Language Barriers and Cultural Issues May Lead to More Agitation in Dementia Patients
Michelle Milliken
Neuropsychiatric symptoms impact the vast majority of dementia patients. These symptoms can include depression, apathy, agitation, aggression, sleep disturbances, and hallucinations. They are often severe. A new study finds that for immigrants, cultural considerations and language barriers may impact how these symptoms present.
Research recently published in the journal BMC Geriatrics looked at how neuropsychiatric symptoms differed between immigrant and non-immigrant dementia patients in Australian nursing homes. The researchers say that the symptoms can have cultural links and that it may be difficult to understand what’s causing these issues if patients don’t speak the local language.
Pelden Chejor, lead researcher from Edith Cowan University in Australia, says, "Over 31% of aged care residents were born overseas, and 9.2% of people using aged care preferred a language other than English. In 2019 - 2020, 21% of people living with dementia in [residential aged care homes] 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."
To investigate how these patients may experience neuropsychiatric symptoms, Chejor’s team used data from patients referred to Dementia Support Australia programs. They focused on how neuropsychiatric symptoms and pain differed between immigrants, both English-speaking and non-English speaking, and non-immigrants.
The data came from 24,000 patients, 36% of whom were immigrants living with dementia. The researchers found that there wasn’t a difference in symptom severity or related caregiver stress between the groups, but there was a difference in which symptoms they were more apt to have. Non-immigrants suffered more often from hallucinations, while non-English-speaking immigrants had more agitation and aggression. The team says boredom and loneliness played a role in this aggression and agitation, but the biggest factors were found to be language barriers and cultural considerations.
Chejor says, "The higher severity of agitation or aggression is likely driven by communication difficulties as there was no difference for the English-speaking immigrants. 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.
"Our study calls for increased awareness and education on the impact of culture and language for people receiving residential care and exhibiting [behaviors and psychological symptoms of dementia]. 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."
