Culturally focused dementia care needed for Canada’s senior immigrants, researchers say

2022/03/12 Leave a comment

A reminder that immigrants also age and thus do not do much, if anything, to address longer-term demographics. Striking that immigrants now form almost one-third of all seniors (earlier waves) and thus not surprising that more supports needed (e.g., language, foods):

It all began when Navjot Gill’s grandmother started to mistake her for her aunt.

That’s what happens when you get older, said Gill’s family, but as time went on, it happened more often.

As a student studying dementia, Gill, who lives with her family in Hamilton, Ont., knew it wasn’t that simple — something more was going on and it was going to be hard on everyone.

For South Asian families, it’s understood that family takes care of its own. And it’s not uncommon for many to assume, said Gill, that when an elder first encounters symptoms of dementia, it’s just a normal part of aging — denial that is often driven by a lack of awareness and cultural stigma.

There’s no word for dementia in Gill’s mother tongue, Punjabi, and most of the resources she could find to share with her parents were in English and not culturally specific.

“I’m engaged in dementia research, I know these things, and even I’m not able to fully [explain it],” said Gill, who is 27 and now working on her PhD at the University of Waterloo. “It took a while to come to the point of this is not a normal part of aging … dementia is something that is outside the realm of normal.”

Dementia is an overall term for a set of symptoms, including memory loss and difficulty performing tasks, caused by disorders affecting the brain. Alzheimer’s is the most common type of dementia, with risk of developing the disease growing as people age.

Canada’s senior immigrant population now makes up over a third of the overall population of older people, and that has Gill and other advocates calling for more culturally appropriate care and dedicated dementia research to serve these individuals as they enter long-term care homes — to make the transition easier on the entire family.

Ngozi Iroanyah went through a similar experience when her father was diagnosed with dementia in 2007.

“My community is Nigerian and we also don’t talk about dementia, we don’t talk about seniors’ mental health. It’s heavily, heavily stigmatized,” she said.

Iroanyah said stigmatization can lead to isolation and discourage families from seeking the right treatments.

Having worked in health care for over two decades, and as manager of diversity and community partnerships with the Alzheimer Society of Canada, she knew what the next steps were, and even then, it was a “minefield,” she said.

“Then when you add the cultural piece on top of that, it was even more so: What do we do? What do we need? Where can we go? What are the supports? And there weren’t any supports,” said Iroanyah.

Supporting the older immigrant population

Organizations like the Alzheimer Society and the Research Institute for Aging recognize more work is needed to better understand and support the diverse needs of older adults with dementia.

Canada’s senior immigrant population is growing. According to Statistics Canada, in 2016, senior immigrants represented 31 per cent of the total senior population over age 65.  Asia and Africa were among the top continents that sought immigration to Canada.

The Alzheimer Society estimates 500,000 people are living with dementia, a figure that is estimated to grow to 912,000 by 2030.

“Because we have an aging population that is more culturally, ethnically diverse and racially diverse, are we prepared in Canada? We see that our younger population is not increasing as plentiful, so who is going to be taking care of these older populations?” said Iroanyah.

She said the Alzhiemer Society is developing more education and awareness resources for culturally diverse groups and their caregivers, as well as other groups that are underrepresented in dementia research, including the LGTBTQ population and rural communities.

A BIPOC research program is also expected to launch this year, Iroanyah added, to support researchers who want to better understand the impacts of dementia within BIPOC populations.

“We need statistics, we need data and numbers to be able to understand what is happening, to be able to understand what these experiences are, and to be able to understand what the need is,” she said.

Specialized care programs uncommon

Finding culturally specific care and programs for Gill’s grandmother became an impossible task, she said. Nowhere could she find a place that would feel familiar.

“At one point I was looking at nursing homes, just to see, and there is no way my grandmum would be able to survive in that [environment] because everything would be alien to her,” she said, from language, to activities — even the food.

A spokesperson for the Ontario Ministry of Long-Term Care said in a statement that the province “realizes the importance of homes providing culturally specific services to meet the needs of their residents,” and though individual homes may choose to provide culturally specific services or programs, that information is not tracked by the province.

Of the 36 long-term care homes in the Waterloo-Wellington area, some have catered to the Mennonite community’s needs, said a spokesperson with Home and Community Care Support Services Waterloo Wellington. None, however, provide culturally specific care for Chinese, South Asian or Black residents — the region’s three most populous cultural groups.

“Co-ordinators work with patients and families to complete care needs assessments including determining what is important in individuals’ care experiences such as ethnocultural, language and religious aspects,” the spokesperson said, adding they can help find a more suitable care home elsewhere in the province.

For now, Gill is dedicating her studies to understanding the impacts of dementia within the South Asian community and their caregivers.

“The further you move from the GTA [Greater Toronto Area] the more scarce culturally appropriate services become and the South Asian community is the biggest visible minority according to Statistics Canada,” she said.

“I’m bilingual and can speak the local language, so I can use that to my benefit to interview people and remove that first barrier, where they might not participate in our research because they don’t speak English.”

Gill and her family are doing what they can to care for her grandmother at home, where she can stay in an environment that is familiar to her and communicate with people in her own language.

As she continues with her research, Gill hopes her work will bring more awareness and ultimately help support more older adults and their caregivers in her community.

Source: Culturally focused dementia care needed for Canada’s senior immigrants, researchers say

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High Alzheimer’s Rates Among African-Americans May Be Tied To Poverty : NPR

2017/07/17 Leave a comment

Social factors matter:

Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer’s and other forms of dementia, researchers reported Sunday at the Alzheimer’s Association International Conference in London.

Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans.

The findings could help explain why African-Americans are twice as likely as white Americans to develop dementia. And the research suggests genetic factors are not a major contributor.

“The increased risk seems to be a matter of experience rather than ancestry,” says Megan Zuelsdorff, a postdoctoral fellow in the Health Disparities Research Scholars Program at the University of Wisconsin-Madison.

Scientists have struggled to understand why African-Americans are so likely to develop dementia. They are more likely to have conditions like high blood pressure and diabetes, which can affect the brain. And previous research has found some evidence that African-Americans are more likely to carry genes that raise the risk.

But more recent studies suggest those explanations are incomplete, says Rachel Whitmer, an epidemiologist with Kaiser Permanente’s Division of Research in Northern California.

Whitmer has been involved in several studies that accounted for genetic and disease risks when comparing dementia in white and black Americans. “And we still saw these [racial] differences,” she says. “So there is still something there that we are trying to get at.”

The research presented at the Alzheimer’s conference suggests the missing factors involve adverse life experiences beginning in childhood. These experiences have already been linked to a range of diseases, including heart disease and cancer.

“We’re starting to understand how early life stress and early life deprivation can increase your risk of a number of health outcomes in late life,” Whitmer says. “And the latest thing is understanding how and why that might affect the brain.”

Whitmer was part of a team that presented results of a study of more than 6,000 Kaiser Permanente health plan members, most born in the 1920s.

The team wanted to know whether people who grew up in harsher conditions were more likely to develop dementia. So they looked at people who’d been born in states with high infant mortality rates — an indicator of social problems like poverty and limited access to medical care.

White people’s risk of dementia wasn’t affected by their place of birth. But black people were 40 percent more likely to develop dementia if they’d been born in a state with high infant mortality.

“These people left the state and subsequently moved to northern California, yet there was still this very robust association between being born in a state with high infant mortality and increased risk of dementia,” Whitmer says.

Scientists from the University of Wisconsin presented results of a study of the link between stressful life events and mental function in middle age. They studied more than 1,300 people in their 50s and 60s, including 82 African-Americans.

Stressful experiences included having a parent with a drinking problem, financial insecurity, legal issues, divorce, being fired from a job, and the death of a child.

African-Americans reported 60 percent more of these stressful events than white Americans. But that was only part of the difference, Zuelsdorff says.

“The impact of these stressful events was stronger in African-Americans than it was in non-Hispanic white participants,” she says.

The researchers discovered this by administering tests that reveal the brain’s speed and flexibility in doing certain tasks. These abilities normally decline with age. So the team looked for evidence that stressful events were accelerating this decline.

And they found that in white participants, each stressful event added about a year and a half to normal brain aging. But in African-Americans, each event aged the brain an extra four years.

The next challenge for researchers is to figure out precisely how adverse life experiences are changing the brain, Zuelsdorff says. That will mean looking at the effects of stress hormones and seeing whether stress leads to inflammation in the brain, something that has been associated with Alzheimer’s.

Source: High Alzheimer’s Rates Among African-Americans May Be Tied To Poverty : Shots – Health News : NPR

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