Johnston Karen, Preston Robyn, Strivens Edward, Qaloewai Sefanaia, Larkins Sarah
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia.
Aging Ment Health. 2020 Aug;24(8):1183-1195. doi: 10.1080/13607863.2019.1606891. Epub 2019 May 10.
Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia. A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out. Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving. There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.
痴呆症已成为日益重要的健康问题，在资源匮乏的国家以及原住民群体中尤为如此。理解赋予痴呆症的文化意义，是政策制定以及为痴呆症患者、其家人和护理行业提供符合文化习俗的护理与支持的一个重要方面。本综述调查了低收入和中等收入国家（LMIC）的原住民群体中痴呆症的概念，这些群体对痴呆症的诊断和正规护理有限，以及这些概念如何影响对痴呆症的应对。我们对以英文报道的定性研究进行了系统检索，这些研究调查了低收入和中等收入国家以及原住民群体对痴呆症的看法、态度或理解。我们进行了定性分析和元综合分析。经过质量评估，19篇文章被纳入本综述。痴呆症很少被概念化为一种以进行性认知衰退为特征的明确病理状况。相反，痴呆症的概念存在于衰老、精神疾病、传统文化信仰和殖民创伤的概念之中。对痴呆症的应对受到社区、卫生服务提供者以及护理文化规范的影响，并得以延续。有必要从特定环境中所有利益相关者的角度理解痴呆症的概念，以及关键利益相关者之间存在的动态反应。社区知识体系有助于理解对痴呆症适当且可接受的健康和社区护理应对措施，以及减少污名化的方法。如果提高认识运动要改善痴呆症患者和护理人员的福祉，关于痴呆症的包容性讨论至关重要。
