Cultural Considerations

History taking

A comprehensive history forms the foundation of the assessment process. It is essential that a history is obtained from a family member who knows the older person well. This usually involves a separate interview without the client. The same information should be sought from a client from a non-English speaking background as would be sought from older people from an English speaking background.

Additionally, the assessment needs to be culturally appropriate and sensitive. To do this effectively the practitioner needs to establish an understanding of culturally relevant issues for each person, for example, for an older person from a refugee background particular attention and sensitivity needs to be given to issues of trauma, war experiences, migration, family separation and the disappearance of relatives, etc.

Effective communication

Practitioners working with people with dementia need to pay particular attention to their communication style. These issues are equally relevant whether working with an older person who speaks fluent English, or working through an interpreter.

Some of the key considerations around screening or assessing a CALD client for dementia are included below.

Some key considerations around screening or assessing a CALD client for dementia:

• Check and use the client’s preferred mode of address (for example, Mrs Wong, or Kim, for Mrs Kim Wong).
• Obtain a personal profile, including showing an interest in the clients past and current activities.
• Provide support for their sense of identity and self-worth.
• Be attentive to non-verbal cues (e.g., agitation, frustration).
• Not raising your voice to try to enhance the older person’s understanding.
• Talking in a calm and reassuring manner.
• Providing clear information in a caring, sensitive manner.
• Ensuring you directly face the older person while speaking to them; for people with hearing impairment, this is particularly important. (Note: for some cultures, eye contact is not the norm – the practitioner needs to determine this prior to or at the commencement of the assessment).
• Use short, easily comprehensible sentences.
• Ensure that the person’s dignity is preserved at all times.
• Ensure that the client has maximal sensory input available, that is, appropriate glasses are worn; hearing aids (if required) are worn and turned on;  and dentures are in place so they can communicate.
• Rephrase questions or statements if they do not appear to have been understood.
• Ensure that the views of the older person are sought, and that the interaction is not merely between the practitioner and the carer.
• Ensure adequate engagement and time for the interaction, questions and discussion between the practitioner, client and their family.

It is recognised that as people age, it is not unusual to lose proficiency in speaking a second language. As a result older people with conditions affecting memory tend to revert to their first language. When working with people from a CALD background who do not speak English well, health providers should use a qualified interpreter (McGrath et al., 2001).

Using competent and appropriate assessors

The most effective strategy for effective assessment is to have a language matched assessor or a qualified interpreter if a competent practitioner who speaks the older person’s language is not available.

Efforts should be made to establish and promote a model of care whereby a referral network of competent bi- and multi-lingual practitioners can be supported and readily accessed to undertake appropriate screening and assessment.

Use of professional interpreters to assist with interpreting

Where possible, aim to match the interpreter to the client by age and gender, region/dialect and cultural group.

The assessing practitioner should remain vigilant in observing the interaction between the older person, their family, the interpreter and themselves to ensure the process progresses smoothly.

Interpreter phone services are also available (for example in urgent situations where an interpreter is not able to be accessed quickly), although this is a less satisfactory arrangement than having an interpreter in the room with the older person, their family and the practitioner.

Use of bi/multi-lingual staff to assist with interpreting

The bi/multi-lingual staff available, will need to have sufficient skills, sensitivity and understanding to manage the complexities of the dementia screening process.

Use of family members to assist with interpreting

Family members provide important background information and they should be actively engaged in the assessment process where possible. However, professional interpreters are needed, as family members may lack objectivity, and may be unfamiliar with medical and cognitive assessment terminology.

Creating optimal environments

Providing an optimal physical and social environment for CALD older people with dementia supports their unique needs and improves the quality of care for the client and their family. The care-setting environment can support or hinder the social connectedness and sense of self for CALD older people with dementia.

Approaches to care and support should be in line with the older person’s social, cultural and religious activities, needs and capabilities.

Involving family

Involve the family in providing an optimal care setting for the CALD older person (Department of Health, State of Victoria, 2010c). For example:

• Ask family members to attend a care planning meeting and develop a partnership with them. Explicitly contact family members to encourage participation, questions and comments.
• Share information about a person’s daily experiences and special activities and discuss how family members might help in care routines or activities and provide opportunities for them to do so.
• Encourage involvement in activities that keep family connectedness:
• Invite family and friends to play a part in special events, for example birthdays, Sunday lunch and religious celebrations.
• Be attuned to cultural events and occasions friends and family members can share, for example Diwali celebrations for Indian families, New Year celebrations for Chinese people, and Eid celebrations for Muslim families.
• Be honest, approachable and open with family members and ask about what matters to them.

Spirituality and religion

Spirituality and religion are important to many CALD older people and their families and are strong predictors of quality of life. They are part of the person’s identity, their life story and sense of belonging.

Aged care services have a responsibility to provide spiritual support and to promote a quality of life (Ministry of Health, 2008; DHB Shared Services, 2013; Department of Health, State of Victoria, 2010c). Spiritual and religious involvement helps people to cope with many issues as they age, and as their health declines. Providing for people’s spiritual and religious needs can reduce the psychological morbidity related to chronic and terminal illness.

It is important that dementia care facilities and services have a policy of finding out people’s spiritual and religious needs and that staff understand the importance of this and are trained in how to address the religious needs of their clients. Providing prayer rooms is important.

Spiritual needs

To ensure clients’ spiritual needs are met:

• Find out people’s spiritual preferences when they first enter a facility, not just as they near death, and use experienced and knowledgeable spiritual and religious leaders and pastoral care workers.
• Find out whether a person practises particular beliefs, but word your enquiries about spiritual and religious beliefs carefully.
• Hold any discussion of spiritual needs in a safe environment with someone whose interpersonal skills allow information to be gathered using a conversational style.
• Respect the privacy of those who either publicly or privately practise their beliefs, and support opportunities for these practices, such as providing a place for prayer.
• People receiving care commonly ask staff members about spiritual matters. Address such questions in an open, non-judgemental manner.