Department of Psychology, University of Southern California, Los Angeles, California 90089, USA.
Int Psychogeriatr. 2013 Apr;25(4):517-30. doi: 10.1017/S104161021200213X. Epub 2012 Dec 14.
Many minority ethnic (ME) older adults face several culturally associated and systemic barriers to timely dementia diagnoses that may result in delays to dementia care-seeking. We aimed to develop and propose a model illustrating variables that influence dementia care-seeking among ME older adults.
We conducted a literature review on the effects of these barriers on diagnostic delays and impairment levels at initial evaluation. We also strived to provide a basis for the Sociocultural Health Belief Model (SHBM) to guide future research and service planning pertaining to culture and dementia care-seeking.
There was consistent evidence that ME older adults with dementia tended to have greater diagnostic delays and higher levels of cognitive impairment and behavioral and psychological symptoms of dementia at initial evaluation than their non-Hispanic White counterparts. We also found several barriers to dementia care-seeking among ME groups. These barriers included lower levels of acculturation and accurate knowledge about dementia, more culturally associated beliefs about dementia, such as the perception of memory loss as normal aging and stigma associated with dementia, and health system barriers.
The SHBM provides an empirically based conceptual framework for examining cross-cultural differences in dementia care-seeking among diverse groups. We provide recommendations for future research, such as the need for research with more diverse ethnic subgroups and the examination of group-specific cultural values. We conclude with a discussion of the clinical and service implications of our review, including potential interventions aimed at facilitating timely dementia diagnoses among ME older adults.
许多少数族裔（ME）老年人在及时诊断痴呆症方面面临着与文化相关的和系统的障碍，这可能导致他们寻求痴呆症护理的时间延迟。我们旨在开发并提出一个模型，说明影响 ME 老年人寻求痴呆症护理的变量。
我们对这些障碍对诊断延迟和初始评估时认知障碍程度的影响进行了文献回顾。我们还努力为社会文化健康信念模型（SHBM）提供基础，以指导未来与文化和痴呆症护理寻求相关的研究和服务规划。
有一致的证据表明，患有痴呆症的 ME 老年人在初始评估时往往比非西班牙裔白人老年人有更大的诊断延迟和更高的认知障碍以及行为和心理症状的痴呆症程度。我们还发现了 ME 群体中寻求痴呆症护理的几个障碍。这些障碍包括较低的文化适应水平和对痴呆症的准确认识，对痴呆症更具文化相关性的观念，例如将记忆力丧失视为正常衰老以及与痴呆症相关的耻辱感，以及卫生系统障碍。
SHBM 为研究不同群体中跨文化差异的痴呆症护理寻求提供了一个基于经验的概念框架。我们为未来的研究提出了建议，例如需要对更多不同的族裔亚群进行研究，并研究特定群体的文化价值观。我们最后讨论了我们的综述的临床和服务意义，包括旨在促进 ME 老年人及时诊断痴呆症的潜在干预措施。
