Assessing Asian older people

The available literature on Asian older people and mental health inform us that there are higher rates of depression in older Asian migrants because they tend to have fewer family contacts and smaller social networks. It is interesting to note however, that in a report by Mehta (2012) Chinese, Indian and Other Asian people all had significantly lower rates of self-harm as compared to European/Other people.

Vascular dementia was found to be more prevalent in Japanese immigrants prior to acculturation, but after becoming acculturated there is an increase in Alzheimer dementia.

Similar rates of dementia were noted across cultures in America, but diagnosis of Asian clients was difficult due to language barriers and lack of formal education making screening tests difficult to interpret.

Trinh & Ahmed (2009) highlight the following as useful practices when working with older CALD clients.

• Invite family members to assist with:
  • Physical needs, negotiating a new environment.
  • Confirmation or clarification of information.
  • Interpretation in the event that a qualified interpreter is not available, or to clarify expressions for the client in the event of poor English and/or poor hearing.
  • Providing an accurate family history.
• Medical history
  Assessing chronic health conditions (cancer, heart disease, stroke etc.) is essential as these are known to affect mental health of elderly. Rates of depression can be two to three times higher in elderly clients with chronic health issues (Black et al., 1992).
• Functional status
  Level of functioning of Asian older people is often understated by their children. It may be necessary to refer for an over 65 assessment for Home Based Support Services or mental health day stay as the pressure on families of a dependent older person is considerable.
• Elder abuse
  It is important to assess for elder abuse (see Mehta, 2012). Apart from assessing for physical, sexual and psychological abuse, it is also important to be aware of possible improper use of funds and other resources, and/or exploitation. Older people often experience neglect and CALD clients can be more vulnerable because of acculturation issues as well as isolation if no family is available.
• Medication
  Encourage clients to bring all medication to the interview to avoid confusion and difficulty recalling names and dosages of medication (combinations of medications can cause confusion).
• Educational history
  This must be assessed prior to making treatment plans and arranging for further assessment. Be aware that literacy influences test outcomes.
• Employment history
  This will be an important indicator of pre-morbid functioning.