how to maximise the search for help and minimise stigma (Nielsen & Waldemar, 2016), which includes receiving information on healthcare services and how to use them (Boughtwood et al., 2011; Casado et al., 2015; Lawrence et al., 2008; S. E. Lee et al., 2018; Regan, 2016; Vissenberg et al., 2018). Family caregivers need to know medical devices and/or supplies they could use and financial compensation for these (Vissenberg et al., 2018). Education on communication, person-centred care, personal care skills and altering family caregivers’ expectations of people of migrant origin with dementia should be provided. It might be helpful to teach family caregivers about identifying and removing triggers of behavioural and psychological symptoms of dementia (BPSD) (Xiao et al., 2015). Family caregivers should be empowered not to isolate themselves and should receive information about sharing care (Ahmad, van den Broeke, Saharso, & Tonkens, 2020; Regan, 2016). It should be made clear that self-care is essential for family caregivers, and utilising healthcare services that support families’ recovery ultimately helps people of migrant origin with dementia (Boughtwood et al., 2011; Lawrence et al., 2008). If the family has concerns about nursing homes, these should be discussed to provide relief of unfounded fears by stressing the benefits, such as the professional care they can provide (Caldwell, Low, & Brodaty, 2014). It would also be helpful if healthcare professionals point out alternative information sources, that is CDs, DVDs and websites (Gillespie et al., 2015). Cultural beliefs about dementia hindering help-seeking must be addressed, that is that home placement means deserting the person with dementia (Caldwell et al., 2014) or that help-seeking is shameful (Herat-Gunaratne et al., 2020). It should also be made clear that planning care does not equate to treachery or failing one’s duty but could be beneficial to everyone involved (Mukadam, Cooper, Basit, & Livingston, 2011).

Education must be culturally sensitive, presented in easily understood language and supply culturally appropriate materials for people of migrant origin with dementia, their families and the community in different languages and different formats, for example visual presentations, such as DVDs (Gillespie et al., 2015; La Fontaine et al., 2007; Tillmann et al., 2019; Vissenberg et al., 2018).

Healthcare professionals.

Educating general practitioners (GPs) about people of migrant origin with dementia and training them to have greater cross-cultural competence – including experience with the use of culturally sensitive tools – and greater proficiency in offering culturally appropriate care can improve the ability to provide timely diagnosis, treatment and care. This could lead to people of migrant origin with dementia and their family caregivers obtaining information und utilising healthcare services (Hossain & Khan, 2020; Sagbakken, Spilker, & Nielsen, 2018; Xiao et al., 2015). Chow et al. (2000) point out that the enhancement of a dementia diagnosis could lead to an increased number of referrals. The literature highlights different important ways to educate healthcare professionals so that they are knowledgeable about their options (Tillmann et al., 2019). Education should include information on epidemiology, early signs and symptoms, use of cross-cultural diagnostic tools and guidance for risk reduction (Sagbakken, Spilker, & Nielsen, 2018; Tillmann et al., 2019; Vissenberg et al., 2018; Xiao et al., 2015). Healthcare professionals need information on how to treat affected people (Tillmann et al., 2019) and how to guide interventions after a dementia diagnosis is made, which include, for instance interventions for challenging behaviour (Sagbakken, Spilker, & Nielsen, 2018; Xiao et al., 2015) and providing culturally sensitive dementia care (Vissenberg et al., 2018). They need to know specialised services for people of migrant origin with dementia and their family caregivers and regional services that are offered in other languages (Regan, 2016; Tillmann et al., 2019). Healthcare professionals need to be trained in verbal and nonverbal communication skills (Sagbakken, Spilker, & Nielsen, 2018; Söderman & Rosendahl, 2016; Vissenberg et al., 2018; Xiao et al., 2015) and in dealing with cultural challenges and barriers, such as language barriers (Tillmann et al., 2019). They need to be made aware of difficulties in their interactions with people of migrant origin (Tillmann et al., 2019). Furthermore, there is a need to educate them about cultural differences in handling dementia and wrong assumptions they might make. For instance Næss and Moen (2015) point out the assumption that Muslim immigrants will be cared for solely by their families has a ‘mythical dimension’ that perpetuates the belief that they do not accept formal help. Additionally, the potential disadvantages of consulting nonprofessional interpreters need to be addressed (Tillmann et al., 2019). Healthcare professionals have indicated a desire to have an overview of available organisations that provide culturally sensitive care (Vissenberg et al., 2018). Hossain and Khan (2020) note that written care guidelines and care plans for people of migrant origin with dementia would be helpful for healthcare professionals who are not culturally or religiously experienced or skilled. Regarding how to provide education to healthcare professionals, Lee et al. (2018) found that dementia care workers favour written material over interactive elements as well as short and recurring sessions over day-long sessions.

Basic conditions.

Culturally and linguistically appropriate programmes and information for family caregivers can help increasing their capacity for taking care of a person with dementia (Xiao et al., 2015). Education works when bicultural/bilingual workers deliver it because they are able to challenge some of the communities’ traditional ways of thinking, which leads to an increase in the utilisation of healthcare services (Boughtwood et al., 2011; Xiao et al., 2015). It is worth considering having social and healthcare workers offer education in religious institutions initiated by the leader of that institution. Doing so could help to overcome the stigma associated with mental health problems and could lead to increased social support, decreased strain and self-isolation (Regan, 2016; Sagbakken, Spilker, & Nielsen, 2018). It is imperative to develop and implement public outreach that is suited for the target group (Herat-Gunaratne et al., 2020; McCleary et al., 2012; Piechotta & Matter, 2008). Outreach activities aimed at the community, such as immigrant organisations or senior centres, may generate further awareness and acknowledgement of dementia as an illness (Sagbakken, Spilker, & Nielsen, 2018; States, Susman, Riquelme, Godwin, & Greer, 2006). GPs and other stakeholders can initiate public campaigns, community approaches or other possible ways of gaining information (Vissenberg et al., 2018). To reach people of migrant origin with dementia and their families and change thoughts about dementia and care, Xiao et al. (2015) suggest using local radio and newspapers. Health promotion also needs to be communicated in a culturally sensitive way, and it is best to relay these messages in the community and the hospitals that are mostly frequented by people of migrant origin (La Fontaine et al., 2007). It is worth considering the translation of established education programmes into different languages (Xiao et al., 2015). A consideration of the formats through which education is provided is an important factor. The literature suggests that websites, online communities and apps can be helpful resources (Chiu et al., 2009; J.-L. Lee et al., 2017; Pagán-Ortiz, Cortés, Rudloff, Weitzman, & Levkoff, 2014).

Healthcare professionals

To support access to culturally sensitive services, there is a need to increase competence in responding to the needs of immigrant patients with dementia and to hold sensitive discussions and debates about culture, religious beliefs and values under circumstances that allow them to be addressed in a way that does not undermine the culture of people of migrant origin (Herat-Gunaratne et al., 2020; Hossain & Khan, 2020; Sagbakken, Spilker, & Nielsen, 2018).

Acknowledging the culture.

Healthcare professionals need to know more about and should recognise and respect cultural values and religious beliefs of people of migrant origin with dementia and how these influence health behaviour (Berdai-Chaouni, Smetcoren, & de Donder, 2020; Caldwell et al., 2014; Casado et al., 2015; Hossain & Khan, 2020). For instance Casado et al. (2015) note that help-seeking behaviour among Asian Americans is affected by a sense of shame. Determining factors such as ethnicity, first language, usual behaviour and favourite foods could help professionals gain knowledge of the patient and culture (Kong, Deatrick, & Evans, 2010). It is important to avoid generalisations and stereotypes (Jutlla, 2015; La Fontaine et al., 2007). Initiating an open dialogue about the care needs and condition of people of migrant origin with dementia is necessary to build trust (Sagbakken, Spilker, & Ingebretsen, 2018; Sagbakken, Spilker, & Nielsen, 2018; Vissenberg et al., 2018).

Collaboration.

GPs are a source of information, support and guidance for people of migrant origin with dementia and their families (Gillespie et al., 2015; La Fontaine et al., 2007). They can raise awareness of dementia and build trust with people of migrant origin (Vissenberg et al., 2018). The importance of such collaborations with healthcare professionals (Tezcan-Güntekin, 2018; Vissenberg et al., 2018) and among people of migrant origin with dementia, their families and healthcare professionals is mentioned throughout the literature (Casado et al., 2015; Gillespie et al., 2015; Lawrence et al., 2008; Sagbakken, Spilker, & Ingebretsen, 2018). The encouragement of a ‘strong collaboration between primary organisations, specialised memory clinics, and governmental organizations’ is needed ‘to optimise healthcare, to strengthen the provision of information, to enhance the availability of culturally sensitive facilities and to invest in the training and education of professionals’ (Vissenberg et al., 2018). It is helpful for healthcare professionals to work closely with other professionals who care for/work with people of migrant origin with dementia and their families (Vissenberg et al., 2018; Xiao et al., 2015). The use of interprofessional case analysis can support the development of culturally and diversity-sensitive attitudes among professionals (Tezcan-Güntekin, 2018). Collaborations could assist in monitoring behaviour and symptoms over the course of the disease and support ongoing discussions among healthcare professionals, family members and the person of migrant origin with dementia (Sagbakken, Spilker, & Nielsen, 2018). Just as important as working with other healthcare professionals is collaborating with the families. It is necessary for healthcare professionals to work with every involved family member and not just the primary family caregiver (La Fontaine et al., 2007; Lawrence et al., 2008). Lawrence et al. (2008) note that this is especially important since siblings, spouses and children play a central role in the formation of the caregiver’s mindset regarding caregiving. When involving the family, it is necessary to assess family relationships, care expectations, family dynamics and role conflicts (Casado et al., 2015). Collaboration helps to avoid undermining the strong ethos of self-help and family help (La Fontaine et al., 2007) and could make it easier to provide better and more consistent care (Sagbakken, Spilker, & Ingebretsen, 2018).

Basic conditions

Healthcare professionals need room for flexibility and collaborations with family caregivers. To guarantee that time is available, structurally supportive policies and organisational measures are necessary (Berdai-Chaouni et al., 2020), as are efforts to build relationships with family caregivers and formal caregivers (Berdai-Chaouni & de Donder, 2019). Bilingual healthcare professionals could assist family caregivers in utilising healthcare services (Xiao et al., 2015) and play an important role in facilitating communication (Rosendahl, Söderman, & Mazaheri, 2016). Söderman et al. (2018) suggest that when it is not possible to have bilingual staff available, ‘assistant nurses have an increased responsibility and commitment to a resident and thus learn to interpret the resident’s needs and desires’. Gillespie et al. (2015) point out that healthcare professionals should consult interpreter services (if available) when disseminating information and recommendations.

Healthcare services

Culture

It is necessary to promote cultural competence in healthcare services (Berdai-Chaouni & de Donder, 2019; Boughtwood et al., 2011; Herat-Gunaratne et al., 2020) and to have an understanding of the health beliefs and behaviour of people of migrant origin with dementia and how factors affect these health beliefs (La Fontaine et al., 2007). Dementia care services need to be transparent and ‘culture-, religion- and migration-sensitive’ whilst still maintaining an individualised care strategy (Berdai-Chaouni & de Donder, 2019; Caldwell et al., 2014; Casado et al., 2015; Hanssen & Kuven, 2016; Jutlla, 2015; Lawrence et al., 2008; S. E. Lee et al., 2018; Mogar & von Kutzleben, 2015; Söderman & Rosendahl, 2016; Vissenberg et al., 2018); for instance individuals from some cultures prefer to be cared for by providers of the same sex (Hossain & Khan, 2020; Mogar & von Kutzleben, 2015). Boughtwood et al. (2011) note that ‘having an understanding of the culture was as important as language abilities’. Herat-Gunaratne et al. (2020) point out that for some, it is more important that home caregivers respect and understand the cultural background of a person of migrant origin with dementia and their family than sharing the same ethnic background, whilst other studies found that a shared cultural background is essential (Casado et al., 2015; S. E. Lee et al., 2018; Rosendahl et al., 2016). If services could employ bicultural or bilingual workers or workers from the same culture or country as their patients, they would provide a service that is suited for the needs of people of migrant origin with dementia and their family caregivers (Boughtwood et al., 2011; Caldwell et al., 2014; Herat-Gunaratne et al., 2020) because those caregivers could initiate communication and enhance the patients’ wellbeing (Kong et al., 2010). They could act as liaisons between the ethnic community and healthcare services, offer education and information and refer people to appropriate services. They could also help in translating brochures and communicating with services (Boughtwood et al., 2011). Bicultural/bilingual workers are also preferred by some family caregivers (Casado et al., 2015). Lee et al. (2018) suggest looking for potential dementia care workers in ethnic communities, as they could be able to provide culturally sensitive care. The language barrier is an often-mentioned factor that could be overcome by recruiting bicultural/bilingual workers but also by employees learning a few shared words, applying clear nonverbal communication and using easy language (Cooper et al., 2018; Rosendahl et al., 2016; Söderman & Rosendahl, 2016), as Söderman and Rosendahl (2016) report in their study of a Swedish-speaking nursing staff in a group home in Sweden. The nursing staff wished to learn some essential words in the languages of people of migrant origin (Söderman & Rosendahl, 2016). The families of people of migrant origin with dementia could be a source for learning some words in the language of people of migrant origin with dementia, and thoughtful planning of the shifts of staff members who speak the language of people of migrant origin with dementia could be worth considering (Cooper et al., 2018). Language is an important factor in promoting contact with people of migrant origin, creating a feeling of togetherness, and identifying cultural values and traditions; it is used to affect and convey emotions and memories (Boughtwood et al., 2011; Hossain & Khan, 2020; Söderman & Rosendahl, 2016; Söderman et al., 2018). It also helps group homes run their business smoothly and has a positive effect on the person with dementia as they accommodate to their new surroundings. Communication in their native language can improve the mood of people of migrant origin, increase their activity level, and decrease their anxiety and their prescriptions for sedative drugs (Söderman & Rosendahl, 2016). Rosendahl, Söderman and Mazaheri (2016), as well as Söderman & Rosendahl (2016), note that residents in group homes are appreciative when they can listen to music in their mother tongue, and access to cultural elements on the radio, in the newspaper and on TV creates a feeling of togetherness. Hanssen and Kuven (2016) point out that traditional food ‘creates a feeling of belonging and joy in the lives of patients with dementia’. Other studies confirm that people of migrant origin with dementia and their families prefer and appreciate having traditional foods served (Caldwell et al., 2014; Hossain & Khan, 2020; Kong et al., 2010; Rosendahl et al., 2016). When traditional foods are served, the appetite of the person with dementia improves and they eat more, which helps them avoid undernutrition (Hanssen & Kuven, 2016; Söderman & Rosendahl, 2016). It also facilitates interactions and makes people of migrant origin with dementia feel respected and more calm (Hanssen & Kuven, 2016).

Which healthcare services are needed.

Different care options, interventions and initiatives that address culture and communication are mentioned throughout the literature. These could help to break down negative opinions regarding healthcare services and build rapport with and understanding of the healthcare system among affected people of migrant origin (Hossain & Khan, 2020). These include multi-lingual low-threshold regional information and consultation services (Piechotta & Matter, 2008; Tezcan-Güntekin, 2018; Tillmann et al., 2019), culturally relevant support groups/services and psychosocial interventions in different languages, all of which give family members the opportunity to obtain information and support, alleviate caregiver burden and stress and provide opportunities to exchange experiences (Casado et al., 2015; Gillespie et al., 2015; Herat-Gunaratne et al., 2020; Tezcan-Güntekin, 2018; Vissenberg et al., 2018). There is a need for networks, including caregiver networks where family caregivers can get together to socialise and share their emotions (Boughtwood et al., 2011) and networks for people with dementia that provide information about available healthcare services and how to utilise them (Regan, 2016). There is a need for culturally sensitive care institutions, such as nursing homes, day care facilities and home- and community-based services (Casado et al., 2015; Næss & Moen, 2015; Vissenberg et al., 2018; Xiao et al., 2015) as well as specialised memory clinics (Tillmann et al., 2019; Vissenberg et al., 2018). Linguistically appropriate services can minimise barriers to accessing those services (Xiao et al., 2015), as can the use of online interpreting services and other technology solutions that help with language barriers (Cooper et al., 2018). Family caregivers express the desire for services that provide care for people of migrant origin with dementia whilst the caregivers use the service (Piechotta & Matter, 2008). They would also prefer services that are nearby (Caldwell et al., 2014). Söderman & Rosendahl (2016) suggest when it is not feasible to create group homes for single ethnicities, professional caregivers of various ethnicities should be recruited and consulted when their expertise is required. The need for a care coordinator – a professional who is aware of existing healthcare services, has knowledge of the healthcare system and acts as a facilitator to connect people of migrant origin with dementia and their family caregivers with healthcare services and is a consistent contact person for everyone involved – is also mentioned (Vissenberg et al., 2018).

Basic conditions.

Services must be organised in a way that enables employees to collaborate with family caregivers, allows them flexibility (Berdai-Chaouni & de Donder, 2019) and provides care alternatives that consider cultural and individual needs (Söderman & Rosendahl, 2016). Another important factor is continuity of care. Regular changes in the people who work with people of migrant origin with dementia and their families lead to inconsistent care provision and confusion and fear in the person with dementia. It also hinders healthcare professionals’ ability to learn about the people with dementia, monitor their cognitive development and read and interpret their body language (Hossain & Khan, 2020; Kong et al., 2010; Mukadam et al., 2011; Regan, 2016; Sagbakken, Spilker, & Nielsen, 2018; Söderman & Rosendahl, 2016). Vissenberg et al. (2018) suggest that practice-based nurse specialists help with these issues. Furthermore, there is a need for professional translators, tools that support dialogues about care needs with people of migrant origin with dementia and their family caregivers, and active home-care organisations (Vissenberg et al., 2018). A need for further utilisation and integration of dementia teams and coordinators in primary healthcare was identified. Such teams and coordinators could work closely with GPs and perform examinations of people of migrant origin with dementia in their homes (Sagbakken, Spilker, & Nielsen, 2018).

Trust and support.

Building trust among people of migrant origin with dementia, their families and service providers is important (Regan, 2016). Getting to know the person who is caring for their loved one with dementia helps family caregivers build trust (Boughtwood et al., 2011; Hossain & Khan, 2020). Regan notes that to build rapport between people of migrant origin and service providers, home visits may be preferable over visits to healthcare services (Regan, 2016). Being there for family caregivers when issues arise or when they need support is important, and practical support could be provided by making regular phone calls, offering tips on care and financial assistance and providing case management or home visits (Boughtwood et al., 2011; Chow et al., 2000; Lawrence et al., 2008). It is important to make clear that services are meant to provide support for caring for the person with dementia and are not meant to replace family care (Herat-Gunaratne et al., 2020; Lawrence et al., 2008). Such information could help to increase acceptance and utilisation of professional care (Tezcan-Güntekin, 2018).

Discussion

The aim of this systematic literature analysis was to identify factors related to intercultural care for people of migrant origin with dementia and point out requirements and aspects needed to ensure intercultural care. Important aspects that were identified in this analysis are an awareness of the culture of people of migrant origin with dementia and their families and the need to ensure that healthcare services are capable of caring for them in a culturally appropriate manner. Thorough education of people of migrant origin with dementia and their families and healthcare professionals is essential, as is collaboration among professionals and between professionals and people of migrant origin with dementia and their families. These factors can benefit affected people as well as healthcare professionals. Berdai-Chaouni et al. (2020) found in their study that professional caregivers are afraid of being accused of racism and are insecure in their interactions with people of migrant origin with dementia and their family caregivers. Appropriate education could help to alleviate these concerns, decrease stereotyping and contribute to fruitful interactions and collaborations between healthcare professionals and people of migrant origin with dementia and their families. Education and information have an impact on healthcare professionals, making them better prepared for and more adept at providing culturally sensitive care. Healthcare services would benefit by being able to provide culturally sensitive approaches and being more aware of different cultures. People of migrant origin and their families would receive better information about dementia, self-help and self-care, healthcare services and support. Healthcare professionals and affected people also expressed the need for information about available healthcare services. To address that need, brochures for healthcare professionals and for people of migrant origin with dementia and their families should be created and disseminated to all healthcare professionals as well as migrant organisations, religious institutions and community centres. Furthermore, more public outreach should be initiated, as should advertising of information and support sources. Online education also broadens the reach of information, provided that it is well advertised in the right places and suits the needs of the target group, and increases the opportunity for others to be inspired by such actions and implement them elsewhere. It is important to point out the digital divide: There is evidence that people of migrant origin are less likely to have their own computer and/or access to the internet (Fairlie, 2014; Hutchings, Sheppard, & Jisc, 2021). Despite this circumstance, it would be helpful to provide an online platform for people of migrant origin and their family caregivers and one for healthcare professionals with information, materials and an overview of organisations and institutions that offer culturally sensitive care. Such platforms could give healthcare professionals help in supporting people of migrant origin with dementia and their families and access to helpful information, whilst people of migrant origin with dementia and their family caregivers – with access to a computer and internet – could find information on the condition, what to do next and where to find help. The presence of bicultural/bilingual workers or workers from the same culture in services was mentioned in the literature as a measure for offering culturally sensitive care. Of course, it is helpful if people working in those services know the culture and/or speak the language of people of migrant origin with dementia, but they should also be informed about dementia and caregiving to ensure that they are prepared to interact not just with people of migrant origin, but specifically people of migrant origin with dementia. This analysis also notes that bicultural/bilingual workers may not only serve as a link between the ethnic community and healthcare services; they may also provide education and information and help to translate brochures and provide translation during interactions with healthcare services. For professional caregivers working in healthcare services, this might be a heavy burden in addition to their normal workload. Instead of having bicultural/bilingual workers perform all of those additional jobs, it might be worth hiring a specialist to perform them. That way, bicultural/bilingual workers who undertake care tasks and interact with people of migrant origin with dementia and their families can avoid being overwhelmed with an additional workload. Additionally, culturally sensitive diagnostic tools such as the Mini-Cog or the RUDAS need to be implemented more frequently. Another way to ensure an interculturally appropriate approach to diagnostics could be for hospitals, GPs and medical practices to develop an anamnesis and testing procedure for use with people of migrant origin with dementia that offers a structured protocol for performing tests (e.g. using culturally sensitive screening instruments like the RUDAS) but also leaves room to tailor the process to individual person of migrant origin (e.g. consulting with a translator in an assessment situation if needed). Another frequently mentioned option for improving culturally sensitive care is the care navigator. Previous research has highlighted that a care navigator/culture broker can be very helpful in connecting people of migrant origin (with dementia) and their families with the healthcare system. These individuals have extensive knowledge of culturally specific views on illness and health, traditional customs and fears. In a best-case scenario, this care navigator is from the same culture as the affected person of migrant origin, but when this is not feasible, it is important that the care navigator has a thorough knowledge and understanding of different cultures (Hodge, Cadogan, Itty, Williams, & Finney, 2016; Lindsay, Tétrault, Desmaris, King, & Piéart, 2014; Monsees et al., 2020). Ensuring that care providers have time and flexibility to interact with patients could give them a better chance to get to know people of migrant origin with dementia and their families and help them create individualised approaches for each patient, since people of migrant origin with dementia are not one large homogenous group in which everyone can be treated the same way.

A model of intercultural care needs to consider diagnostics, education, healthcare services, healthcare professionals, people of migrant origin with dementia and their families as well as care navigators. The two most essential aspects of such a model are education and the care navigator. Education is important because teaching people of migrant origin, healthcare professionals and healthcare services about dementia and migration might lead to better understanding, greater culture sensitivity and improved interactions. Care navigators are essential because they act as a connection between the people involved and the organisation/institution and connects everyone with one another. The model proposed in this article (see Figure 2) shows the interdependence of education and diagnostics because better education of healthcare professionals could improve their ability to perform diagnostics, and improved education of people of migrant origin might make them more aware of possible dementia symptoms and therefore more likely to consult their GP for a diagnosis. On the other hand, if a dementia diagnosis is made, this could lead the affected person of migrant origin to obtain information/education about the next steps to take. Diagnostic involves culturally sensitive tools, the use of an interpreter/intercultural mediator and increased attention to the possibility of dementia. Education should be offered in different formats and should target people of migrant origin with dementia and their families as well as healthcare professionals. Healthcare professionals should be motivated to collaborate with other professionals and affected people and to be knowledgeable of their culture. For healthcare services, transparency, flexibility and continuity in their actions are important. Embracing the culture of people of migrant origin and employing bicultural/bilingual workers is therefore essential.

Figure 2.

Intercultural care.

The proposed model leaves room for improvement and discussion. This is a theoretically derived model that has not been tested in practice. Therefore, it is not clear whether each component combined leads to the desired success in providing interculturally sensitive care. It might not be feasible for every healthcare professional and healthcare service to take the time they need for every patient and collaborate with everyone if they have time limitations or lack the resources to obtain appropriate education or provide culturally sensitive care and/or diagnostics. The frameworks of institutions and organisations might not allow them to be flexible in their work or to institute a degree of continuity in their work. Additionally, providing education in different formats and different languages to ensure that everyone has access to suitable information could pose a considerable challenge. Another thing to consider when interpreting these findings is that the search strategy might not have found every article that is available on this topic, and the inclusion of more articles might have led to different findings.

Conclusion

The findings presented have been synthesised into a model that offers a guide for providing support and help for people of migrant origin and improving healthcare professionals’ and services’ provision of intercultural care. The main factors that were identified were acknowledging and considering the cultural background of people of migrant origin with dementia, offering appropriate education to healthcare professionals and people of migrant origin and establishing collaborations among people of migrant origin with dementia, their families and healthcare professionals. Such efforts might help not only by providing culturally sensitive care but by helping people of migrant origin access the healthcare system and its services so they can get the help and support they might need. Additionally, they can support interactions between people of migrant origin and healthcare professionals that are positive, appreciative and helpful.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Jessica Monsees

Jessica Monsees is a psychologist and works as a doctoral researcher in the research group ‘Interventional Health Care Research’ at the Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald. She obtained her Bachelor’s degree in Psychology at the University Bremen and her Master’s Degree in Clinical Psychology at the University Osnabrück. Since August 2017 she works at the DZNE in projects on ‘Dementia & Migration’ and ‘Frontotemporal Dementia’.

Tim Schmachtenberg has been working as a doctoral researcher in the ‘Interventional Health Care Research’ group at the Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, since 1 April 2019. There he is involved in the project EU-Atlas Dementia and Migration, which focuses on the care situation of people with a migration background and dementia in Europe. Previously, Mr. Schmachtenberg obtained his Bachelor’s degree in sociology and political science and his Master’s degree in sociology at the University of Kassel.

PD Dr. Jochen René Thyrian is a trained psychologist with a diploma received by the university of Würzburg in 1999. He published his theses about ‘emotion recognition after traumatic brain injury’. He worked as a neuropsychologist before changing into behavioural psychology and preventive medicine at the university of Greifswald. He conducted population-based prevention trials, mainly focussing on smoking and drinking behaviour and received his PhD in 2005. His doctoral thesis was about the Transtheoretical Model of Behaviour Change (TTM). As part of his time he spent 1 year at the Canver Prevention Research Center at the university of Rhode Island with Jim Prochaska and Wayne Velicer, funded by the Krupp von Bohlen und Halbach Foundation. In 2011 he was habilitated by the university of Greifswald and received the venia legend in epidemiology and social medicine. Since 2010 he works at the Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), where he was successfully tenured after completing the tenure track. Since 2012 he is leading a working group in interventional health care research. The research interests of René Thyrian are: dementia care, population.-based interventional trials, early/ timely diagnoses, migration, caregiver, postdiagnostic support. He has authored or co-authored more than 130 paper in Pubmed listed journals and his third-party funded projects amount more than million Euro. He has conducted several large population-based trials and was awarded several prizes, among which is the Hufeland Preis.

References

Ahmad

van den Broeke

Saharso

Tonkens

(2020). Persons with a migration background caring for a family member with dementia: Challenges to shared care. The Gerontologist, 60(2), 340–349. https://doi.org/10.1093/geront/gnz161

APPGD . (2013). Dementia does not discriminate. The experiences of black, Asian and minority ethnic communities. Alzheimer’s Society.

Beattie

Daker-White

Gilliard

Means

(2005). ‘They don’t quite fite the way we organise our services’ - Results from a UK field study of marginalised groups and dementia care. Disability & Society, 20(1), 67–80. https://doi.org/10.1080/0968759042000283647

Berdai-Chaouni

de Donder

(2019). Invisible realities: Caring for older Moroccan migrants with dementia in Belgium. Dementia, 18(7–8), 3113–3129. https://doi.org/10.1177/1471301218768923

Berdai-Chaouni

Smetcoren

A.-S.

de Donder

(2020). Caring for migrant older Moroccans with dementia in Belgium as a complex and dynamic transnational network of informal and professional care: A qualitative study. International Journal of Nursing Studies, 101, 103413. https://doi.org/10.1016/j.ijnurstu.2019.103413

Borson

Scanlan

J. M.

Watanabe

S.-P.

Lessig

(2006). Improving identification of cognitive impairment in primary care. International Journal of Geriatric Psychiatry, 21(4), 349–355. https://doi.org/10.1002/gps.1470

Boughtwood

Shanley

Adams

Santalucia

Kyriazopoulus

Rowland

Pond

(2011). The role of the bilingual/bicultural worker in dementia education, support and care. Dementia, 12(1), 7–21. https://doi.org/10.1177/1471301211416173

Bowes

Wilkinson

(2003). ‘We didn’t know it would get that bad’: South Asian experiences of dementia and the service response. Health and Social Care in the Community, 11(5), 387–396. https://doi.org/10.1046/j.1365-2524.2003.00440.x

Caldwell

Low

L.-F.

Brodaty

(2014). Caregivers’ experience of the decision-making process for placing a person with dementia into a nursing home: comparing caregivers from Chinese ethnic minority with those from English-speaking backgrounds. International Psychogeriatrics, 26(3), 413–424. https://doi.org/10.1017/S1041610213002020

10.

Canevelli

Lacorte

Cova

Zaccaria

Valletta

Raganato

Bruno

Bargagli

A. M.

Pomati

Pantoni

Vanacore

(2019). Estimating dementia cases amongst migrants living in Europe. European Journal of Neurology, 26(9), 1191–1199. https://doi.org/10.1111/ene.13964

11.

Casado

B. L.

Lee

S. E.

Hong

(2015). The experience of family caregivers of Older Korean Americans with dementia symptoms. Clinical Gerontologist, 38(1), 32–48. https://doi.org/10.1080/07317115.2014.970316

12.

Chiu

Marziali

Colantonia

Carswell

Gruneir

Tang

Eysenbach

(2009). Internet-based caregiver support for chinese canadians taking care of a family member with Alzheimer disease and related dementia. Canadian Journal on Aging, 28(4), 323–336. https://doi.org/10.1017/S0714980809990158

13.

Chow

T. W.

Ross

Fox

Cummings

J. L.

Lin

K.-M.

(2000). Utilization of Alzheimer’s disease community resources by Asian-Americans in California. International Journal of Geriatric Psychiatry, 15(9), 838–847. https://doi.org/10.1002/1099-1166(200009)15:9<838::AID-GPS209>3.0.CO;2-U

14.

Cooper

Rapaport

Robertson

Marston

Barber

Manela

Livingston

(2018). Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey. International Journal of Geriatric Psychiatry, 33(3), 504–509. https://doi.org/10.1002/gps.4786

15.

Diaz

Kumar

B. N.

Engedal

(2015). Immigrant patients with dementia and memory impairment in primary health care in Norway: A national registry study. Dementia and Geriatric Cognitive Disorders, 39(5–6), 321–331. https://doi.org/10.1159/000375526

16.

Fairlie

(2014). Race and the digital divide. UC Santa Cruz: Department of Economics.

17.

Gillespie

R. J.

Harrison

Mullan

(2015). Medication management concerns of ethnic minority family caregivers of people living with dementia. Dementia, 14(1), 47–62. https://doi.org/10.1177/1471301213488900

18.

Hanssen

Kuven

B. M.

(2016). Moments of joy and delight: The meaning of traditional food in dementia care. Journal of Clinical Nursing, 25(5–6), 866–874. https://doi.org/10.1111/jocn.13163

19.

Herat-Gunaratne

Cooper

Mukadam

Rapaport

Leverton

Higgs

Quincy

Burton

(2020). “In the Bengali vocabulary, there is no such word as care home”: Caring experiences of UK Bangladeshi and indian family carers of people living with dementia at home. The Gerontologist, 60(2), 331–339. https://doi.org/10.1093/geront/gnz120

20.

Hodge

F. S.

Cadogan

Itty

T. L.

Williams

Finney

(2016). Culture-broker and medicald decoder: Contributions of caregivers in American Indian cancer trajectories. Journal of Community and Supportive Oncology, 14(5), 221–228. https://doi.org/10.12788/jcso.0254

21.

Hossain

M. Z.

Khan

H. T. A.

(2020). Barriers to access and ways to improve dementia services for a minority ethnic group in England. Journal of Evaluation in Clinical Practice, 26(6), 1629–1637. https://doi.org/10.1111/jep.13361

22.

Hossain

M. Z.

Stores

Hakak

Dewey

(2019). Traditional gender roles and effects of dementia caregiving within a South Asian ethnic group in England. Dementia and Geriatric Cognitive Disorders, 48, 330–336. https://doi.org/10.1159/000506363

23.

Hutchings

Sheppard

Jisc

(2021). Exploring the impact of digital and data poverty on BAME learners. Jisc.

24.

International Organization for Migration . (2020). Migration data portal. https://migrationdataportal.org/?i=stock_old_perc&t=2019&m=1&rm49=150

25.

Jutlla

(2015). The impact of migration experiences and migration identities on the experiences of services and caring for a family member with dementia for Sikhs living in Wolverhampton, UK. Ageing & Society, 35(5), 1032–1054. https://doi.org/10.1017/S0144686X14000658

26.

Kenning

Daker-White

Blakemore

Panagioti

Waheed

(2017). Barriers and facilitators in accessing dementia care by ethnic minority groups: A meta-synthesis of qualitative studies. BMC Psychiatry, 17, 316–328. https://doi.org/10.1186/s12888-017-1474-0

27.

Kong

E.-H.

Deatrick

J. A.

Evans

L. K.

(2010). The experiences of korean immigrant caregivers of non-english-speaking older relatives with dementia in American nursing homes. Qualitative Health Research, 20(3), 319–329. https://doi.org/10.1177/1049732309354279

28.

La Fontaine

Ahuja

Bradbury

N. M.

Phillips

Oyebode

J. R.

(2007). Understanding dementia amongst people in minority ethnic and cultural groups. Journal of Advanced Nursing, 60(6), 605–614. https://doi.org/10.1111/j.1365-2648.2007.04444.x

29.

Lawrence

Murray

Samsi

Banerjee

(2008). Attitudes and support needs of Black Caribbean, south Asian and White British carers of people with dementia in the UK. The British Journal of Psychiatry, 193(3), 240–246. https://doi.org/10.1192/bjp.bp.107.045187

30.

Lee

S. E.

Casado

B. L.

Hong

(2018). Exploring experience and perspectives of foreign-born direct care workers in dementia care: Accounts of Korean American personal care aides caring for older Korean Americans with dementia symptoms. Dementia, 17(4), 423–438. https://doi.org/10.1177/1471301216647832

31.

Lee

J.-L.

Nguyen

Park

Tran

Nguyen

Huynh

(2017). Usages of computers and smartphones to develop dementia care education program for Asian American family caregivers. Healthcare Informatics Research, 23(4), 338–342. https://doi.org/10.4258/hir.2017.23.4.338

32.

Lindsay

Tétrault

Desmaris

King

Piéart

(2014). Social workers as “cultural brokers” in providing culturally sensitive care to immigrant families raising a child with a physical disability. Health & Social Work, 39(2), e10–e20. https://doi.org/10.1093/hsw/hlu009

33.

Mackenzie

(2006). Stigma and dementia: East European and South Asian family carers negotiating stigma in the UK. Dementia, 5(2), 233–247. https://doi.org/10.1177/1471301206062252

34.

Mayring

(2014). Qualitative content analysis. Theoretical foundation, basic procedures and software solution. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-395173

35.

McCleary

Persaud

Hum

Pimlott

N. J. G.

Cohen

C. A.

Koehn

Leung

K. K.

Dalziel

W. B.

Kozak

Emerson

V. F.

Silvius

J. L.

Garcia

(2013). Pathways to dementia diagnosis among South Asian Canadians. Dementia, 12(6), 769–789. https://doi.org/10.1177/1471301212444806

36.

McMurtray

Saito

Nakamoto

(2009). Language preference and development of dementia among bilingual individuals. Hawaii Medical Journal, 68(9), 223–226.

37.

Mendez

M. F.

Perryman

K. M.

Pontón

M. O.

Cummings

J. L.

(1999). Bilingualism and dementia. The Journal of Neuropsychiatry and Clinical Neurosciences, 11(3), 411–415. https://doi.org/10.1176/jnp.11.3.411

38.

Mogar

von Kutzleben

(2015). Demenz in Familien mit türkischem Migrationshintergrund. Organisation und Merkmale häuslicher Versorgungsarrangements. Zeitschrift für Gerontologie & Geriatrie, 48, 465–472. https://doi.org/10.1007/s00391-014-0802-y

39.

Monsees

Schmachtenberg

Hoffmann

Kind

Gilmore-Bykovskyi

Kim

A. J.

Thyrian

J. R.

(2020). Dementia in people with a Turkish migration background - Experiences and utilization of healthcare services. Journal of Alzheimer’s Disease, 77(2), 865–875. https://doi.org/10.3233/JAD-200184

40.

Morgan

Crowder

(2003). Mini mental state examinations in English: Are they suitable for people with dementia who are Welsh speaking? Dementia, 2(2), 267–272. https://doi.org/10.1177/1471301203002002009

41.

Mukadam

Cooper

Basit

Livingston

(2011). Why do ethnic elders present later to UK dementia services? A qualitative study. International Psychogeriatrics, 23(7), 1070–1077. https://doi.org/10.1017/S1041610211000214

42.

Mukadam

Waugh

Cooper

Livingston

(2015). What would encourage help-seeking for memory problems among UK-based South Asians? A qualitative study. BMJ Open, 5(9), e007990–e007997. https://dx-doi-org.web.bisu.edu.cn/10.1136/bmjopen-2015-007990

43.

Næss

Moen

(2015). Dementia and migration: Pakistani immigrants in the Norwegian welfare state. Ageing & Society, 35(8), 1713–1738. https://doi.org/10.1017/S0144686X14000488

44.

Nielsen

T. R.

Antelius

Spilker

R. S.

Torkpoor

Toresson

Lindholm

Plejert

(2015). Dementia care for people from ethnic minorities: A Nordic perspective. International Journal of Geriatric Psychiatry, 30(2), 217–222. https://doi.org/10.1002/gps.4206

45.

Nielsen

T. R.

Waldemar

(2016). Knowledge and perceptions of dementia and Alzheimer’s disease in four ethnic groups in Copenhagen, Denmark. International Journal of Geriatric Psychiatry, 31(3), 222–230. https://doi.org/10.1002/gps.4314

46.

Pagán-Ortiz

M. E.

Cortés

D. E.

Rudloff

Weitzman

Levkoff

(2014). Use of an online community to provide support to caregivers of people with dementia. Journal of Gerontological Social Work, 57(6–7), 694–709. https://doi.org/10.1080/01634372.2014.901998

47.

Parveen

Peltier

Oyebode

J. R.

(2017). Perceptions of dementia and use of services in minority ehthnic communities: a scoping exercise. Health and Social Care in the Community, 25(2), 734–742. https://doi.org/10.1111/hsc.12363

48.

Pham

T. M.

Petersen

Walters

Raine

Manthorpe

Mukadam

Cooper

(2018). Trends in dementia diagnosis rates in UK ethnic groups: analysis of UK primary care data. Clinical Epidemiology, 10, 949–960. https://doi.org/10.2147/CLEP.S152647

49.

Piechotta

Matter

(2008). Die Lebenssituation demenziell erkrankter türkischer Migranten/-innen und ihrer Angehörigen. Fragen, Vermutungen und Annahmen. Zeitschrift für Gerontologie & -psychiatrie, 21(4), 221–230. https://doi.org/10.1024/1011-6877.21.4.221

50.

Purandare

Luthra

Swarbrick

Burns

(2007). Knowledge of dementia among South Asian (Indian) older people in Manchester, UK. International Journal of Geriatric Psychiatry, 22(8), 777–781. https://doi.org/10.1002/gps.1740

51.

Regan

J. L.

(2016). Ethnic minority, young onset, rare dementia type, depression: A case study of a Muslim male accessing UK dementia health and social care services. Dementia, 15(4), 702–720. https://doi.org/10.1177/1471301214534423

52.

Rosendahl

S. P.

Söderman

Mazaheri

(2016). Immigrants with dementia in Swedish residential care: An exploratory study of the experiences of their family members and Nursing staff. BMC Geriatrics, 16, 18. https://doi.org/10.1186/s12877-016-0200-y

53.

Sagbakken

Spilker

R. S.

Ingebretsen

(2018). Dementia and migration: Family care patterns merging with public care services. Qualitative Health Research, 28(1), 16–29. https://doi.org/10.1177/1049732317730818

54.

Sagbakken

Spilker

R. S.

Nielsen

T. R.

(2018). Dementia and immigrant groups: A qualitative study of challenges related to identifying, assessing, and diagnosing dementia. BMC Health Services Research, 18(1), 910. https://doi.org/10.1186/s12913-018-3720-7

55.

Schmachtenberg

Monsees

Thyrian

J. R.

(2021). What elements are important in current treatment and care guidelines to provide culturally sensitive care for people with migration background and dementia? - A systematic analysis. Frontiers in Public Health, 17(S10), Article e053578. https://doi.org/10.1007/s10389-021-01531-z

56.

Schouler-Ocak

Aichberger

M. C.

Penka

Kluge

Heinz

(2015). Psychische Störungen bei Menschen mit Migrationshintergrund in Deutschland. Bundesgesundheitsblatt, 58(6), 527–532. https://doi.org/10.1007/s00103-015-2143-4

57.

Söderman

Rosendahl

S. P.

(2016). Caring for ethnic older people living with dementia - Experiences of nursing staff. Journal of Cross-Cultural Gerontology, 31(3), 311–326. https://doi.org/10.1007/s10823-016-9293-1

58.

Söderman

Rosendahl

Sällström

(2018). Caring and uncaring encounters between assistant nurses and immigrants with dementia symptoms in two group homes in Sweden - An observational study. Journal of Cross-Cultural Gerontology, 33(3), 299–317. https://doi.org/10.1007/s10823-018-9351-y

59.

States

R. A.

Susman

W. M.

Riquelme

L. F.

Godwin

E. M.

Greer

(2006). Community health education: Reaching ethnically diverse elders. Journal of Allied Heatlh, 35(4), 215–222.

60.

Teng

E. L.

Manly

J. J.

(2005). Neuropsychological testing: Helpful or harmful? Alzheimer Disease & Associated Disorders, 19(4), 267–271. https://doi.org/10.1097/01.wad.0000190805.13126.8e

61.

Tezcan-Güntekin

(2018). Demenzerkrankungen bei Menschen mit Migrationshintergrund und ethische Konflikte im medizinischen und pflegerischen Alltag. Ethik in der Medizin, 30, 221–235. https://doi.org/10.1007/s00481-018-0491-y

62.

Tillmann

Just

Schnakenberg

Weckbecker

Weltermann

Münster

(2019). Challenges in diagnosing dementia in patients with a migrant background - A cross-sectional study among German general practitioners. BMC Family Practice, 20, 34. https://doi.org/10.1186/s12875-019-0920-0

63.

van Wezel

Francke

A. L.

Kayan-Acun

Devillé

W. L. J. M.

van Grondelle

N. J.

Blom

M. M.

(2018). Explanatory models and openness about dementia in migrant communities: A qualitative study among female family carers. Dementia, 17(7), 840–857. https://doi.org/10.1177/1471301216655236

64.

Vissenberg

Uysal

Goudsmit

van Campen

Buurman-van Es

(2018). Barriers in providing primary care for immigrant patients with dementia: general practitioners’ perspectives. BJGP Open, 2(4), bjgpopen18X101610. https://doi.org/10.3399/bjgpopen18x101610

65.

Xiao

L. D.

Habel

de Bellis

(2015). Perceived challenges in dementia care by vietnamese family caregivers and care workers in South Australia. Journal of Cross-Cultural Gerontology, 30(3), 333–352. https://doi.org/10.1007/s10823-015-9264-y

Intercultural care for people of migrant origin with dementia – A literature analysis

Abstract

Background

Research question

Method

Findings

Discussion

Keywords

Introduction

Methods

Literature search

Findings

Diagnostic

Education and information

People of migrant origin and family caregivers.

Healthcare professionals.

Basic conditions.

Healthcare professionals

Acknowledging the culture.

Collaboration.

Basic conditions

Healthcare services

Culture

Which healthcare services are needed.

Basic conditions.

Trust and support.

Discussion

Conclusion

Footnotes

Declaration of conflicting interests

Funding

ORCID iD

References