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Leszko M, Allen DJ. Caring From a Distance: Experiences of Polish Immigrants in the United States Providing Care to Parents With Dementia Overseas. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad086. [PMID: 37288778 DOI: 10.1093/geronb/gbad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Aging populations and an increasing number of immigrants in recent years have led to numerous changes in intergenerational relationships. Although many studies have investigated the impact of providing care to a parent with dementia, little is known about the impact of caregiving activities provided from a distance, such as in the case of immigration, and over a long period of time to a person with dementia. Our understanding of how transnational caregiving for a person with dementia affects relationships is also limited. Using the Intergenerational Solidarity Theory as a theoretical framework, this paper examines the experiences of adult children and immigrant caregivers of a parent with dementia living in Poland. METHODS A qualitative, semistructured interview was conducted with 37 caregivers living in the United States while providing transnational care to a parent with Alzheimer's disease or other forms of dementia. The data analysis was based on the thematic analysis strategy. RESULTS Four themes were identified: (1) filial obligations and solidarity, (2) caregivers' contradictory emotions regarding transnational care, (3) financial and emotional exhaustion, and (4) challenges of nursing home dilemmas. DISCUSSION Transnational caregivers represent a unique group who face distinctive challenges related to competing demands and limited resources. This study contributes to a better understanding of their experiences whereas the findings highlight the importance of addressing the mental and physical well-being of immigrant caregivers of individuals with dementia and have important implications for health care professionals and immigration policies. Implications for future research were also identified.
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Affiliation(s)
- Magdalena Leszko
- Department of Psychology, University of Szczecin, Szczecin, Poland
| | - Dorota J Allen
- Department of Child Development and Family Studies, Purdue University, Hammond, Indiana, USA
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2
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Tsai LP, Barr JA. The experiences and perceptions of immigrant informal caregivers about engaging with professional services in the host country: A scoping review. Int J Nurs Pract 2023:e13227. [PMID: 38128928 DOI: 10.1111/ijn.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
AIM The inquiry explored immigrant informal caregivers' experiences and perceptions about engaging with professional services in the host country. BACKGROUND The number of informal caregivers is rising, with more people providing home caring. Nurses and other health services are crucial in supporting informal caregivers. Research needs to focus more on immigrants, not just other caregivers. DESIGN This was a scoping review. DATA SOURCES Five databases (January 2017-December 2022) were searched, and 16 articles were included in this inquiry. REVIEW METHODS This scoping review used the Joanna Briggs Institute Scoping Review methodology. This inquiry asked one question: What is the current knowledge about immigrant informal caregivers' experiences and perceptions when engaging mainstream professional services? Themes were identified using a thematic analysis approach. RESULTS Three themes emerged from the review: 'finding cultural bridges: culturally connecting with services'; 'building cultural bridges: addressing "them and us" and "acculturation-sensitive services"'. CONCLUSION Professional service providers are currently not meeting immigrant caregivers' needs. New knowledge is presented, that nurses and health professional services must provide acculturation-sensitive care, commencing with an assessment of the individual's acculturation status. By understanding acculturation status, nurses are more likely to customize person-centred care. Acculturation status refers to the degree that the individual has adapted to the new culture while retaining some traditional cultural beliefs and practices. Acculturation-sensitive care is more likely to provide authentic holistic care that optimizes well-being.
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Affiliation(s)
- Lily P Tsai
- Faculty of Health, Charles Darwin University, Casuarina, Australia
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3
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Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
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Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
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4
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Duran-Kiraç G, Uysal-Bozkir Ö, Uittenbroek R, van Hout H, Broese van Groenou MI. Informal caregiver and nurse perceptions of access to culturally appropriate health care for ethnic minority persons with dementia: A qualitative study. J Adv Nurs 2023. [PMID: 37113024 DOI: 10.1111/jan.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
AIMS This study explored what informal caregivers of ethnic minority (EM) persons with dementia in the Netherlands perceive as culturally accessible health care and nurses' perceptions of how cultural competence can be improved to facilitate access to health care for EM persons with dementia and their informal caregivers. DESIGN Qualitative description research with semi-structured individual interviews and focus group discussions (FGDs). METHODS Semi-structured interviews with 15 nurses and 6 informal caregivers provided input for two FGDs with nurses about the need to strengthen their cultural competence to improve access to health care for EM persons with dementia and their informal caregivers. Interview data were collected between September 2020 and April 2021 in the Netherlands. Focus group discussion data were collected between June and September 2021 in the Netherlands. RESULTS Nurses and informal caregivers experienced difficulty building and maintaining a relationship. Contrary to informal caregivers' experiences, nurses felt a shared cultural background with the persons with dementia and informal caregiver is necessary. Although nurses acknowledged the importance of cultural knowledge, cultural skills, in particular, were mentioned as needing improvement. Examples are mapping involved family members and their roles, asking the right questions and letting go of personal judgements. Nurses frequently mentioned stereotypical thinking and seeing 'the other' as different, and collaboration with(in) family proved difficult for informal caregivers and nurses. CONCLUSION Strengthening cultural skills will contribute to facilitating better access to cultural appropriate health care for EM persons with dementia and their informal caregivers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT This study explores what is perceived as culturally accessible health care and what nurses need to improve their cultural competence. We show that strengthening nurses' cultural competence by addressing which skills should be improved can improve access to health care for EM persons with dementia and their informal caregivers.
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Affiliation(s)
- Gözde Duran-Kiraç
- Research Group Living Well with Dementia, Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Özgül Uysal-Bozkir
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Ronald Uittenbroek
- Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Hein van Hout
- Departments of General Practice and Medicine of Older People, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
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Knipping D, Garnett A, Jiang BB. Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity. J Appl Gerontol 2023. [PMID: 36866817 DOI: 10.1177/07334648231158490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.
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Affiliation(s)
| | - Anna Garnett
- Nursing, 6221University of Western Ontario, London, ON, Canada
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6
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Claeys A, Berdai-Chaouni S, Tricas-Sauras S, De Donder L. Barriers and facilitators in providing care for patients with a migration background. J Clin Nurs 2023; 32:912-925. [PMID: 35968776 DOI: 10.1111/jocn.16491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. BACKGROUND People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. DESIGN AND METHODS Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. RESULTS Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. CONCLUSIONS Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. RELEVANCE TO CLINICAL PRACTICE Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background. PATIENT OR PUBLIC CONTRIBUTION Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.
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Affiliation(s)
- Ann Claeys
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Saloua Berdai-Chaouni
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sandra Tricas-Sauras
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Social Approaches to Health Research Centre, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Gulestø R, Lillekroken D, Halvorsrud L, Bjørge H. Different senses of one's place: Exploring social adjustment to home-based care services among family caregivers from minority ethnic backgrounds who have relatives living with dementia. DEMENTIA 2023; 22:359-377. [PMID: 36594107 DOI: 10.1177/14713012221148528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Western dementia care policies emphasise that family caregivers from minority ethnic backgrounds must become more engaged in healthcare services. However, research exploring experiences of receiving services such as home-based care, and thus adjustment to the service, among family caregivers from minority ethnic backgrounds who have relatives with dementia is still scarce. Therefore, inspired by Pierre Bourdieu's theoretical concepts of field, habitus and capital, we explored how family caregivers from different minority ethnic backgrounds justified decisions about whether to receive home-based care and their social adjustment to the service. Using empirical data from semi-structured interviews with nine family caregivers from different minority ethnic backgrounds, we demonstrated that different mindsets and available social resources gave rise to various actions. Although some family caregivers were optimistic about receiving home-based care, our findings point to tensions between the ideals of care practices and the organisational structures surrounding home-based care as a service. Among those who had experiences with home-based care, we found that organisational limitations, particularly in terms of efficiency demands and time constraints, influenced their behaviours and thus their social adjustments to the service. For some, these limitations eventually resulted in cancellation of the service. However, not all had the same opportunities to make these decisions, indicating that, although family caregivers from minority ethnic backgrounds receive home-based care, this does not necessarily entail a deficiency-free service. Furthermore, we argue that public discourses on this subject can be challenged by encouraging one to look beyond ethnic and cultural labels towards other factors, such as organisational structures, that might largely influence the use of home-based care among these family caregivers.
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Affiliation(s)
- Ragnhild Gulestø
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Faculty of Health Sciences, 158935Oslo Metropolitan University, Oslo, Norway
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Shrestha S, Arora S, Hunter A, Debesay J. Changing dynamics of caregiving: a meta-ethnography study of informal caregivers' experiences with older immigrant family members in Europe. BMC Health Serv Res 2023; 23:43. [PMID: 36650497 PMCID: PMC9847080 DOI: 10.1186/s12913-023-09023-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The population of Europe is ageing and becoming more ethnically diverse due to migration. Finding suitable long-term caring arrangements for older immigrants in Europe has been one of healthcare policymakers' concerns in the last decade. However, relatively few older people with an immigrant background live in long-term care facilities, and many prefer to be cared for by their family members. Little is known about immigrant family caregivers' experiences of caring for older family members and the support they need while providing care. This study aims to synthesize the qualitative literature exploring the experiences of individuals caring for older family members with immigrant backgrounds from Africa, Asia and South America living in Europe. METHODS We searched the electronic databases Medline Ovid, Embase Ovid, PsycInfo Ovid, SocIndex EBSCOhost, CINAHL EBSCOhost, Scopus, Social Care Online, ASSIA ProQuest, and Google Scholar for original, peer reviewed research articles, published in English from 2011 to 2022. The seven-step interpretive methodology in meta-ethnography developed by Noblit and Hare (1988) was followed for qualitative synthesis. RESULTS After assessing 4155 studies for eligibility criteria, 11 peer-reviewed articles were included in this review. The qualitative synthesis of these included articles resulted in four main themes: strong care norms for parents, the moral dilemma of continuing care, uneven care sharing, and the use of formal care services. CONCLUSIONS Caregiving dynamics are changing, both in terms of motivations and approaches to caregiving. Furthermore, there are gender disparities in the distribution of caregiving duties, particularly with women carrying the more significant burden of care. The care burden is further exacerbated by the lack of culturally sensitive formal services complementing the care needs of the ageing immigrants and their family caregivers. Therefore, those searching for alternatives to informal care should be met with appropriate health and care services in terms of language, culture, religion, and lifestyle, delivered in a non-judgmental way.
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Affiliation(s)
- Sunita Shrestha
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Sanjana Arora
- Centre for Intercultural Communication, VID Specialized Univeristy, Stavanger, Norway
| | - Alistair Hunter
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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9
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Stenberg J, Hjelm K. Migrant informal caregiver perceptions and experiences of caring for a family member with dementia: A systematic review and thematic synthesis. J Clin Nurs 2022; 32:2178-2192. [PMID: 35655377 DOI: 10.1111/jocn.16390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe migrant family caregivers' experiences and perceptions of caring for a family member with dementia. BACKGROUND There are demographic trends of aging populations and increased migration between countries. Age-associated diseases, such as dementia, are expected to increase, with migrants being at significantly increased risk. Knowledge of how dementia care is provided within migrant families is scarce. DESIGN Systematic review and thematic synthesis of qualitative research were performed to inform the development of interventions that can acknowledge and respond to the needs, concerns and preferences of migrant family caregivers. METHODS Searches were performed in PubMed, PsycINFO and CINAHL and reference lists in published articles were reviewed for the period 2000-October 2020. The CASP checklist for qualitative research was used to assess evidence quality, and the ENTREQ framework was used as a guide for study reporting. RESULTS Twenty-six articles from 10 Western countries, including 360 informal migrant caregivers from more than 30 countries of origin, were eligible. Within four areas of construct-perceptions of dementia and initial help-seeking; barriers to accessing and using formal dementia care; caregiver burden and coping and resilience-12 descriptive themes were identified. Several concepts cut across the themes, such as language difficulties; the role of the family in relation to care and support; cultural perceptions of dementia and care; stigma, pride and shame; the importance of religion and the importance of trust. CONCLUSIONS The review revealed commonalities among migrant family caregivers that resulted in reduced understanding of dementia and the importance of diagnosis and treatment. RELEVANCE TO CLINICAL PRACTICE To prevent a negative trajectory in caregiving, with perceived demands causing high levels of stress and strain, several barriers to migrants accessing and using formal care need to be assessed and addressed.
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Affiliation(s)
- Jenny Stenberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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10
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Chejor P, Laging B, Whitehead L, Porock D. Experiences of older immigrants living with dementia and their carers: a systematic review and meta-synthesis. BMJ Open 2022; 12:e059783. [PMID: 35613772 PMCID: PMC9125757 DOI: 10.1136/bmjopen-2021-059783] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To systematically review and synthesise evidence on the experiences of older immigrants living with dementia and their carers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Studies exploring the experiences of older immigrants living with dementia and their carers were eligible. Databases were searched including CINAHL, MEDLINE, PsycINFO, PubMed, Embase, Web of Science and Cochrane Library from January 2000 to April 2021. Quality assessment was undertaken using the Critical Appraisal Skills Programme checklist for qualitative studies. Data were then synthesised using the thematic synthesis approach. RESULTS The results of this meta-synthesis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Enhancing transparency in reporting the synthesis of qualitative research statement. A total of 3857 studies were returned from the database search. Eighteen studies were included for meta-synthesis. Five synthesised findings were identified: living with dementia and caregiving; family relationships; barriers to dementia care services; stigma and discrimination; and legal and financial issues. The experiences of living with dementia and caregiving presented multiple challenges for older immigrants living with dementia and their families. However, there seems to be very little difference between the experiences of those who have migrated to a new country and those who were born and aged in the same country, but the ability to access and use the available services is different. CONCLUSION A lack of culturally appropriate dementia services, language barriers and dementia stigma can impede access to dementia care for older immigrants. Strategies to mitigate these barriers are urgently needed to ensure people from culturally and linguistically diverse backgrounds with dementia and their families have the information, education and support to access dementia services, in addition to research that explores the experiences of culturally and linguistically diverse populations. PROSPERO REGISTRATION NUMBER CRD42021277913.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
| | - Bridget Laging
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Davina Porock
- Centre for Research in Aged Care, Edith Cowan University, Perth, Western Australia, Australia
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11
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Monsees J, Schmachtenberg T, René Thyrian J. Intercultural care for people of migrant origin with dementia - A literature analysis. DEMENTIA 2022; 21:1753-1770. [PMID: 35506672 DOI: 10.1177/14713012221086702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Close to 12 million people of migrant origin who are 65 years or older live in different European countries. In the European Union (EU) and the European Free Trade Association (EFTA) countries, approximately half a million are estimated to have dementia. This rate is expected to increase in the coming decades. People of migrant origin who develop dementia and their families face challenges people without migration backgrounds do, but due to cultural differences, additional challenges may arise. There is an increasing need for interculturally sensitive care. There is research on certain aspects of intercultural care and this study will be a comprehensive summary of current topics in intercultural care. RESEARCH QUESTION What factors of intercultural care for people of migrant origin with dementia can be identified? What requirements and aspects are necessary to ensure intercultural care? METHOD A systematic literature analysis in the databases PubMed, PsycInfo and Psychology and Behavioural Sciences Collection was conducted. FINDINGS Thirty-nine articles were eligible for analysis. Enhancement in the areas diagnostics, education and information, healthcare services and healthcare professionals to ensure intercultural care is needed. DISCUSSION Current evidence supports the need for (a) thorough education of people of migrant origin with dementia, their families and healthcare professionals, (b) collaborations among everyone involved, (c) embracing different cultures in healthcare services, (d) the implementation of a care navigator functioning as a contact person and connecting all relevant parties with one another and (e) dementia testing suitable to the target group to ensure culturally sensitive and appropriate care for people of migrant origin with dementia and their families.
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Affiliation(s)
- Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Tim Schmachtenberg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany; and Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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12
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Bosma C, Smits C. Behavioral changes in migrants with dementia : Experiences of professional caregivers. Z Gerontol Geriatr 2022; 55:281-286. [PMID: 35394191 DOI: 10.1007/s00391-022-02057-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Professional caregivers take care of an increasing number of migrants with dementia who may show behavioral changes. OBJECTIVE Insight into the experiences of professional caregivers concerning the care for people with a migration background who suffer from dementia and behavioral changes. MATERIAL AND METHODS Semi-structured interviews with 20 professional caregivers providing community and residential care. RESULTS The caregivers' experiences focus on behavioral changes itself and on their efforts to offer person-centered care. Caregivers are aware of the mismatch between the cultural background of the client and their relatives and the professional care context. The different care perspectives of relatives and professionals sometimes result in conflict and poor collaboration. Over time, the reflections on experiences result in an awareness that more expertise and support is needed. CONCLUSION Professional caregivers deserve support in their aim to provide high quality care for migrants with dementia and behavioral changes.
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Affiliation(s)
- Corina Bosma
- Carintreggeland, Hengelo, The Netherlands, Postbus 506, 7550 AM.
| | - Carolien Smits
- Programme Older adults and Health, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
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13
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Duran-Kiraç G, Uysal-Bozkir Ö, Uittenbroek R, van Hout H, Broese van Groenou MI. Accessibility of health care experienced by persons with dementia from ethnic minority groups and formal and informal caregivers: A scoping review of European literature. DEMENTIA 2021; 21:677-700. [PMID: 34879748 PMCID: PMC8813582 DOI: 10.1177/14713012211055307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of persons with dementia from ethnic minority backgrounds is increasing.
However, ethnic minority groups use health care services less frequently compared to the
general population. We conducted a scoping review and used the theoretical framework
developed by Levesque to provide an overview of the literature concerning access to health
care for ethnic minority people with dementia and (in)formal caregivers. Studies mentioned
barriers in (1) the ability to perceive a need for care in terms of health literacy,
health beliefs and trust, and expectations; (2) the ability to seek care because of
personal and social values and the lack of knowledge regarding health care options; and
(3) lack of person-centered care as barrier to continue with professional health care.
Studies also mentioned barriers experienced by professionals in (1) communication with
ethnic minorities and knowledge about available resources for professionals; (2) cultural
and social factors influencing the professionals’ attitudes towards ethnic minorities; and
(3) the appropriateness of care and lacking competencies to work with people with dementia
from ethnic minority groups and informal caregivers. By addressing health literacy
including knowledge about the causes of dementia, people with dementia from ethnic
minorities and their informal caregivers may improve their abilities to access health
care. Health care professionals need to strengthen their competencies in order to
facilitate access to health care for this group.
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Affiliation(s)
- Gözde Duran-Kiraç
- Health and Social Care Department, 8771Windesheim University of Applied Sciences, Zwolle, Netherlands.,Vrije Universiteit, Amsterdam, Netherlands
| | - Özgül Uysal-Bozkir
- 6984Erasmus School of Social and Behavioural Sciences, Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Netherlands
| | - Ronald Uittenbroek
- Health and Social Care Department, 8771Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Hein van Hout
- Departments of General Practice & Medicine of Older People, 522567Amsterdam University Medical Centers, Amsterdam, Netherlands; Vrije Universiteit, Amsterdam, Netherlands
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14
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Lillekroken D, Halvorsrud L, Gulestø R, Bjørge H. Family caregivers' experiences of providing care for family members from minority ethnic groups living with dementia: A qualitative systematic review. J Clin Nurs 2021; 32:1625-1641. [PMID: 34786789 DOI: 10.1111/jocn.16127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To review the literature on family caregivers' experiences of providing care for a family member from an ethnic minority group living with dementia within the European context. BACKGROUND Due to labour migration during the late 1960s and early 1970s, many European countries are now encountering an increasing number of older people from diverse ethnic minority groups who have been diagnosed with dementia. Although family care is predominantly used as a care pathway among families with immigrant backgrounds, little is known about family caregivers' experiences of providing care for a family member with dementia. DESIGN A systematic review of qualitative literature. METHODS Eight databases (CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS, Social Care Online, SocIndex and Epistemonikos) were searched for original, peer-reviewed papers, published in English between 2010 and 2021. The literature review was conducted and reported in accordance with PRISMA 2020 checklist for reporting systematic reviews. RESULTS After identifying, screening and assessing articles for eligibility, 14 articles were critically appraised using the standardised assessment tool Mixed methods Appraisal Tool (MMAT, version 2018) and included in the review. The data synthesis process identified four themes across the qualitative studies: controversies and challenges; a lack of health literacy; barriers to seeking support from the healthcare or social services; and models of care. CONCLUSIONS Most of the family caregivers highlighted the value of being able to care for a family member living with dementia. However, the findings also reveal that they experience controversies and challenges due to their lack of dementia health literacy and perceived barriers to seeking healthcare support. RELEVANCE TO CLINICAL PRACTICE The findings from the current review can inform healthcare and social services in relation to implementing models of care that facilitate and complement family caregivers' role in caring for family members living with dementia from minority ethnic groups.
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Affiliation(s)
- Daniela Lillekroken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Ragnhild Gulestø
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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15
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Schmachtenberg T, Monsees J, Thyrian JR. What elements are important in current treatment and care guidelines to provide culturally sensitive care for people with a migration background and dementia? A systematic analysis. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01531-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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How is migration background considered in the treatment and care of people? A comparison of national dementia care guidelines in Europe. BMC Public Health 2020; 20:1555. [PMID: 33059649 PMCID: PMC7559782 DOI: 10.1186/s12889-020-09668-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background People with a migration background are vulnerable to dementia. Due to problems such as underdiagnosis or access barriers, the care of this population is a public health challenge in Europe. Many countries are issuing care guidelines, but a systematic overview of their references to migration groups is lacking. This study aims to analyze national dementia care guidelines regarding their focus on people with a migration background, what specific actions to ensure healthcare have been undertaken at the national level, and whether recommendations for action are made for this population. Methods This study is a systematic analysis of national dementia care guidelines of the EU and EFTA (European Free Trade Association) countries. Using the discourse analysis model by Keller (2011), 43 documents from 24 EU and 3 EFTA countries were systematically screened for migration references via keyword and context analysis. The content of the migration-related section was paraphrased, memos and comments were added, and the individual text passages were coded using the strategy of open coding. Results Twenty-seven of the 35 EU and EFTA countries have guidelines or similar documents on care for people with dementia, and 12 refer to migration. Norway, Sweden, and Northern Ireland refer to this topic in detail. The focus of the migration-related guidelines is on the early detection and diagnosis of dementia. The main message is that standardized diagnostic tools such as the MMSE (Mini-Mental State Examination) or the clock test are not suitable for linguistic minorities. Nine countries make recommendations for the care of people with a migration background and dementia, but only Norway, Sweden, and Denmark point to available healthcare services. A key recommendation is that the linguistic and cultural background of people should be considered when selecting diagnostic tests. Several countries refer to the validity of the RUDAS (Rowland Universal Dementia Assessment Scale) for migrants. Conclusions The topic of migration plays a subordinate role in the dementia care guidelines of European countries. Almost all countries lack appropriate diagnostic tools and healthcare services for people with a migration background. Consequently, this group is vulnerable to underdiagnosis and a lower level of care.
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