Language barriers contribute to higher aggression in immigrants with dementia

Immigrants living with dementia are more likely to present with agitation and aggression compared with their non-immigrant counterparts

Behaviours and psychological symptoms of dementia (BPSD), such as agitation and aggression, are common. However, its presentation may be influenced by the cultural background of the person, according to research from Edith Cowan University (ECU) in conjunction with The Dementia Centre, HammondCare.

The study found immigrants were more likely to present with agitation or aggression, while non-immigrants were more likely to present with hallucinations and delusions.

The researchers investigated differences in clinical and demographics characteristics and BPSD between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to Dementia Support Australia (DSA) programs.

BPSD were common between the groups, with language barriers and cultural considerations frequently observed for immigrants, adding to the contributing factors.

In 2019-2020, 21% of people living with dementia in residential aged care facilities in Australia were immigrants from non-English speaking countries.

“International studies have reported that immigrants experience a higher prevalence of dementia due to differing life experiences including those related to trauma, low literacy, and socioeconomic status,” said lead researcher Pelden Chejor.

Loneliness, boredom, language barriers, and cultural considerations significantly contributed to BPSD for non-English-speaking immigrants compared with non-immigrants, the research found.

“Our findings indicated a significantly lower rate of hallucinations for immigrants and non-English-speaking immigrants compared to non-immigrants.

“Additionally, non-English-speaking immigrants were significantly lower on delusions and disinhibition than non-immigrants,” said Mr Chejor.

The higher severity of agitation or aggression was likely driven by communication difficulties as there was no difference for the English-speaking immigrants, he said.

“Cognitive decline can impair both the ability to express and comprehend spoken language and people living with dementia who have English as their additional language may lose their ability to communicate in English and subsequently use their first language as the primary language of communication.”

The researchers called for increased awareness and education on the impact of culture and language for people receiving residential care and exhibiting BPSD.

“Future research should explore related factors such as length of stay in Australia and English language proficiency to learn more about BPSD presentations for different immigrant groups. By doing so, we can better manage these symptoms,” Mr Chejor said.

DSA, a free, Australian Government-funded dementia behaviour support program, has supported over 60,000 clients and 98% of aged care homes in every state and territory since 2016.

“Communicating effectively with the person living with dementia, and taking the time to know them, including their language background and culture, is essential. In many cases this can mean responding with support without the need for a pharmacological intervention,” said Head of DSA Marie Alford.

The research published in BMC Geriatrics can be found here

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