The Role of Cultural Competence in Dementia
The Role of Cultural Competence in Dementia
Over five million people in the United States are diagnosed with some form of dementia, and many more with cognitive impairment remain undiagnosed. In addition, most individuals with dementia experience one or more neuropsychiatric symptoms such as depression, anxiety, irritability, agitation, hallucinations, or delusions at some point during disease progression. The vast majority of individuals with dementia, including those with symptoms of serious mental illness, are cared for in home and community based settings by unpaid caregivers, often family members, who struggle with the daily challenges of providing care and services to someone with dementia. This article will briefly review selected aspects of the need for community care for individuals with dementia and cultural aspects related to dementia and mental health. A detailed case study will illustrate some of the challenges related to the mental health of individuals with dementia living in the community. We specifically discuss culturally competent care, using the example of a Nepalese refugee family caring for a family member with dementia and depression, as a critical aspect of the care plan. Finally, we provide implications for practice for organizations wishing to engage families in a comprehensive system of home-based dementia care.
Over five million people in the United States (U.S.) are diagnosed with some form of dementia, and many more with cognitive impairment remain undiagnosed (Centers for Disease Control and Prevention [CDC], 2014). In addition, most individuals with dementia experience one or more neuropsychiatric symptoms (NPS) such as depression, anxiety, irritability, agitation, hallucinations, or delusions at some point during disease progression. One study that considered the cumulative prevalence of NPS over a five year period reported depression and apathy as most common, with a cumulative prevalence of 77% and 71% respectively (Steinberg et al., 2008). While depressive symptoms are extremely common in patients with dementia, it is not clear whether depression is a risk factor for dementia, an early symptom of dementia, or simply a reaction to cognitive and functional decline (Richard et al., 2013).
The vast majority of individuals with dementia, including those with symptoms of serious mental illness (SMI) are cared for in home and community based settings by unpaid caregivers, often family members, who struggle with the daily challenges of providing care and services to someone with dementia (Miller, 2012). As with many progressive chronic conditions, the needs of individuals with dementia and their caregivers change over time, as individuals in later stages of dementia require more physical care; skills to address unmet needs (often characterized as "challenging behaviors"); assistance with activities of daily living (ADLs); and support with making end-of-life decisions.
As with other mental health conditions, individuals with dementia and their caregivers often contend with a variety of challenges related to managing cognitive, psychological, and behavioral symptoms of the illness. For this reason, nurses and other members of the healthcare team must develop skills and expertise to support and engage individuals with dementia and their caregivers. The goals of care are to prevent, identify, and manage manifestations of dementia and related mental health disorders, such as psychosis or depression, in order to promote the best possible quality of life for the individual and caregiver.
This article will briefly review selected aspects of the need for community care for individuals with dementia and cultural aspects related to dementia and mental health. A detailed case study will illustrate some of the challenges related to the mental health of individuals with dementia living in the community. We specifically discuss culturally competent care, using the example of a Nepalese refugee family caring for a family member with dementia and depression, as a critical aspect of the care plan. Finally, we provide implications for practice for organizations wishing to engage families in a comprehensive system of home-based dementia care.
Abstract and Introduction
Abstract
Over five million people in the United States are diagnosed with some form of dementia, and many more with cognitive impairment remain undiagnosed. In addition, most individuals with dementia experience one or more neuropsychiatric symptoms such as depression, anxiety, irritability, agitation, hallucinations, or delusions at some point during disease progression. The vast majority of individuals with dementia, including those with symptoms of serious mental illness, are cared for in home and community based settings by unpaid caregivers, often family members, who struggle with the daily challenges of providing care and services to someone with dementia. This article will briefly review selected aspects of the need for community care for individuals with dementia and cultural aspects related to dementia and mental health. A detailed case study will illustrate some of the challenges related to the mental health of individuals with dementia living in the community. We specifically discuss culturally competent care, using the example of a Nepalese refugee family caring for a family member with dementia and depression, as a critical aspect of the care plan. Finally, we provide implications for practice for organizations wishing to engage families in a comprehensive system of home-based dementia care.
Introduction
Over five million people in the United States (U.S.) are diagnosed with some form of dementia, and many more with cognitive impairment remain undiagnosed (Centers for Disease Control and Prevention [CDC], 2014). In addition, most individuals with dementia experience one or more neuropsychiatric symptoms (NPS) such as depression, anxiety, irritability, agitation, hallucinations, or delusions at some point during disease progression. One study that considered the cumulative prevalence of NPS over a five year period reported depression and apathy as most common, with a cumulative prevalence of 77% and 71% respectively (Steinberg et al., 2008). While depressive symptoms are extremely common in patients with dementia, it is not clear whether depression is a risk factor for dementia, an early symptom of dementia, or simply a reaction to cognitive and functional decline (Richard et al., 2013).
The vast majority of individuals with dementia, including those with symptoms of serious mental illness (SMI) are cared for in home and community based settings by unpaid caregivers, often family members, who struggle with the daily challenges of providing care and services to someone with dementia (Miller, 2012). As with many progressive chronic conditions, the needs of individuals with dementia and their caregivers change over time, as individuals in later stages of dementia require more physical care; skills to address unmet needs (often characterized as "challenging behaviors"); assistance with activities of daily living (ADLs); and support with making end-of-life decisions.
As with other mental health conditions, individuals with dementia and their caregivers often contend with a variety of challenges related to managing cognitive, psychological, and behavioral symptoms of the illness. For this reason, nurses and other members of the healthcare team must develop skills and expertise to support and engage individuals with dementia and their caregivers. The goals of care are to prevent, identify, and manage manifestations of dementia and related mental health disorders, such as psychosis or depression, in order to promote the best possible quality of life for the individual and caregiver.
This article will briefly review selected aspects of the need for community care for individuals with dementia and cultural aspects related to dementia and mental health. A detailed case study will illustrate some of the challenges related to the mental health of individuals with dementia living in the community. We specifically discuss culturally competent care, using the example of a Nepalese refugee family caring for a family member with dementia and depression, as a critical aspect of the care plan. Finally, we provide implications for practice for organizations wishing to engage families in a comprehensive system of home-based dementia care.