Opinion

Dementia care: why cultural competence is so important

Appreciation of cultural context can help nurses understand attitudes to dementia and the particular needs of BME people

Appreciation of cultural context can help nurses understand attitudes to dementia and the particular needs of BME people


BME people are missing out on early support from dementia services. Picture: iStock

There is an increasing number of older people in the UK who come from diverse backgrounds, and dementia – often associated with old age – is more high-profile than ever.

The results of a recent study (see further reading) on new dementia diagnoses suggest that much more work needs to be done to ensure people from black and minority ethnic (BME) communities get the help they need. The study found that dementia diagnosis rates vary between different ethnic communities. It adds to the increasing body of evidence that people with dementia from BME communities continue to under-access diagnostic services and are more likely to be in crisis when they do. This means they and their families are missing out on early practical and emotional help in the present, as well as support to make plans for the future.

Factors influencing under-diagnosis

The reasons are complex but contributing factors include:

  • Lower levels of dementia awareness in some minority communities. This means that early symptoms, such as becoming more forgetful or less able to manage everyday activities, may be missed or seen as signs of old age to be ‘put up with’.  
  • In some minority ethnic communities there is still a stigma about dementia. The symptoms are seen as shameful, so people may be unwilling to acknowledge or talk about any concerns and may hide them in the family.
  • If someone has had negative experiences of services or has experienced racism in the past they may be unwilling to access mainstream health or social care services.
  • Communication issues, especially where someone does not have English as a first language. This may prevent some minority communities from accessing services.

As an Admiral Nurse who has worked with families of people with dementia, and through my research on ethnicity and dementia, I am aware everyone is an individual, but there is an urgency to promote positive dementia support among BME communities in the UK.

National and local dementia awareness-raising campaigns targeting BME communities are needed but they are not the whole answer. Services must ensure the advice and support they provide can meet specific cultural needs where present, and are accessible to all sectors of the community. Specialist dementia nurses – Admiral Nurses – have an important role because they offer tailored support and advice to each family.

Whatever their roles, it is important for nurses to:

  • Be vigilant in recognising where someone may have the early signs of dementia and encourage and support them and/or their family to seek a diagnosis or support.
  • Work in a culturally competent way – being open to and respectful of how other people view the world and their beliefs about health and care.
  • Be conscious of and sensitive about how to talk about dementia with people, but not avoid doing so with those who may have limited dementia awareness or consider it a taboo subject.
  • Seize opportunities to dispel myths about dementia, for example, when talking to a family member of a person with dementia or by giving formal talks in places where minority communities meet.
  • Find out what dementia services are available locally and nationally to be able to direct people to these if needed.
  • Identify what help is available in required languages and use interpreters where needed.

Further reading

A comparison of new dementia diagnosis rates across ethnic groups in UK primary care


Contacts

  • Admiral Nurse dementia helpline is on 0800 888 6678
  • Anyone with questions or concerns about dementia can visit Dementia UK

Julia Botsford, consultant Admiral Nurse, Dementia UK

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