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Chinese American and Dementia

CHINESE AMERICANS AND DEMENTIA

PREVALENCE OF DEMENTIA AMONG CHINESE AMERICANS

The true prevalence of dementia is unknown since there are currently no large scale prospective population-based studies examining the prevalence of Alzheimer’s disease and related disorders among Chinese Americans. Huang et al. 2002 published the first systematic report of the socio-demographic characteristics of newly admitted older Chinese to an urban nursing home in the United States. Using the Minimum Data Set database, the author selected 250 residents (125 Chinese, 57 white, 53 Hispanic, and 23 black) over age 60. Among the Chinese Americans the majority were first-generation immigrants and spoke primarily Cantonese or Mandarin Chinese. Compared with whites, they were more likely to be married, less likely to have lived alone, more likely to be using Medicaid, less likely to make medical decision alone, and more likely to depend on family members for decision-making. Nearly 75% of this group demonstrated significant cognitive impairment.

CHINESE AMERICAN CULTURAL BELIEFS ABOUT DEMENTIA

1. Dementia is a form of normal aging. Many families interpret the memory difficulties and behavioral problems associated with dementia as the result of normal aging. One study suggested that due to this belief, some Chinese families do not think that symptoms of dementia represent an illness that requires medical assessment or treatment.(Elliott, Di Minno, Lam et al. 1996

2. Dementia is a form of mental illness. Some Asians families perceive symptoms of dementia( paranoia, hallucinations, delusions etc.) to be synonymous with other types of mental illness such as schizophrenia. The Chinese word for dementia is represented by two characters one which means crazy and the other means catatonic. The stigma, shame and negative responses experienced by families and patients interfere with their willing to seek appropriate medical assessment and treatment in the early stages of the illness.

3.Dementia is a source of shame. Chinese American families may minimize the behavioral/cognitive disturbances associated with dementia. Many families will hide the elder with dementia from public view and avoid sharing family secrets or embarrassing information with strangers, including health care providers. They may feel that discussing the problems of caring for a Chinese American elder with dementia with outsiders would cause the family to lose face.

4. Dementia is a result of fate. Dementia is perceived by some Chinese Americans as inevitable. This fatalistic attitude often delays elders and their caregivers seeking diagnosis or treatment interventions for cognitive disorders.

5. Dementia is retribution for the sins of the family or of one’s ancestors.

6. Dementia is an imbalance between the body complementary forms of energy (“yin” and “yang”).

 

Chinese American Caregiver Attitudes about dementia

Traditional Chinese values dictate that the dedicated caregivers for elders are their oldest son and his wife or other children if the eldest son is not available. When a daughter marries, she becomes responsible for the care of her in-laws. She is no longer considered part of the family caregiver network for her family of origin. on. There are also many Japanese Americans who live alone or with a spouse who are begin.

Many Chinese families maintain strong social and spiritual ties with the surrounding Chinese community. Successful community outreach and

 

Recommendations for Health care providers

1. Determine the Patient’s country of origin and the specific nature of his/her migration Chinese Americans come to America from a variety of countries( e.g.Taiwan, Hong Kong, main land China, Vietnam) with significantly difference in their political, cultural and social environments. Clarifying the patients pre-emigration lifestyle, will help the clinician provide the most appropriate services for the patient and his family.

2. Provide accurate assessments of the elder’s ability to conduct activities of daily living since family members may minimize or deny the degree of the elders level of functional impairment.

3. Develop collaborations with highly regarded, existing Asian community agencies to improve your credibility with patients and their families and increase their likelihood of participating in those services.

4. Identify the primary language or dialect of the patient and his caregivers. Cantonese and Mandarin are the two Chinese language forms most commonly spoken by émigrés to the US, there are numerous other dialects which patients may speak. Accessing language appropriate translation services is a key element and developing rapport with the patient and establishing a collaborative working relationship.

5. Identify the primary caregiver and decision maker within the family. Actively develop a rapport with these people and collaborate with them on developing a Provide culturally sensitive, relevant materials about dementia written in the language of the target population

6. Continually expand you knowledge of the culture and social values of Chinese Americans

7. Use Asian media (Asian newspapers, television and radio stations) to publicize the availability of Chinese friendly dementia care services

8. Develop bilingual, culturally sensitive in-home dementia care services to assist family caregivers

 

REFERENCES

1. Working with Chinese Families in the Context of Dementia, Elliott KS, Di Minno M, Lam D et al. In Ethnicity and Dementia (eds) G. Yeo and D.Gallagher Thompson, L Thompson (pp.89-100). Taylor and Francis

2. Asian and Pacific Islanders Dementia Care Network Project

3. Sociodemographic and health characteristics of older Chinese on admission to a nursing home: a cross-racial/ethnic study.Huang ZB, Neufeld RR, Likourezos A et al.J Am Geriatr Soc. 2003 Mar;51(3):404-9.