Alzheimer's in other Cultures

[Wendy Gammon, M.A., M.Ed.]

I have been most fortunate in my lifetime to have studied and lived in a few different countries and traveled throughout Europe, the (then) Soviet Union and parts of North Africa. This afforded me the opportunity to observe different family structures and especially observed different ways cultures treat their elderly. As we have been focused on Alzheimer's in our WEGO group, I wanted to dig deeper and learn how other cultures perceive and manage dementia in the family unit.

Because we have such a rich and culturally diverse population in the US, we can observe firsthand how different groups regard dementia. Culture influences the way Alzheimer's is perceived, treated and managed. Culture also influences the role and attitudes of the caregiver.

The US has almost 5 million Native Americans, with the Cherokee and Navajo tribes being the largest. It was interesting to learn that incidences of dementia in this population are rarely reported. This is due to a few causes, one being that Native Americans tend to die earlier than the American population, so the typical Alzheimer's of the elderly is not often observed. Tribal beliefs regard illness, including dementia, as an imbalance of the spiritual, mental, physical and social relationships. "Healing" is a sacred business involving spirituality and faith healing. Caregivers take the senile into their homes and care for them aided by the tribal holy man who often serves as spiritual and physical healer.

The Asian-American population in the US is robust, especially since the great immigration following the end of Vietnam War in 1975. For many, growing old in the US has been not, however, been a fulfillment of the American Dream, but rather a traumatic experience because of the role of the elderly in a youth-obsessed America. Read this account by Ngoc B. Lam, who laments growing old in California where she feels "....In America, you lose so much the older you get-----friends, relatives, mobility , a sense of yourself."

http://news.newamericamedia.org/news/view_article.html?article_id=df1d29064cdc4b8218e1ec853f1769e2

http://news.newamericamedia.org/news/view_article.html?article_id=a5a836535be597380caa5ce1def00b5b
This article describes how different Asian-American groups regard dementia. The Hmong peoples of southeast Asia refer to dementia as a "loss of soul". Many Chinese regard it as a form of madness or an imbalance in the yin and yang; and many Vietnamese view the demented patient as one possessed by demons or evil spirits in retribution for their own past sins--or sins of their ancestors. It is generally regarded as an incurable affliction and therefore to be managed by family rather than cured by doctors. In Korea, for example, it is the daughter-in-law who cares for her husband's ailing parents. An excellent and concise article summarizing dementia in the Chinese American culture can be found at: http://www.ethnicelderscare.net/ethnicity&dementiachinese.htm.
Information includes attitudes of Chinese American caregivers, resources and recommendations for health care providers working with this population.

The Hispanic population in America is a mix of many cultures, including people from North and South America, Central America, the Caribbean and Spain. Their culture is also a rich mixture of belief systems surrounding dementia. Some regard dementia as "the evil eye", or a bad case of "nerves" or (again), a punishment for sins committed long ago. Dementia is also frequently regarded as a mark of shame. Senility is a private matter not openly discussed outside the family. It is interesting that the role of "caregiver" is unknown in the usual sense. Relatives close ranks and care for the dementia patient as an expected task associated with their traditional role as younger family member.

A shared thread among these cultures: Elders are to be respected and cared for no matter what the needs or condition. Committing one's elders to a nursing facility is 'unthinkable' and a mark of shame, guilt and failure for the family. In nearly every culture, in spite of the acceptance of one's role and responsibilities to elder family members, these caregivers suffer the same guilt and burnout associated with caring for patients. Unfortunately, these caregivers infrequently access available community resources and choose to rely on the family unit for all emotional and physical support.

A great challenge facing the Americanized younger generations in these families is how to more effectively bring these parents and grandparents into the healthcare system. Providers need to learn about the belief systems of their patients. Knowledge, acceptance and a willingness to blend their unique beliefs with traditional Western medicine can deliver better health care to these Americans.