Dementia and Ethnic Minorities

1. Dementia and Ethnic Minorities A workshop to promote multicultural health care By Charity Brooks

2. Review: What is Dementia? • Dementia- loss of intellectual functions (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a person’s daily functioning • Dementia is not a disease itself but rather a group of symptoms that may accompany certain diseases or conditions, such as Alzheimer’s Disease • Symptoms include a change in personality, mood, and behavior www.alz.org

3. Demographics of Minorities in the U.S. • African-American- 12.3% • Asian- 3.6% • American Indian/Alaska Native- 0.9% • Hispanic/Latino- 12.5% • Other- 5.5% Total: 34.8% *The impact of dementia on minorities, and the response of health care workers to them, is significant due to the implications of the minority population* www.census.gov

4. How does Dementia Affect Ethnic Minorities? • The Double Jeopardy Hypothesis Social Handicap= Age + Race • Triple jeopardy= Age + Race + Dementia

5. Factors Influencing the Hypotheses • Institutional Racism- discrimination that exists in social structures and institutional practices, placing racism in a historical, cultural, socio-economic, and political context • Color-blindness- treats minorities in the same way that majority whites are treated, denying cultural differences and negating the various experiences of minorities • Not always intentional racism, but it ignores the structural inequalities present in the system

6. Factors Influencing the Hypotheses • Lack of Cultural Awareness- it is difficult to diagnose dementia when patients have different cultures and languages than the practitioner • It is important for psychiatrists and practitioners to be aware of the culture and racism of their profession and the overall social climate • Cultural values should be respected, but should not be used to justify lack of services

7. Factors Influencing the Hypotheses • Most services available for dementia are focused towards white, English-speaking clients, causing minority ethnic patients with dementia to remain underserved; this reinforces the message that these mainstream agencies do not belong for minority groups • Because specific minority ethnic organizations may not be aware of the implications of dementia, minority ethnic families can be isolated due to a lack of support rather than choice

8. Factors Influencing the Hypotheses • Linguicism- a form of prejudice that involves making judgments about one's wealth, education, social status, and other traits based on their use of language • Miscommunication- if there is a language barrier that exists between native speakers and non-native speakers of English (health care workers and patients, for example), miscommunication can occur, hindering effective care- the result of limited English proficiency (LEP)

9. Factors Influencing the Hypotheses • Stereotypes- the myth that all minority families look after their extended family, including health care and dementia symptoms • Minority groups tend to be viewed as a homogenous groups with easily identifiable characteristics • Although minority families from different ethnic groups may traditionally have extended family living with them, it should not be seen as the norm

10. Traditional Views of Ethnic Minority Immigrants in the U.S. • Although these views may still be in place and it is important to be aware of them, they should not be viewed as the cultural norm and cause cultural stereotypes.

11. Traditional Latino Views of Family and Alzheimer’s • The family unit is extremely important in the Hispanic/Latino community, being the center of activity and support. • Care for elders may be provided by the extended family who may reside in the same home. • Adult children and grandchildren can help bring knowledge to older family members and support them in accessing health care services. • Doctors are respected and viewed as authority figures. • Latinos may receive health care information from Spanish language media, including newspapers, radio and television. • Language barriers may prevent access to health care information and other services. • Particularly in the early stage, Alzheimer’s disease is viewed as normal aging. • Families may not seek out services because they do not wish to bring shame upon the family.

12. Traditional Asian Views of Family and Alzheimer’s • Family is the foundation of daily living • Family members have a strong sense of duty to care for each other. • Elders are highly respected and obeyed. • Multigenerational family ties exist, with families often living together. • Families may oppose long term care, believing it is shameful to place loved ones in residential care. • Strong internal cultural mechanisms help shape their support system, which includes having values that address the care and support of elderly family members. • Language barriers may prevent access to health care information and other services. • Alzheimer’s disease and other forms of dementia may be perceived as forms of mental illness with shame attached, and this sense of shame may extend beyond the diagnosed individual to the entire family. • The behavioral symptoms of dementia may be seen as a natural consequence of aging.

13. Recommendations for Improving the Healthcare of Elderly Minorities • Providing trained and licensed translators and interpreters for patients and their families so that they can effectively communicate with health care workers • Making translated information concerning dementia available to health care agencies and minorities suffering from dementia

14. Recommendations for Improving the Healthcare of Elderly Minorities • Cultural training needs to be provided for practitioners so that the they can support minorities with dementia and their families in culturally sensitive ways • By working to achieve racial equality in employment through training and awareness, organizations can evaluate the management, recruitment procedures, and qualification requirements that affect the ways in which minorities are served

15. Recommendations for Improving the Healthcare of Elderly Minorities • Outreach work can serve the purpose of educating community organizations and areas that are frequented by elderly minorities about dementia, as well as encouraging practitioners to create partnerships with these organizations • Further research is important to improve the services to minorities with dementia • In the U.S., research focusing on ethnic minorities has been termed “ethnogeriatric” research

16. Group Work • Case Studies • In groups, read the sample case studies and discuss them • Underline all of the examples and factors that relate to what has been discussed about dementia and ethnic minorities

17. Group Work • Case Study Questions • What are the ways in which the culture of the patients was addressed? What are ways in which it was not addressed? • Were there examples of racism in your case study? If so, in what ways? • How was language addressed in the case study? Were translators or interpreters used? • How were the services of the minority elders affected due to their ethnicity? • Did the families respond in the way you expected? Did their cultural background determine the way they responded to the care of their families? • How did knowledge or lack of knowledge of dementia affect the subject in the case study? • How would you respond as a health care worker in your specific situation?

18. Group Work • Have a class discussion pertaining to your specific case studies • Explain the context of your group’s case study, and allow for feedback from other group members

19. References • Brownlie, J. (1991) A Hidden Problem? Dementia Amongst Minority Ethnic Groups. Stirling: University of Stirling. • Case studies used in this presentation were modified based upon Browlie’s case studies in her research • “Cultural Competency” • www.alz.org/Resources/Diversity/downloads/GEN_EDU-10steps.pdf • “Alzheimer’s Association” • www.alz.org • Wikipedia- The Free Encyclopedia • http://en.wikipedia.org