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Aim: To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia. Background: Due to the nature of global immigration and recruitment strategies, healthcare is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care. Method: A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1(st) January 2006 to 31(st) July 2016. Results: A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people, impact of cultural perceptions on service use, acculturation of the workforce, and cross cultural communication. Conclusion: Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care. Relevance to clinical practice: Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person-centred dementia care. This article is protected by copyright. All rights reserved.

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... Andere erwähnte Begri e waren "Narr" und "senil" (Antelius und Kiwi 2015). In einigen Fällen sind es die kulturellen Wahrnehmungen des Alterns und nicht der Demenz, die beein ussen, wie migrierte Betreuer auf die Bedürfnisse von Menschen mit Demenz reagieren (Brooke et al. 2018). Das Verhalten kann auch auf Tagträume oder darauf zurückgeführt werden, dass die Person einfach nur "lästig" ist, manchmal mit der Annahme, dass sie schon immer so war (Antelius und Kiwi 2015 ...
... er wie sie darauf zugreifen können(Egede-Nissen et al. 2016). Möglicherweise fällt es ihnen auch schwer, den Unterricht in ihren Arbeitsplan zu integrieren oder sie können sich ihn nicht leisten. Die lokalen Regierungen und Arbeitgeber sollten sich bemühen, sicherzustellen, dass P egekrä e die Möglichkeit haben, ihre Sprachkenntnisse zu verbessern.Brooke et al. (2018) legen nahe, dass Open-Access-Training und -Ausbildung notwendig ist, um die breiteren Aspekte der Kommunikation wie Akzente, Verhaltenskommunikation und Mimik usw. abzudecken.Migrierte Betreuer können eine sehr unterschiedliche Einstellung zur Betreuung älterer Menschen, einschließlich Menschen mit Demenz, haben als die meisten der Mens ...
... Demenzp egerinnen und -p eger mit nahöstlichem Hintergrund in Schweden (P ege von Menschen mit Demenz aus dem gleichen Hintergrund) betonten, dass Menschen aus ihren Heimatländern die P ege älterer Angehöriger als eine religiöse Verp ichtung betrachten, die von Angehörigen sowie durch den Druck von Moscheen, Kirchen, Verbänden, entfernten Verwandten und sogar Nachbarn durchgesetzt wird(Antelius und Plejert 2016). Einerseits mögen einige migrierte Betreuer Familien von Menschen mit Demenz in der Heimp ege kritisch gegenüberstehen, was auf ihrem eigenen Glauben an die kindliche Pietät beruht; andererseits benötigen einige migrierte Betreuer ein besseres Verständnis der kindlichen Pietät, aber auch ein Bewusstsein dafür, dass Familien, die in westliche Kulturen ausgewandert sind, ihre Überzeugungen durch den Prozess der Akkulturation angepasst haben können (Antelius und Kiwi 2015,Brooke et al. 2018). Dies wurde in Bezug auf Familien mit nahöstlicher Abstammung in den Niederlanden berichtet, die eine positivere Sichtweise auf die professionelle P ege haben könnten und die Fürsorge als Sicherstellung der P ege und nicht als P ege durch sich selbst interpretieren könnten(Van Wezel et al. 2016). ...
Technical Report
Full-text available
This is the German translation of a comprehensive report aimed at improving the situation of people with dementia, their carers and professional carers from minority ethnic backgrounds through the identification and promotion of intercultural care and support. The key sections of the report cover issues related to the prevalence, assessment and diagnosis of dementia in minority ethnic groups; interpreter-mediated dementia assessments of people from minority ethnic groups; working with and involving local minority ethnic groups in the development of intercultural care and support; live-in/migrant carers for people with dementia; and challenges encountered by professional and informal carers.
... Healthcare providers need to be aware of the cultural traditions within some minority ethnic communities to provide care within the family but also to avoid stereotyping and considering this as refl ecting the wishes of all members of the community (Turner et al. 2005, Brooke et al. 2018. Moreover, the acceptance of help is not necessarily all or nothing and there may be diff erences in the kinds of services that individuals and groups consider acceptable. ...
... Other terms mentioned included 'fool' and 'senile' (Antelius and Kiwi 2015). In some cases, it is the cultural perceptions of ageing rather than dementia which infl uence how migrant carers respond to the needs of people with dementia (Brooke et al. 2018). Behaviour may also be attributed to daydreaming or to the person just being 'burdensome' and 'troublesome', sometimes with the assumption that they have always been like that (Antelius and Kiwi 2015 (2016) also highlight the ambitions of some migrant dementia carers to move from the residential care setting to take up a more qualifi ed post. ...
... Romero (2012) highlights the feminised and ethnifi ed nature of much of the care provided to dependent older people in Europe, calls for social workers to challenge the situations and inequalities that are inherent in public policies and advocates for a higher level of social justice. Brooke et al. (2018) suggest the need for all care workers to understand dementia from a biopsychosocial perspective, that it is not a natural consequence of ageing and to understand the importance of preventive interventions, early diagnosis and that symptomatic treatments are available. Whilst the emphasis may oft en be on migrant dementia carers adapting to the culture of the host country, it should not be overlooked that there is not a single culture but many cultures within any country. ...
Technical Report
Full-text available
This comprehensive report aims at improving the situation of people with dementia, their carers and professional carers from minority ethnic backgrounds through the identification and promotion of intercultural care and support. The key sections of the report cover issues related to the prevalence, assessment and diagnosis of dementia in minority ethnic groups; interpreter-mediated dementia assessments of people from minority ethnic groups; working with and involving local minority ethnic groups in the development of intercultural care and support; live-in/migrant carers for people with dementia; and challenges encountered by professional and informal carers.
... Les prestataires de soins de santé doivent être conscients des traditions culturelles au sein de certaines communautés ethniques minoritaires pour fournir des soins au sein de la famille mais également pour éviter les stéréotypes et de considérer que cela re ète les souhaits de tous les membres de la communauté (Turner et al. 2005, Brooke et al. 2018. Par ailleurs, l'approche du « tout ou rien » ne s'applique pas nécessairement au fait d'accepter de l'aide, et il peut y avoir des di érences quant aux types de services que les personnes et les groupes considèrent comme acceptables. ...
... En Suède, des soignants originaires du Moyen-Orient et responsables de personnes atteintes de démence (de la même origine) ont souligné que les personnes issues de leur pays d'origine considéraient les soins des parents âgés comme une obligation religieuse appliquée par les membres de la famille et sous la pression des mosquées, des églises, des associations, de la famille éloignée et même des voisins (Antelius et Plejert 2016). D'un côté, il peut arriver que certains soignants migrants critiquent les familles des personnes atteintes de démence placées en maison d'accueil sur la base de leurs propres croyances sur la piété liale ; de l'autre, certains soignants migrants auraient peut-être besoin de mieux comprendre la piété liale mais également être conscients du fait que les familles ayant migré dans des cultures occidentales peuvent avoir adapté leurs croyances à travers le processus d'acculturation (Antelius et Kiwi 2015, Brooke et al. 2018. Ces observations ont été faites à l'égard de familles originaires du Moyen-Orient et vivant aux Pays-Bas, qui ont peut-être une vision plus positive des soins professionnels et peuvent considérer que la prise en charge permet d'assurer que les soins sont bien dispensés plutôt que de les fournir entièrement euxmêmes (Van Wezel et al 2016). ...
... Les termes « fou » et « sénile » ont également été mentionnés (Antelius et Kiwi 2015). Dans certains cas, ce sont plus les perceptions culturelles de la vieillesse que de la démence qui in uencent la manière dont les soignants migrants répondent aux besoins des personnes atteintes de démence (Brooke et al. 2018). Les comportements peuvent également être attribués à la rêverie ou au simple fait que la personne est « pénible » ou « dérangeante », et l'on suppose parfois qu'elle a toujours été ainsi (Antelius et Kiwi 2015). ...
Technical Report
Full-text available
This is the French translation of a comprehensive report aimed at improving the situation of people with dementia, their carers and professional carers from minority ethnic backgrounds through the identification and promotion of intercultural care and support. The key sections of the report cover issues related to the prevalence, assessment and diagnosis of dementia in minority ethnic groups; interpreter-mediated dementia assessments of people from minority ethnic groups; working with and involving local minority ethnic groups in the development of intercultural care and support; live-in/migrant carers for people with dementia; and challenges encountered by professional and informal carers.
... A recent systematic review has identified four elements of acculturation of nurses and healthcare professionals working in aged and dementia care (Brooke et al. 2018). The four 3 elements include: the influence of their cultural perceptions of dementia illness and older people, secondly their cultural perceptions on the appropriateness of service use for people with dementia, thirdly acculturation into the workforce and lastly support with cross-cultural communication. ...
... The four 3 elements include: the influence of their cultural perceptions of dementia illness and older people, secondly their cultural perceptions on the appropriateness of service use for people with dementia, thirdly acculturation into the workforce and lastly support with cross-cultural communication. Brooke et al. (2018) concluded the need to support migrant nurses and healthcare professionals to adapt to the host country, workforce and language with a focus on local dialects to enable them to provide person-centred care for people with dementia. ...
Article
Abstract Background: Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse’s cultural heritage on their beliefs and understanding of dementia. Objectives: To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand. Design: An explorative hermeneutic phenomenology design. Settings: Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boškin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman). Participants: Student nurses studying nursing in England (n=81), Slovenia (n=41), Philippines (n=53) and New Zealand (n=6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n=100) and towards the end of their studies (n=81) participated. Methods: Completion of focus groups (n=23), in England (n=10), Slovenia (n=6), Philippines (n=6), and New Zealand (n=1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data. Results: Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: ‘my granddad’: familial experience, and ‘better to be with her’: familial home. Dementia discourse emerged from the terminology student nurses applied, such as: ‘preconceptions and misconceptions’ of aggression, and ‘considered crazy’ stigma of dementia due to a lack of awareness. Conclusions: The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education.
... Cherry et al (2016) found that early encounters of adolescents and adults with older people encourage positive attitudes towards ageing. Carlson and Idvall (2015) and Brooke et al (2017) recommended that nursing students should be exposed to older people's care during undergraduate education, and Neville (2016) argued that exposure to older people's care is needed in education and clinical practice to enhance positive ageism. In its standards of proficiency for registered nurses, the NMC (2018a) states that 'registered nurses provide leadership in the delivery of care for people of all ages and from different backgrounds, cultures and beliefs' and that 'they provide nursing care for people who have complex mental, physical, cognitive and behavioural care needs, those living with dementia, the elderly, and for people at the end of their life'. ...
... Garbrah et al (2017) suggested that there is a need for age friendly curricula and for nurses who specialise in gerontology to act as mentors and role models. There is also a need for a greater understanding of the culture of the nursing workforce and of dementia care (Brooke et al 2017). ...
Article
Background: An ageing population with a range of co-morbidities means the number of hospital admissions of older people with dementia is increasing. People with dementia can find acute hospital settings unsettling and they need to be cared for by a workforce skilled and knowledgeable in dementia care. Aim: To explore nursing students’ experiences of, and socialisation in, dementia care in the acute hospital setting in England through a secondary qualitative analysis of data from a phenomenological study of nursing students’ cultural beliefs around, and understanding of, dementia. Method: Data from ten focus groups with 81 undergraduate nursing students at two universities in the south of England were subjected to content analysis. This was a secondary qualitative analysis of data retrieved from an earlier study. Findings: Two categories emerged: ‘exposure to dementia care’ and ‘socialisation in dementia care’. Participants often felt unprepared to care for patients with dementia and their experiences were negatively affected by staff’s views of patients with dementia, who were often considered challenging to manage. Participants also encountered specialist dementia nurses who enabled them to learn more about person-centred dementia care. Conclusion: Optimal dementia care knowledge and skills can contribute to enhanced patient outcomes and positive attitudes towards older people’s care. To reduce deficits in dementia care education, nurses need regular continuing professional development in dementia care, higher education institutions need to commit to developing dementia care in their curricula, and students need to be socialised in dementia care earlier during undergraduate nurse education.
... While undoubtedly dynamic, what is at stake in dementia and the responses to it is invariably influenced by broad contributions from culture, language and nationality (Calia et al., 2019). Individuals and organisations employ widely varying assumptions and beliefs about the meaning of personhood and the provision of person-centred care that are not always consistent (Hunter et al., 2016;Brooke et al., 2018). As a result, what appears under the rubric of person-centred care is highly variable and does not conform to a single accepted definition. ...
Article
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It has become commonly expected that the “personhood” of people with dementia should be recognised, understood in the relational sense that is now widely adopted in healthcare practices. Despite its broad acceptance, however, the concept of personhood remains problematic in dementia care, as a result both of the theoretical challenges it poses and the practices that arise from it. This work employs the technique of ethnographic observation of residents, family members, and care staff of an aged care facility to explore the ways in which various modalities of the “self” are displayed in persons with dementia. The results provide insights into the moral and ontological impact of personhood on the systems that structure and influence interactions involving people with dementia. We conclude that privileging a preserved identity in dementia, and delivering care that conforms to contemporary “person-centred” expectations may limit recognition of the fluid, ongoing selfhood of people with dementia and that a reconsideration of this focus may enable us to expand our understanding of, and our responses to, their changing experiences.
... This is of utmost importance also in a multicultural society, where perception of healthcare differs depending on cultural background and values, and differences may generate significant stress, both physically and mentally. 32 Supporting the families and working in team have always been natural parts in palliative care. This is obvious especially in cancer care, where the families participate in the planning of care and receive adequate support from the healthcare team if needed. ...
Article
Full-text available
Objectives Informal caregivers of patients with chronic obstructive pulmonary disease (COPD) experience a heavy caregiver burden, but few studies have explored what support they need. The aim of this study was to describe perceptions of healthcare support to informal caregivers, both from the family caregiver’s and the staff’s perspective. Design A qualitative interview study involving semi-structured interviews and analysed with content analysis. Participants In total, 54 participated: 36 informal caregivers of patients with severe (stage 3–4) COPD and 17 healthcare staff. Results Two main themes emerged from the analysis: (1) Ambiguity impedes provision of support. Both caregivers and staff experienced ambiguity. The informal caregivers needed emotional, practical and informational support but talked about unclear expectations, while the staff described an uncertainty about their duties regarding the families. There were no routines to unburden the families. Moreover, language and cultural barriers hampered their efforts. (2) Knowledgeable and perceptive communication is key to support. Both caregivers and staff described positive experiences of dialogue. The dialogue may facilitate means to caregiver support and was a support in itself. Conclusions Our findings suggest that strategies and routines for caregiver support, including communication skills among the staff, should be developed, to move toward the family perspective advocated in palliative- and nursing family care.
... A meta-analysis of studies considering the impact of healthcare professionals' and care workers' culture vis-a-vis their provision of person-centred dementia care (Brooke, Cronin, Stiell, & Ojo, 2017) found staff were sometimes aware of the value of using language and non-verbal communication appropriate to an individuals' background. It also found, however, that staff often struggle to bridge the related cultural gap between themselves and residents. ...
Article
This paper considers the significance of how staff in residential aged care facilities interpret the non-verbal communication and behaviour of residents vis-a-vis their assessments of residents’ preferences and ability to participate in decision-making. It highlights the risks associated with staff members’ failure to interpret residents’ non-verbal communication and behaviour with reference to residents’ backgrounds and prior experiences. It also considers how non-verbal communication implemented by staff may impact residents’ emotional state and, as a consequence, decision-making abilities. Drawing on interview data with aged care staff from Queensland and Victoria, it demonstrates that care staff in residential facilities appear to rely heavily on non-verbal signals in assessing the decision-making capacity and preferences of residents with dementia. It also indicates that many staff fail to consider residents’ non-verbal communication and behaviour with due consideration of residents’ individual histories.
... Ageism can be overcome by understanding the different cultures of older people, how care is provided and ageing perceived. With particular reference to older person care and dementia the provision of culturally appropriate person-centred care has been identified as essential (Brooke et al 2017). ...
Article
Abstract The global population is ageing, and this trend is expected to continue. Cultures around the world socialise with older people differently with distinctive attitudes towards ageing. Ageism is a complex multifaceted concept that includes attitudes and behaviours. In the UK, ageism and discriminatory practices exist within nursing, and nurse educationalists and clinicians need to address ageist attitudes and promote older people care as healthcare needs increase. Within the context of nursing there is a lack of synthesised evidence which measures ageism amongst nursing students. This paper examines the Relating to Older People Evaluation (ROPE) questionnaire which has been used in different student populations in Higher Education (HE) including nursing students. A systematic search across databases was conducted from June 2007 to December 2017 resulting in 6 quantitative studies. Statistical analysis of ROPE was not possible, so a thematic analysis of the narrative was completed identifying two themes: attitudes predict behaviour and socialisation to ageism in HE. There remains a need to explore ageism and ageist attitudes of student nurses in HE. The ROPE is a suitable tool to measure student nurses’ ageist attitudes and behaviours.
... Although there is an expectation that staff working in New Zealand hospitals attained a minimum IELTS score of 7.0, there always remains the possibility that questions posed, as they are in the ADQ, were misunderstood. Also cultural values in regard to people with dementia vary across cultures (Brooke, Cronin, Stiell, & Ojo, 2017). For example, in the context of the US study -set in care home facilities -it was shown that Black and other minority staff were less likely than Whites to report person-centred care. ...
Article
Background: Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. Methodology: A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the 'Approaches to Dementia Questionnaire'; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Results: Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Conclusion: Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice.
... Diverse backgrounds, as well as cultural and language differences, become particularly relevant when older people with dementia require formal care. Even in care settings where the workforce is acculturated to care practices that accommodate the cultural background of residents, incorporating preferences for food, clothing and communication is often overlooked, and cultural identities are easily rendered invisible and neglected (Brooke et al. 2017). Over the past decade important work to establish CALD guidelines in Australia (Australian Government Department of Health 2017) and more recently New Zealand, has supported the notion of improving cultural identity (Peri and Cheung 2016;Nare et al. 2017). ...
Article
Full-text available
Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds. This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities. Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.
... Language, communicative difficulties and hearing loss, as well as culture, are factors that need to be taken into account and are described as barriers to interaction. [27][28][29] Strategies to enable interaction included Getting to know the patient, Building a shared understanding and Enabling opportunity for agency. ...
Article
Introduction: The introduction of effective, evidence-based approaches to centredness in health care is hindered by the fact that research results are not easily accessible. This is partly due to the large volume of publications available and because the field is closely linked to and in some ways encompasses adjoining fields of research, for example, shared decision making and narrative medicine. In an attempt to survey the field of centredness in health care, a systematic overview of reviews was conducted with the purpose of illuminating how centredness in health care is presented in current reviews. Methods: Searches for relevant reviews were conducted in the databases PubMed, Scopus, Cinahl, PsychINFO, Web of Science and EMBASE using terms connected to centredness in health care. Filters specific to review studies of all types and for inclusion of only English language results as well as a time frame of January 2017-December 2018, were applied. Results: The search strategy identified 3697 unique reviews, of which 31 were included in the study. The synthesis of the results from the 31 reviews identified three interrelated main themes: Attributes of centredness (what centredness is), Translation from theory into practice (how centredness is done) and Evaluation of effects (possible ways of measuring effects of centredness). Three main attributes of centeredness found were: being unique, being heard and shared responsibility. Aspects involved in translating theory into practice were sufficient prerequisites, strategies for action and tools used in safeguarding practice. Further, a variety and breadth of measures of effects were found in the included reviews. Conclusions: Our synthesis demonstrates that current synthesized research literature on centredness in health care is broad, as it focuses both on explorations of the conceptual basis and the practice, as well as measures of effects. This study provides an understanding of the commonalities identified in the reviews on centredness in healthcare overall, ranging from theory to practice and from practice to evaluation. Patient or public contribution: Patient representatives were involved during the initiation of the project and in decisions about its focus, although no patient or public representatives made direct contributions to the review process.
... Though migrant care workers have made significant contributions to the aged care sector by filling the gaps in staff shortages, their understandings of dementia and care need to be better understood as research shows that culture shapes perceptions and behavior toward dementia care (Brijnath, 2014;Leibing & Cohen, 2006). For instance, some cultures view dementia as part of the normal aging process, whereas other cultures view dementia as an embarrassment or dishonorable (Brooke, Cronin, Stiell, & Ojo, 2017). Evidence shows that culture provides an additional layer of complexity in delivering appropriate dementia care and it may influence the type of care migrant workers deliver (Ow Yong & Manthorpe, 2016). ...
Article
Background and objectives: In high-income countries, an increasing number of people living with dementia in residential aged care facilities are being cared for by an increasingly multicultural workforce. The purpose of this review was to investigate migrant aged care workers' dementia care experiences and to identify enablers and challenges that influence their retention. Research design and methods: Utilizing Arksey and O' Malley's approach, PubMed, Scopus, CINAHL, Web of Science, and EMBASE were searched for peer-reviewed studies published from 2000 to November 2018. Selection criteria were studies with original research, focusing on dementia care among migrant aged care workers, and conducted in high-income countries. Results: Seventeen articles were identified incorporating 13 (76.47%) qualitative, 1 (5.88%) quantitative, and 3 (17.65%) mixed method designs. A limited understanding of dementia and experiences of dementia care were reported among some migrant care workers in residential aged care facilities. The identified enablers to retention were the availability of organization support services; professional development opportunities; reciprocity and mutual respect between migrant care workers, care recipients, and coworkers; and good working conditions. Factors such as discrimination from care recipients and coworkers and limited understanding of workplace culture were identified as barriers to migrant care workforce retention. Discussion and implications: Migrant care workers are valuable contributors to the aged care workforce. It is important to consider their cultural perceptions of dementia in relation to care provision. In addition, their exposure to occupational psychosocial risk factors in conjunction with the challenges associated with resettlement and dementia care needs to be addressed.
... Undoubtedly, the intersection of good culture and dementia care highlights the importance of cultural influences in understanding dementia and how care is provided for PwAD [58]. Additional studies are suggested to evaluate the impact of Namaste Care on Asian families and Asian healthcare providers, considering social and cultural norms that are unique in different Asian communities. ...
Article
Full-text available
A locally-adapted, multisensory, psychosocial intervention called Namaste Care program was developed to improve the daily life of persons with advanced dementia (PwAD) through arranging meaningful activities and physical interactions by healthcare staff (Namaste Carers). Congruent with Asian values, the families of PwAD were invited to participate in Namaste Care sessions. The study aimed to explore the influence of Namaste Care on cognitive status and quality of life (QOL) of PwAD, and perceptions and attitudes of caregivers and Namaste Carers toward dementia care were determined. A total of 10 individuals, including patient-caregiver dyads (n = 4) and Namaste Carers (n = 6) participated in a program in a tertiary hospital in Singapore. Quality of Life in Late-Stage Dementia (QUALID) scale and Severe Impairment Rating Scale (SIRS) were employed to evaluate QOL and cognition, respectively, in the pre- and post-survey program in patient-caregiver dyads. Namaste Carers’ knowledge and attitudes toward PwAD were assessed using the Questionnaire on Palliative Care for Advanced Dementia (qPAD). Caregivers and Namaste carers were interviewed post-program separately. A concurrent explanatory mixed-method analysis was done. The mean age of PwAD was 84 years, with 75% (n = 3) patients on enteral tube feeding. Namaste carers were nurses with an average experience of 4.1 years in dementia care. On comparison of pre- and post-program scores of PwAD, QUALID scores showed a decrease (indicating an improvement in the QOL), while the SIRS scores were increased (indicating an improved cognitive response). Namaste Carers scored high on qPAD, reflecting the good understanding and a positive attitude toward PwAD. Thematic analysis of 10 interview transcripts from caregivers and Namaste Carers revealed three themes: the polarizing paradigm of care in advanced dementia; pre-eminence of the Asian family values, and theme of “small actions make a big difference”. Namaste Care served as a bridge between the person-centered care approach and the biomedical model of dementia care. Namaste Care with family participation may be the cornerstone of PwAD to receive culturally-appropriate personalized care and serve as a premise for the operationalization of person-centered care in Asian societies, and undeniably across the world.
... The Workgroup recommends a personcentred, cultural competency framework [45] that addresses: (1) experiences of persons living with dementia and caregivers; (2) their lived environment; and (3) their socio-cultural context. The sociocultural context includes attitudes, values, beliefs, and behaviours of cultures, as well as how these intersect with age, race, ethnicity, gender/gender identity, sexual orientation, and relationship to persons living with dementia, as well as account for educational background, social class, linguistics, religion, and other social and behavioural determinants of health [46,47]. ...
Article
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This policy paper presents workforce development recommendations for research, clinical care and public stakeholders as they plan future research activities to strengthen the workforce to support the healthcare and social needs of persons living with dementia and their families and caregivers. To create these recommendations, the 2020 National Research Summit on Care, Services and Supports for Persons with Dementia and Their Caregivers (2020 Summit) convened a Workforce Development Stakeholder Workgroup. The Stakeholder Workgroup consisted of an interprofessional team of health professionals from academia, professional organizations, and the federal government with expertise in dementia workforce development. The resulting ten workforce development recommendations represent four themes: (1) Accountability by addressing progress towards implementing the 2017 Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers (2017 Summit) workforce recommendations; (2) Improving recruitment, retention, and job quality for direct care workers; (3) Creating a tech-savvy and culturally competent workforce; and (4) Developing educational core competencies, domains and milestones. These recommendations will positively impact the ability of persons living with dementia and their caregivers to access person- and family-centred dementia care that promotes independence and quality of life among those navigating their dementia journey.
... Language and cultural differences can pose serious challenges on a healthcare providerservice user relationship (Nichols, Horner & Fyfe, 2015) level. The use of proper everyday verbal and nonverbal communication is recognised as an important factor when communicating with elderly patients (Brooke et al., 2017) and incorrect pronunciation or use of a word could result in increased patient agitation (Egede-Nissen et al. 2016). Notwithstanding the fact that there is scarce evidence on how linguistic and cultural competence training to healthcare personnel can affect patient-related outcomes (McCalman, Jongen and Bainbridge, 2017), such interventions can positively influence the individuals' attitudes, knowledge and behaviour resulting in better care (Truong, Paradies and Priest, 2014). ...
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Malta is facing an increasing demand and decreasing supply of local nurses and engagement of culturally and linguistically diverse (CALD) personnel is becoming the main solution to mitigate such problems. The case study examines the perceptions of CALD nurses about the content and utility of a Maltese language and culture awareness program. A qualitative methodology was adopted and data collected through focus group interviews conducted with sixteen (16) participants. Qualitative content analysis using Framework Method was used to analyse the data. Views on the training program have been divided between elements related to individual utility, service user utility, quality of delivery and areas for improvement. The results indicate that training can provide significant advantages in terms of enhancing cultural competence and cross-cultural encounters amongst CALD nurses working in elderly long term care and it is recommended that such programs are encouraged to be taken on board by organisations operating in similar health and social care services.
... Organizations take all their people through cultural humility and implicit bias training (Diaz et al., 2020). Crucially, adequate training aids the adaptation process of immigrant health care professionals toward providing culturally responsive people-centered care (Brooke et al., 2017) and (3) obtaining employee feedback and monitoring are relevant, and the audit is the most significant tool in practice. Transparency on diversity issues drives change, specifically public diversity goals, followed by transparent reporting on key measures (Beech et al., 2017). ...
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Purpose The aim of this paper is to present a conceptual model on foreign-born health care workers from developing countries working in the US. The model covers their motivations for migration, the consequences in terms of the inequality and exclusion they may experience and the role of institutional responses at micro-, macro- and meso-level of intervention. Design/methodology/approach The paper is based on: (1) in-depth review of key literature studies on the foundation theories of international migration including sociology, economics, anthropology, psychology and human resource management, (2) analysis of theoretical approaches to medical migration across disciplines, (3) analysis of the international and national documentary sources of micro-, macro- and meso-level policies on migration and (4) analysis of evidence on best practices, solutions and aspirational changes across different levels of institutions. Findings (1) Migration of international medical graduates (IMGs) from developing countries to the US can be explained from a micro-, macro- and meso-level of analysis. (2) IMGs who identify as racial/ethnic minorities may experience unfair discrimination differently than their US-born counterparts. (3) Although political/legislative remedies have had some successes, proactive initiatives will be needed alongside enforcement strategies to achieve equity and inclusion. (4) While diversity management initiatives abound in organizations, those designed for the benefit of IMGs from developing countries are rare. (5) Professional identity groups and some nonprofits may challenge structural inequities, but these have not yet achieved economies of scale. Research limitations/implications Although it is well-documented in the US health care literature how ethnic/racial minorities are unfairly disadvantaged in work and career, the studies are rarely disaggregated according to sub-groups (e.g. non-White IMGs and US-born MGs). The implication is that Black IMG immigrants have been overlooked by the predominant narratives of native-born, Black experiences. In placing the realities of native-born Blacks on the entire Black population in America, data have ignored and undermined the diverse histories, identities and experiences of this heterogeneous group. Practical implications An awareness of the challenges IMGs from developing countries face have implications for managerial decisions regarding recruitment and selection. Besides their medical qualifications, IMGs from developing countries offer employers additional qualities that are critical to success in health care delivery. Considering organizations traditionally favor White immigrants from Northern and Southern Europe, IMGs from developed countries migrate to the US under relatively easier circumstances. It is important to balance the scale in the decision-making process by including an evaluation of migration antecedents in comprehensive selection criteria. Social implications The unfair discrimination faced by IMGs who identify as racial/ethnic minority are multilayered and will affect them in ways that are different compared to their US-born counterparts. In effect, researchers need to make this distinction in research on racial discrimination. Since IMGs are not all uniformly impacted by unfair discrimination, organization-wide audits should be in tune with issues that are of concerns to IMGs who identify as racial/ethnic minorities. Likewise, diversity management strategies should be more inclusive and should not ignore the intersectionality of race/ethnicity, nationality, country of qualification and gender. Originality/value Immigrant health care workers from developing countries are integral to the health care industry in the United States. They make up a significant proportion of all workers in the health care industry in the US. Although the literature is replete with studies on immigrant health care workers as a whole, research has rarely focused on immigrant health care workers from developing countries. The paper makes a valuable contribution in drawing attention to this underappreciated group, given their critical role in the ongoing pandemic and the need for the US health industry to retain their services to remain viable in the future.
... Responsibility in this case is often given an additional interpretation by second-generation family caregivers: responsibility to ensure dignified ageing as an appreciation for the first generation's sacrifices. This nuances the dominant image of family care within migrant families solely as filial piety (Brooke et al., 2017) or a moral duty (Ahmad et al., 2020). ...
Thesis
The PhD dissertation explored: 1) a multilayered image of the dementia experience and dementia care provision among labor migrant families, and 2) methodological pathways to contribute to more ethical research involving this population. The findings of this dissertation are based on five studies. The findings show that the experience of dementia and the dementia care trajectory is defined by the intersectional social position of older labor migrants and their families, inviting us to move beyond the binary division between migrants and non-migrants with “having a different culture” as the division line. This while recognizing the impact of having a migration background, a non-normative culture and religion on care provision. The current dementia care is provided by a complex and dynamic transnational network of informal and formal caregivers that also includes alternative care forms. This picture of care provision is sought by family caregivers as an answer to their unmet care needs: A “complexity-sensitive person-centered responsive care” considers the multilayered identity of the older migrant with dementia. This reflects individual and structural professional care gaps to provide inclusive dementia care. Understanding this complexity can advance the provision of better dementia care for older migrants with dementia. Therefore, a new conceptual lens to examine dementia care for a diverse population is suggested. This dissertation also contributes to the debate on how to conduct ethical research on dementia among older migrants by moving away from the culturalist frame where it is currently embedded with biased and narrow assumptions about this population as a result. This dissertation suggests therefore a further exploration of decolonial frameworks as compass for an ethical gerontological research praxis: a praxis that engages us into a process of awareness of and resistance to the historically rooted coloniality of mind in our own knowledge production.
... Furthermore, the majority of healthcare professionals had a nursing background, reflecting the large workforce of nurses in various sectors and functions within the long-term dementia care system [46,47]. Social care professionals and GPs were underrepresented. ...
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Background: People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals. Method: Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports. Results: Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives. Conclusion: Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.
Chapter
The authors provide guidance for interactional research design involving persons with dementia. This guidance includes gaining institutional approval to best guarantee the ethical treatment of persons within this vulnerable population. In particular, the protection of such persons’ identities and personal information are key. Also essential is identifying clear purposes for collecting discourse data, which will then set the types of activities that serve those goals and the agenda. Since collecting data can be complicated, we present ways by which speakers who have dementia may be located. They walk researchers through the steps to gain consent from guardians and permission from residential centers, to include agreement for the use of equipment such as recorders, cameras, or cell phones. This chapter, overall, provides guidance for productive and practical research outcomes by ensuring, first, that the best interest of the study participants is part of the research design.
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Aims and objectives: To learn about the meaning of traditional food to institutionalised patients with dementia. Background: Traditional food strengthens the feelings of belonging, identity and heritage, which help persons with dementia to hold on to and reinforce their cultural identity and quality of life. Taste is more cultural than physiological. Dietary habits are established early in life and may be difficult to change. Being served unfamiliar dishes may lead to disappointment and a feeling of being betrayed and unloved. Design and method: The three studies presented have a qualitative design. In-depth interviews of family members and nurses experienced in dementia care were conducted in South Africa and among ethnic Norwegians and the Sami in Norway. Content-focused analysis, hermeneutic in character, was used to enable the exploration of the thoughts, feelings and cultural meaning described. Results: Traditional foods created a feeling of belonging and joy. Familiar tastes and smells awoke pleasant memories in patients and boosted their sense of well-being, identity and belonging, even producing words in those who usually did not speak. Conclusions: In persons with dementia, dishes remembered from their childhood may help maintain and strengthen cultural identity, create joy and increase patients' feeling of belonging, being respected and cared for. Traditional food furthermore improves patients' appetite, nutritional intake and quality of life. To serve traditional meals in nursing homes demands extra planning and resources, traditional knowledge, creativity and knowledge of patients' personal tastes. Relevance for clinical practice: This study provides insight into culture-sensitive dietary needs of institutionalised patients with dementia. The cultural significance of food for feeling contentment and social and physical well-being is discussed. Besides helping to avoid undernutrition, being served traditional dishes may be very important to reminiscence, joy, thriving and quality of life.
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Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
In quite a short amount of time, Sweden has gone from being a relatively homogeneous society to a multicultural one, with a rapid expansion of immigrants having culturally and linguistically diverse (CALD) backgrounds growing old in Sweden. This is particularly interesting in relation to studying age-related dementia diseases. Research shows that not only do CALD persons with dementia diseases tend to mix languages, have difficulties with separation of languages, or revert to speaking only their native tongue as the disease progresses, but they also show tendencies to experience that they live in the cultural environment in which they were brought up, rather than in the current Swedish one. In this article, we explore findings in relation to one such CALD group in Sweden, Iranians. The article is empirically driven and based on data gathered in 2 separate settings with specific ethnocultural profiles, offering dementia care with Middle Eastern, Arab, and/or Persian profile. Observations were carried out in combination with semistructured in-depth interviews (n = 66). By using a combination of content and ethnographic analysis, 4 main findings related to ethnocultural dementia care were elucidated. These include (a) a wider recognition of people from different CALD backgrounds possibly having different perceptions of what dementia is, (b) a possibility that such ascribed meaning of dementia has a bearing on health maintenance and health-seeking behavior as well as the inclination to use formal services or not, (c) choosing to use formal service in the forms of ethnoculturally profiled dementia care facility seems to relate to being able to “live up to ideals of Iranian culture,” and (d) “culture,” however ambiguous and hotly debated a concept it is, appears to be a relevant aspect of people's lives, an aspect that is both acquired as well as ascribed to oneself and to others. As such, we argue that culture needs to be further addressed in relation to dementia care in multicultural societies because ascribing culture boxes people in as well as out. In addition, ethnocultural contextualization of dementia care needs to be understood in relation to this because it affects the care provided.
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The majority of Vietnamese Australians migrated to Australia as refugees to escape a war and this unique migration background may affect their ability to access and utilize healthcare services in Australia. Inability to utilize dementia services is associated with higher levels of caregiver burden, higher rates of morbidities and mortality and hospitalization. The aim of the study was to explore the perceived challenges of dementia care from Vietnamese family caregivers and Vietnamese care workers. Gadamer's philosophical hermeneutics was used to interpret and describe the experiences of the participants. Data were collected from in-depth interviews with six Vietnamese family caregivers and a focus group with Vietnamese care workers using purposive sampling. Participants were recruited from a Vietnamese community care organization in South Australia. Five themes were identified from the data analysis namely: (1) a need for culturally and linguistically appropriate dementia education programs; (2) a willingness and unwillingness to seek help; (3) poor knowledge of health care service availability related to dementia; (4) the effect of language barrier in accessing services; and (5) the main sources of services utilized. The study revealed that Vietnamese family caregivers and Vietnamese care workers held different views on the association of stigma with dementia. Findings also revealed factors that impacted accessing and utilizing dementia services. These findings facilitate a more comprehensive understanding of Vietnamese family caregivers' needs and have implications for developing individualized support for family caregivers and for consumer-directed dementia services in Australia.
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Background Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. Aims To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). Results Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. Conclusions There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes. Royal College of Psychiatrists.
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The first two parts of the paper lay out some background ideas about the nature of plural societies, and about the various ways that groups and individuals engage interculturally within them (see Berry, 2007, for more detail). The third part examines more closely the meaning of integration and multiculturalism, using concepts and findings from cross-cultural and social psychology. A final section considers the possibility of rooting social solidarity on these concepts.
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This qualitative study explored the medication management experiences of Australian ethnic minority family caregivers of people living with dementia. From the perspective of this group of caregivers, medication management was a source of stress resulting from the progressive loss of ability of care recipients to manage their own medications; the complexity of the medication regime and the caregiver's lack of trust of the care recipient to safely and effectively manage medications. Caregivers used various strategies to manage medications and avoid conflict with care recipients including being watchful and involving other family members in medication management tasks. Family caregivers indicated that a lack of information and access to support to inform their medication management role added to their stress, which was exacerbated in some cases by limited English proficiency. Supportive factors noted by caregivers included a well-established relationship with a community pharmacist, involvement of a geriatrician, family support and caregiver support group participation.
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Older people from culturally and linguistically diverse groups are underrepresented in residential aged care but overrepresented in community aged care in Australia. However, little is known about culturally and linguistically diverse family caregivers in utilising dementia services in Australia because previous studies mainly focused on the majority cultural group. Experiences of caregivers from culturally and linguistically diverse groups who are eligible to utilise dementia services in Australia are needed in order to optimize the utilisation of dementia services for these caregivers. The aim of the study was to explore the experiences of family caregivers from Chinese, Greek, Italian and Vietnamese groups in utilising dementia services. Gadamer's philosophical hermeneutics was used to interpret the experiences of the participants. Focus group discussions and in-depth individual interviews were used to collect data. Data collection was conducted over a six month period in 2011. In total, 46 family caregivers who were caring for 39 persons with dementia participated. Four themes were revealed: (1) negotiating services for the person with dementia; (2) the impact of acculturation on service utilisation; (3) the characteristics of satisfactory services; and (4) negative experiences in utilising services. The present study revealed that the participation of caregivers from culturally and linguistically diverse groups in planning and managing dementia services ranged markedly from limited participation to full participation. The findings of this study suggest that caregivers from culturally and linguistically diverse groups need to be fully prepared so they can participate in the utilisation of dementia services available to them in Australia.
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Publicly available acculturation measures are systematically reviewed based on three criteria: scale descriptors (name of the scale, authors, year, target group, age group, subscales, and number of items), psychometric properties (reliabilities) and conceptual and theoretical structure (acculturation conditions, acculturation orientations, acculturation outcomes, acculturation attitudes, acculturation behaviors, conceptual model and life domains). Majority of the reviewed acculturation measures are short, single-scale instruments that are directed to specific target groups. Additionally, they mainly assess behavioral acculturation outcomes than acculturation conditions and orientations. Regarding the psychometric properties; most measures have an adequate internal consistency; yet cross-cultural validity of the instruments have not been reported. Guidelines for choosing or developing acculturation instruments are provided in the chapter.
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Background People with dementia and their family carers need to be able to access formal services in the community to help maintain their wellbeing and independence. While knowing about and navigating one’s way through service systems is difficult for most people, it is particularly difficult for people from culturally and linguistically diverse (CALD) communities. This study addresses a lack of literature on the use of formal services for dementia by people from CALD backgrounds by examining the experiences and perceptions of dementia caregiving within four CALD communities – Italian, Chinese, Spanish and Arabic-speaking – in south western Sydney, Australia. Methods The study used a qualitative design and the methods included focus groups with family carers and one-to-one interviews with bilingual/bicultural community workers, bilingual general practitioners and geriatricians. A total of 121 family carers participated in 15 focus groups and interviews were held with 60 health professionals. All fieldwork was audiotaped, transcribed and subjected to thematic analysis. Results People from CALD communities are often unfamiliar with the concept of formal services and there may be strong cultural norms about maintaining care within the family, rather than relying on external services. CALD communities often have limited knowledge of services. There is a preference for services that will allow families to keep their relative at home, for safety as well as cultural reasons, and they are particularly reluctant to use residential care. While there is a preference for ethno-specific or multicultural services, mainstream services also need to ensure they are more flexible in providing culturally appropriate care. Positive outcomes occur when ethno-specific services work in partnership with mainstream programs. Dementia service providers need to develop a trusting relationship with their local CALD communities and promote their services in a way that is understandable and culturally acceptable to members of these communities. Conclusions While members of CALD communities may have difficulties accessing formal services, they will use them if they are culturally and linguistically appropriate and can meet their needs. There are a number of ways to improve service provision to CALD communities and the responsibility for this needs to be shared by a range of stakeholders.
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Objective: To review systematically, for the first time, the effectiveness of all pharmacologic interventions to improve quality of life and well-being in people with dementia. Design: Systematic review and meta-analysis. Methods: We systematically reviewed the 15 randomized controlled trials and one review that fitted predetermined criteria. We included studies that reported the outcomes quality of life, well-being, happiness, or pleasure. Measurements: We rated the validity of studies using a checklist. We calculated mean differences between intervention and control groups at follow-up. Results: None of the evaluated trials reported a significant benefit to quality of life or well-being for people with dementia when comparing those taking a drug or its comparator at follow-up (pooled weighted mean difference: 0.18 [95% confidence interval: -0.82 to 0.46]). Conclusion: We found no consistent evidence that any drug improves quality of life in people with dementia. We recommend that all dementia trials should include quality of life as an outcome, as this is important to patients, and cannot be presumed from improvements in cognition or other symptomatic outcomes, especially if the latter are small. Copyright (C) 2012 American Association for Geriatric Psychiatry
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Background Australia is a culturally diverse nation with one in seven Australians born in a non-English speaking country. Culturally and Linguistically Diverse (CALD) populations are at a high risk of developing preventable chronic diseases such as cardiovascular disease, type 2 diabetes mellitus, renal disease, and chronic respiratory disease, especially communities from the Pacific Islands, the Middle East, North Africa, the Indian subcontinent and China. Previous studies have shown that access to services may be a contributing factor. This study explores the experiences, attitudes and opinions of immigrants from different cultural and linguistic backgrounds and their health care providers with regard to chronic disease care. Methods Five focus groups were conducted comprising participants from an Arabic speaking background, or born in Sudan, China, Vietnam or Tonga. A total of 50 members participated. All focus groups were conducted in the participants’ language and facilitated by a trained multicultural health worker. In addition, 14 health care providers were interviewed by telephone. Interviews were digitally recorded and transcribed. All qualitative data were analysed with the assistance of QSR NVivo 8 software. Results Participants were generally positive about the quality and accessibility of health services, but the costs of health care and waiting times to receive treatment presented significant barriers. They expressed a need for greater access to interpreters and culturally appropriate communication and education. They mentioned experiencing racism and discriminatory practices. Health professionals recommended recruiting health workers from CALD communities to assist them to adequately elicit and address the needs of patients from CALD backgrounds. Conclusions CALD patients, carers and community members as well as health professionals all highlighted the need for establishing culturally tailored programs for chronic disease prevention and management in CALD populations. Better health care can be achieved by ensuring that further investment in culturally specific programs and workforce development is in line with the number of CALD communities and their needs.
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Musculoskeletal disorders are among the most common problems affecting the elderly. The resulting loss of mobility and physical independence can be particularly devastating in this population. The aim of this article is to present some of the most frequent musculoskeletal disorders of the elderly, such as fractures, osteoporosis, osteoarthritis, microcrystal disorders, infections, and tumors.
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Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.
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Dementia is a chronic illness involving increasing levels of care, often provided by family members, particularly in culturally and linguistically diverse (CALD) communities. Multicultural community link workers are often the primary service providers assisting families to access health and welfare services and as such have extensive experience of, and possess in-depth knowledge about, CALD family care-giving for dementia. While research has been undertaken on dementia in CALD communities, this research has not focused on the experiences and perceptions of these multicultural workers with regards to CALD family care-giving. In response to this gap in the research, this paper presents the results of an empirical investigation of multicultural workers' perspectives with regard to the cultural traditions informing CALD family care-giving, CALD families' understandings of the term 'carer' and family arrangements regarding care. Due to their close relationship and knowledge of families, multicultural workers can offer an important perspective that is invaluable in informing the provision of carer education and support within CALD communities.
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This paper presents a discussion of the role of the philosophy of pragmatism in the Joanna Briggs meta-aggregative approach to qualitative evidence synthesis. An increasing number of qualitative evidence syntheses are being published in journals, many of them influenced by an interpretive or a critical-realist perspective. One approach to qualitative evidence synthesis is meta-aggregation. Originally designed to model the transparency, auditability and reliability of the established process for effectiveness reviews, meta-aggregation makes a case for the production of synthesized statements that refer to 'lines of action' informing decision-making at the clinical or policy level. This paper draws from the literature written on the philosophy of pragmatism (1877-2008) and from the user guidance on meta-aggregation developed by the Joanna Briggs Institute between 2004 and 2007. Meta-aggregation as a methodology is founded on the principles and assumptions of the philosophical traditions of pragmatism. Meta-aggregation can only reach its full potential if the 'lines of action' suggested will somehow be supported by measures of effectiveness, as demonstrated in mixed method research. The 'lines of action' presented as the result of a meta-aggregative synthesis are directive in nature and inform healthcare practitioners at the point of practical decision-making. The real verification of the 'lines of action' suggested in a meta-aggregation consists of the satisfactorily ending consequences, mental or physical, which the synthesized statements that summarize the basic ideas emerging from the studies are able to generate in end users.
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Survey results from 161 respondents trained in dementia care mapping (DCM) in the United States and United Kingdom (82 and 79 respondents, respectively) addressed the following: (a) To what extent are mappers using DCM? (b) How satisfied are mappers with DCM? (c) What affect does DCM have on mappers' attitudes toward their dementia practice? and (d) What challenges are encountered by mappers in the use of DCM? Analyses using odds ratios were used to make international and training-level (basic vs. advanced) comparisons. Differences across countries were found in use of DCM and lack of satisfaction using DCM codes. Similarities were found with positive affects of DCM on attitudes and lack of time for DCM. Differences in mappers' experiences and perceptions exist across the two countries, warranting increased attention to the cultural contexts within which mappers are situated and how these affect the implementation of DCM within a country.
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Family caregivers of people with dementia, often called the invisible second patients, are critical to the quality of life of the care recipients. The effects of being a family caregiver, though sometimes positive, are generally negative, with high rates of burden and psychological morbidity as well as social isolation, physical ill-health, and financial hardship. Caregivers vulnerable to adverse effects can be identified, as can factors which ameliorate or exacerbate burden and strain. Psychosocial interventions have been demonstrated to reduce caregiver burden and depression and delay nursing home admission. Comprehensive management of the patient with dementia includes building a partnership between health professionals and family caregivers, referral to Alzheimer's Associations, and psychosocial interventions where indicated.
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This article describes the implementation of SHARE (Support, Health, Activities, Resources, and Education), a counseling-based care-planning intervention for persons living with early-stage dementia and their family caregivers (CGs). The foundation of SHARE is built upon assessing and documenting the person living with dementia’s care values and preferences for future care. Using the SHARE approach, CGs are given an opportunity to achieve an understanding of their loved one’s desires before the onset of disease progression when the demand for making care decisions is high. Through working together with a SHARE Counselor, the care dyad begins to identify other sources of support, such as family and friends and service providers, in order to build a more balanced and realistic plan of care for the future. Data were collected from 40 early-stage dementia care dyads to determine the acceptability of having structured discussions about future care in the early stages of dementia. Findings from this study demonstrate the importance of planning in the early stages when persons with dementia can voice their care values and preferences for future care. Finally, this paper illustrates the use of supportive strategies such as rapport building, establishing buy-in, and communication to initiate care-related discussions with care dyads in the early stages that will help lead to more effective decision making in the future.
Book
CULTURE AND PSYCHOLOGY, 6th Edition illustrates how and why culture influences mental processes and behaviors in humans, and is relevant for anyone interacting with people from different cultures. Incorporating current research that highlights the relationship between culture and psychology, the authors use a cross-cultural framework that gives students the tools necessary for evaluating many psychological processes and principles from a cultural perspective. In addition, the text encourages students to question traditionally held beliefs and theories and their relevance to different cultural groups today, and to apply what they learn to their own lives.
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Background: As the population ages, the effects of Alzheimer's disease will be felt by all nurses. Providing proper care for people with Alzheimer's disease is difficult and requires specific skills, attitudes, and knowledge. Limited data exists regarding nursing students' attitudes and knowledge toward people with Alzheimer's disease, whether undergraduate education prepares students to care for this population, or the best methods to support students in learning in an innovative and interactive environment. Objectives: The aim of this study was to determine the effect of different educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease and to explore nursing students' knowledge and attitudes surrounding the care of people with Alzheimer's disease. Design: A convergent mixed method design. A three group (Alzheimer's disease clinical experience, online learning module, and no dementia-specific intervention), pretest and posttest design served as the quantitative arm of the study. A focus group discussion with themes extracted served as the qualitative piece of the study. Setting: College of Nursing in North Texas. Participants: Convenience sample of 94 senior level nursing students enrolled in the undergraduate nursing program's Community Health course. Method: Students completed pre and posttest surveys which included Alzheimer's Disease Knowledge Scale, Dementia Attitudes Scale, and demographic questionnaire. Content analysis was conducted on focus group responses to qualitative interview questions. Results: The Alzheimer's disease clinical group experienced increased knowledge and improved attitudes toward people with Alzheimer's disease compared with students who completed the online module or had no dementia-specific intervention. Four themes emerged from focus group data: Basic Alzheimer's disease knowledge, need for Alzheimer's disease experiential learning, negative feelings related to behaviors, and appropriate responses to behavioral and psychological symptoms of dementia. Conclusion: Experiential learning in the form of clinical placements increased knowledge and improved attitudes about Alzheimer's disease compared with an online module and no dementia-specific intervention.
Article
Purpose – Little is known about migrant Indian care workers working in long-term care facilities for people with dementia in England and the purpose of this paper is to remedy this lack of information in the light of political interest in immigration to the UK and continued staff shortages in parts of the social care sector. Design/methodology/approach – This pilot study investigated the experiences of workplace acculturation among 12 migrant Indian care workers who were employed in English care homes. Qualitative face-to-face interviews were conducted in 2013. Analysis of the interviews was conducted using principles of interpretative phenomenological analysis. Findings – Following analysis five themes emerged along an acculturation timeline. First, during the first six months of their employment, the migrant care workers recalled feeling vulnerable, seemingly marked by a sense of insecurity and an overwhelming state of cognitive burden within an unfamiliar cultural context. Second, simultaneously, the migrants felt perturbed about their new role as direct care workers. Third, few had been able to draw on their networks of friends and relatives to build up knowledge of their new work environments before starting care home employment. Fourth, two years into the work, although they reported feeling better adapted, psychological and socio-cultural adjustments were still thought to be needed. Fifth, most participants retained their ambition to be recognised as a qualified nurse in the UK and to pursue a nursing career outside the social care sector. Research limitations/implications – This is a pilot study in which 12 migrant Indian care home workers were interviewed. Further interviews might provide a greater range of views and experiences. The care homes that participated in this research were in the London region where staff shortages are common in dementia services such as care homes. Practical implications – The findings suggest a need for employers and human resource managers to respond to the specific needs of Indian and other migrants working with older people who are resident in care homes. Such responses should reflect the timeline of their acculturation and employers need also to acknowledge and address aspirations to move on to NHS work. Originality/value – This study is unique to the best of the authors’ knowledge in addressing Indian care workers specifically as a substantial part of the migrant care workforce in the UK. It offers information about their perceptions and suggests practical human response and managerial initiatives.
Article
Background: Nursing workforce in Western European health institutions has become more diverse because of immigration and recruitment from Asian, African, and East-European countries. Minority healthcare providers may experience communication problems in interaction with patients and coworkers, and they are likely to experience conflict or uncertainty when confronted with different cultural traditions and values. Persons with dementia are a vulnerable group, and the consequences of their illness challenge the ability to understand and express oneself verbally. The large number of minority healthcare providers in nursing homes underlines the importance to obtain better knowledge about this group's experiences with the care challenges in dementia care units. Research question: Can you tell about any challenges in the experiences in the encounter with persons suffering from dementia? Participants and research context: Five minority healthcare providers in a nursing home, in a dementia unit. All guidelines for research ethic were followed. Ethical consideration: The participants were informed that participation was voluntary, and they were guarantied anonymity. Method: We used a qualitative method, conducting individual interviews, using a narrative approach. In the analysis, we applied a phenomenological-hermeneutical method, developed for researching life experiences. Findings: One theme and four subthemes: striving to understand the quality of care for persons with dementia. The subthemes: sensitivity to understand the patients' verbal and nonverbal expressions. To understand gratefulness, understand the patient as an adult and autonomous person, and understand the patient as a patient in a nursing home. Challenges comprise both ethical and cultural striving to understand persons with dementia. Conclusion: To care for persons with dementia in an unfamiliar context may be understood as a striving for acting ethically, when at the same time striving to adapt and acculturate to new cultural norms, in order to practice good dementia care.
Article
Continuing her series on dementia care, Aysha Mendes explores the importance of cultural background and its role in the complex identity of every individual patient. Here she considers a variety of related issues, such as food, customs and religion
Article
No Aging in India: Alzheimer's, the Bad Family, and Other Modern Things. LAWRENCE COHEN. Berkeley: University of California Press, 1998; xxv + 367 pp. This is a powerful, provocative book, rich with meaning. Lawrence Cohen weaves together challenging, revealing theory with vivid ethnographic images - of white-clad stooped women mingling with hungry dogs on the narrow lanes of Varanasi (Benaras); of a "hot-minded" mother-in-law yelling out her window for someone to come save her, thus inculpating a "Bad Family" and uncaring daughter-inlaw; of an eager anthropologist trying to find senile old people with whom to do research. By the end the reader gains a new awareness of an important dimension of social and political life in India, as well as of what medical anthropology, gerontology, and ethnographic writing can be. The book is about age, and how people comprehend the body and its behavior in time. Cohen focuses here on loss and decay - "decay of the body, its reason, its voice, its ability to be heard as a speaking subject" - that is, on what may be termed senility (p. xv). As Cohen describes it, the book "is rooted in a sense that our practices of thinking about society, culture, the body, and the nature of our times would benefit from a sustained attention to age as a kind of difference" (p. xv). Cohen does not isolate the study of old age "as a singular object awaiting scholarly appropriation," then, but rather seeks to examine "how age engages larger debates in and out of the academy, particularly those relevant to contemporary India and its political economy and public culture" (p. xvii). Cohen writes as a medical anthropologist who spent some years examining geriatric and gerontological practice in the United States as a medical student before embarking on research in India. The book juxtaposes Alzheimer's and the "Bad Family" as the contemporary master narratives of aging and debility in the United States and India respectively. When he was a kid, Cohen recalls, we used to talk about senility as a vague sort of thing, and when in college, it was still possible for a professor in psychology to lecture that senility was a cognitive defense against the mindlessness of institutionalized old age. Now, Alzheimer's disease has become our dominant paradigm for explaining the losses of age. Without denying the usefulness of Alzheimer's as an explanation for a certain set of behaviors, Cohen challenges us to rethink the medicalization of old age that takes place when we reduce all of the social, political, and existential complexities of aging to the plaques and tangles of a biological brain disease. He argues that Alzheimer's as a disease construct has replaced old age in our structural understanding of the life course, so that old age itself can be "normal" and freed from decline, and debility explained via a stricken brain (p. 60). In India, contemporary master narratives frame aging not in terms of biology, but in terms of the decline of the joint family. Senility - understood locally as a "hot-minded," "weak-brained," or 11 sixtyish" state - points to a Bad Family, transpiring when an old person does not receive familial support, service (seva), and respect. Indian gerontologists and Cohen's other informants invoke the joint family as almost the sole criterion for assessing the well-being of old people. …
Article
AimTo report a meta-ethnography of qualitative research studies exploring the acculturation and socialization experiences of migrant care workers.Background Migrant care workers are increasingly participating in health and social care in developed countries. There is a need to understand this increasingly socioculturally diversified workforce.Data sourcesA comprehensive search through 12 databases and a manual search of journals related to transculture for studies on socialization and acculturation experiences (published 1993–2013) was completed. The inclusion criteria were peer-reviewed studies on the acculturation or socialization experiences of migrant care workers published in English in any country, using a qualitative or mixed-methods approach.Design and Review methodsThis meta-ethnography employed the seven-phase Noblit and Hare method with reciprocal translation, refutational synthesis and lines-of-argument to synthesize qualitative studies.ResultsThree main themes were identified: (a) schema for the migration dream: optimism; (b) the reality of the migration dream: so close, yet so far; and (c) resilience: from chaos to order. A general framework of motivated psychosocial and behavioural adaptation was proposed. This meta-ethnography also revealed the vulnerabilities of migrant nurses in the process of acculturation and socialization.Conclusions The general framework of behavioural and psychosocial adaptation revealed factors that impede and facilitate behavioural and psychosocial changes. Strategies to enrich external and internal resources should be targeted at encouraging multiculturalism and at improving the psychosocial resources of migrant care workers. It is suggested that research investigating the prominence of nursing vulnerabilities be conducted.
Article
s Background The prevalence of dementia is increasing among non-western immigrants. It is known that family care is provided relatively often among immigrant groups. Until now, however, relatively little was known about how relatives of people with dementia in the immigrant communities perceive family care. This study therefore focuses on describing the perspectives of female Turkish, Moroccan and Surinamese Creole family carers in the Netherlands about providing family care to a close relative with dementia. Methods Forty-one individual interviews and six focus group interviews ( n=28) were held with female Turkish, Moroccan and Surinamese Creole family carers who are looking after a close relative with dementia. A qualitative analysis of the interviews has been carried out, supported by the software MaxQda. Results Related to their cultural and religious backgrounds, female family carers with Turkish, Moroccan or Surinamese Creole origins see family care as a task that they should carry out with respect and love. They feel that family care is superior to professional care and that it is principally a task for women. If men do have a role in family care, then it generally covers non-physical aspects. Despite the fact that the family carers interviewed listed aspects that make caring for a close relative with dementia difficult, they do say that they get a great deal of satisfaction from providing this care. In Turkish and Moroccan families in particular this type of care leads to more recognition and appreciation of the daughter or daughter-in-law who is giving it. Conclusion Family carers of Turkish, Moroccan or Surinamese Creole origin derive a great deal of satisfaction from giving family care to a relative with dementia. This fulfilment largely outweighs the burden of care. Professional support or information for these family carers can be improved by also focusing on the positive aspects of providing family care instead of an exclusive focus on reducing the burden.
Article
Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships.
Article
US healthcare facilities have addressed nursing shortages in part by recruiting internationally educated nurses (IENs), and studies suggest IENs may make up a significant percentage of the nursing workforce in urban hospitals. Despite the economic recession of 2008-2012, international nurse migration is expected to continue. Little is known about IENs in the southeastern USA, and no studies have compared their perspectives to those of their US counterparts. The purpose of this study was to gain a deeper understanding about the experiences of IENs compared to those of US registered nurses (RNs) practising in two urban hospitals in southeastern USA. This study involved two rounds of semi-structured interviews of 82 IENs and US RNs. Interviews focused on themes relating to education, barriers to practice, intent to stay in nursing and IENs' migration experiences. Most IENs interviewed migrated to the USA after 1990 to join their family and do not plan to return to their home countries to practise. Most IENs initially received their Associate Degree in Nursing; many have obtained their Bachelor of Science in Nursing degree. IENs and newly licensed US RNs faced similar barriers when they began practising in the USA, but IENs faced additional challenges adjusting to the attitudes of US patients, the perceived lack of respect for nurses and delivering total patient care. IENs would benefit from orientation regarding the cultural differences in the USA. In other ways, their challenges are similar to those of US RNs; policies regarding education, recruitment and retention could target both groups together.
Article
This article discusses the staff's view on dementia and its impact on the care delivered arising out of a qualitative comparative study focusing on long-term care of older people in France, Portugal and Sweden. The aim was to explore the staff's view on the illness dementia; on older people suffering from dementia; the care provided and the impact of various views on the care. The care was studied through observations at 22 care settings in the three countries and the staff's attitudes were explored by means of interviews with 79 people. A relation-oriented phenomenological approach was used. Great differences appeared regarding the various staff groups’ views. The findings also indicated that the staff's view; the cultural context and the organizational environment might have an impact on the care provided. However the impact of professional affiliation and the way of collaborating seemed to be of greater significance than other similarities or differences. An interdisciplinary based starting point, with close collaboration between medical based health care and social care of older people suffering from dementia in integrative care models, is therefore of vital importance.
Article
Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.
Article
To review systematically, for the first time, the effectiveness of all pharmacologic interventions to improve quality of life and well-being in people with dementia. Systematic review and meta-analysis. We systematically reviewed the 15 randomized controlled trials and one review that fitted predetermined criteria. We included studies that reported the outcomes quality of life, well-being, happiness, or pleasure. We rated the validity of studies using a checklist. We calculated mean differences between intervention and control groups at follow-up. None of the evaluated trials reported a significant benefit to quality of life or well-being for people with dementia when comparing those taking a drug or its comparator at follow-up (pooled weighted mean difference: 0.18 [95% confidence interval: -0.82 to 0.46]). We found no consistent evidence that any drug improves quality of life in people with dementia. We recommend that all dementia trials should include quality of life as an outcome, as this is important to patients, and cannot be presumed from improvements in cognition or other symptomatic outcomes, especially if the latter are small.
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Presents an analysis of theoretical and applied developments in the measurement of acculturation. This book gives a diverse, interdisciplinary approach to the topic that includes theory and data relevant to the 4 major ethnic minority groups: African Americans, Asian Americans, American Indians, and Hispanics/Latinos. The volume looks specifically at developments in the analysis of acculturation as a culture-learning process--its relationship with other constructs (such as ethnic identification) and with cultural values and mores. Contributors also examine how acculturation is measured and applied to explain changes in family relations, health status, addictions, and mental health. This book is useful as a reference to those who study diverse ethnic and cultural groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The term person-centred care has become all-pervasive on the UK dementia care scene. It has been suggested that it has become synonymous with good quality care. It seems that any new approach in dementia care has to claim to be pc (person-centred) in order to be P.C. (politically correct). The term is used frequently in the aims and objectives for dementia care services and provision in the UK and the US, although what lies behind the rhetoric in terms of practice may be questionable.
Article
Given that the research area of cognitive intervention studies in the aging population is growing rapidly, it is important to review and gauge more recent intervention studies, in order to determine the evidence for the effectiveness of cognitive interventions. The purpose of the present review was to update the recent systematic reviews of Papp et al. (2009) and Martin et al. (2011), to evaluate the effectiveness of cognitive interventions in healthy older adults and people with MCI, by taking into account the methodological quality of the interventions studies. A systematic review of randomized controlled trials (RCT) and clinical studies published between August 2007 and February 2012 in Pubmed and PsychINFO was performed. The quality of the included RCTs was assessed according to the CONSORT criteria for RCTs. A total of thirty-five studies were included; twenty-seven RTCs and eight clinical studies. The content of the intervention studies differed widely, as did the methodological quality of the included RCTs, but was considerably low with an average of 44% of the Consort items included. The results show evidence that cognitive training can be effective in improving various aspects of objective cognitive functioning; memory performance, executive functioning, processing speed, attention, fluid intelligence, and subjective cognitive performance. However, the issue whether the effects of cognitive interventions generalize to improvement in everyday life activities is still unresolved and needs to be addressed more explicitly in future research.
Article
Filial piety has become an important cultural symbol of civilization in Chinese national vitality which is different with others'. For thousands of years, it has been regarded as a traditional virtue and permeated into the national blood and bone. The Chinese filial piety culture and thought are limited to the nature and influenced by the Confucian ideology. There is also filial idea in the Western culture, which is lean to surpass the nature, and is affected by the Christianity; however, due to various reasons they are in obviously different forms. In the wave of globalization, a large-scale importation of Western thoughts and culture has collided with traditional Chinese thoughts and culture, filial piety is no exception. The paper focuses on exploring the differences and integration of filial piety between Chinese and Western cultures, and the factors contributing to this dissimilarity would be identified. The paper indicates that there are huge differences of the Sino-Western filial morality culture due to their diverse social and historical backgrounds as well as the reasons lie behind geography, nature and values. Bearing these differences in mind can not only reduce unnecessary conflict and clash but enhance mutual understanding and respect in cross-cultural communication, hence seek to the possibility of narrowing the cultural gap. Meanwhile, the two filial ideas could find ways to form the complementarities and coexist harmoniously.
Article
Aim: To gain knowledge about how the original culture may influence communication and interaction with institutionalised patients with dementia and of what particular cultural aspects may come to the fore, exemplified by Sami patients. Method: Qualitative narrative interviews with 15 interviewees, family members of Sami patients with dementia and nursing staff experienced with dementia care were conducted. Hermeneutic, thematic analysis was used. Findings: Although the way dementia influence mental functions, language, etc. is universal, behaviours, reactions and responses may be coloured by the patient's background culture. Knowledge of language, cultural codes and the patient's former life are primary keys to understanding. Rhythm of life, spirituality, singing and tangible aspects of traditional culture like clothes and food constitute important aspects of culture-appropriate care.
Article
The migration of registered nurses as a response to a global nurse shortage has seen a growth in research interest in this area. Much of the research focuses on differences in language and culture which are posed as the attributes of the immigrant nurse. In reporting on an analysis of data drawn from China-educated nurses working in the Australian health care system, this paper explores the social construction of difference and the related intersection of difference and racialisation. A symbolic interactionist approach informed 46 in-depth interviews with 28 China-educated nurses. The method of analysis was initial and focused coding and constant comparison of data. The focus of interpretation was on human action and interaction as contextual and thus structural factors were critical to the analysis. Two levels of meaning were depicted in this study: difference as "you are you and I am I" and difference as "incompetence". Negative meanings were ascribed to difference which in turn legitimised inequality and held the potential to perpetuate racism. We argue that it is problematic to conceptualise difference as individual attributes. Difference needs to be contextualised and thus explored as a complex and socially constructed concept that in its application has social and political implications for immigrant nurses in Australia and elsewhere.
Article
Nurses today are providing care, education, and case management to an increasingly diverse patient population that is challenged with a triad of cultural, linguistic, and health literacy barriers. For these patients, culture and language set the context for the acquisition and application of health literacy skills. Yet the nursing literature offers minimal help in integrating cultural and linguistic considerations into nursing efforts to address patient health literacy. Nurses are in an ideal position to facilitate the interconnections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients. In this article the authors begin by describing key terms that serve as background for the ensuing discussion explaining how culture and language need to be considered in any interaction designed to address health literacy for culturally diverse patients. The authors then discuss the interrelationships between health literacy, culture, and language. Next relevant cultural constructs are introduced as additional background. This is followed by a description of how literacy skills are affected by culture and language, a note about culturally diverse, native-born patients, and a presentation of case examples illustrating how culture and language barriers are seen in patients' healthcare experiences. The authors conclude by offering recommendations for promoting health literacy in the presence of cultural and language barriers and noting the need for nursing interventions that fully integrate health literacy, culture, and language.
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This study examined the prevalence and risk factors for elder abuse in older Chinese with dementia by their family caregivers in Hong Kong. A sample of 122 family caregivers of older persons with dementia was conveniently recruited from local community centers for the elderly. Participants provided information on their demographic characteristics, care recipients' physical functioning and agitated behavior, caregiver burden, and whether they had directed any abusive behavior at the care recipients in the previous month. Sixty-two and 18 per cent of the caregivers reported having verbally or physically abused the care recipients in the past month. Family caregivers who spent more days co-residing with the care recipients, lacked any assistance from a domestic helper, observed more agitated behaviors in the care recipients, and/or reported a higher level of caregiver stress, reported more abusive behaviors. The results of hierarchical regression analysis showed that the number of co-residing days (p < 0.001), lack of any assistance from a domestic helper (p < 0.05), and caregiver burden (p < 0.01) were significant predictors of verbal abuse. Care recipient agitated behavior (p < 0.01) also predicted verbal abuse, with its effect mediated by caregiver burden. For physical abuse, the number of co-residing days (p < 0.01) was the only significant predictor. Verbal and physical abuse were highly prevalent among this population of older Chinese with dementia. A higher level of caregiver stress is related to a higher level of verbal, but not physical abuse inflicted by the caregivers of these older persons with dementia.
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This article draws on available literature and empirical data to discuss the experiences of people with dementia in Kerala, India. India is currently undergoing considerable demographic change. The state of Kerala in the south-west of the country is demographically advanced in comparison with other parts of India and as such is experiencing demographic change and modernization ahead of other parts of the country. The proportion and numbers of older people in Kerala are increasing, which in turn is leading to a higher prevalence of dementia. This article reviews existing literature to describe the context for people with dementia in Kerala. It also draws on empirical data to further illustrate and explore their experiences. People with dementia in Kerala are disadvantaged, as the process of modernization is breaking down traditional forms of care ahead of any significant service provision to replace them. Recent development of services in Kerala aims to provide quality care for people with dementia to counteract these demographic changes.
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Issues of ethnicity and culture, as they relate to Alzheimer disease and related disorders, continue to be under-studied. This article highlights the limited findings regarding ways in which culture can influence caregiving to older persons suffering from dementia across different ethnic groups in the United States. Particular attention is given to how cultural values, norms, and beliefs shape the meanings different ethnic groups assign to dementia. Findings show that family caregiving processes and help seeking are influenced by the meanings family members assign. However, more research is needed in this area. Also, researchers and practitioners could benefit Alzheimer sufferers and their caregivers by incorporating cultural and social information about diverse groups into their future models of research and practice.