James Tiffeny, Mukadam Naaheed, Sommerlad Andrew, Guerra Ceballos Stefanny, Livingston Gill
Division of Psychiatry, University College London, London, UK.
Division of Psychiatry, University College London, London, UK.
Lancet Healthy Longev. 2021 Mar;2(3):e171-e179. doi: 10.1016/S2666-7568(21)00001-5. Epub 2021 Feb 25.
Most people with dementia live in low and middle-income countries (LMICs) and there is an increased dementia prevalence in some minority ethnic groups in high-income countries. However, most interventions are devised for majority populations in high-income countries. We systematically searched 11 electronic databases for culturally tailored interventions for people with dementia and their family carers in LMICs and minority ethnic groups, without limit on language or date. 23 of 22 221 studies fulfilled inclusion criteria. Interventions adapted peripheral intervention components by, for example, translation and reducing the stigma of psychological therapy by emphasising physical illness and learning. Core therapeutic components were not changed. We found evidence-based, multicomponent interventions adapted for Latinx carers were acceptable, feasible, and effective in the USA and Columbia. Interventions developed for carers in India were effective there but not in other LMICs. Culturally adapted cognitive stimulation therapy was acceptable and effective for people with dementia in sub-Saharan Africa. We propose a new conceptual model from our findings to aid implementation of culturally appropriate treatments for people affected by dementia in LMICs and minority ethnic groups. Evidence-based interventions need cultural adaptation for different settings with therapeutic components retained. If they are acceptable, feasible, and remain effective then full effectiveness trials are unnecessary.
大多数痴呆症患者生活在低收入和中等收入国家（LMICs），并且在高收入国家的一些少数族裔中痴呆症患病率有所上升。然而，大多数干预措施是为高收入国家的多数人群设计的。我们系统地检索了11个电子数据库，以查找针对LMICs和少数族裔中痴呆症患者及其家庭护理人员的文化适应干预措施，不限语言或日期。22221项研究中有23项符合纳入标准。干预措施通过例如翻译以及通过强调身体疾病和学习来减少心理治疗的耻辱感等方式调整了外围干预成分。核心治疗成分未改变。我们发现，针对拉丁裔护理人员调整的循证多成分干预措施在美国和哥伦比亚是可接受的、可行的且有效的。为印度护理人员开发的干预措施在印度有效，但在其他LMICs中无效。文化适应的认知刺激疗法对撒哈拉以南非洲的痴呆症患者是可接受且有效的。我们根据研究结果提出了一个新的概念模型，以帮助在LMICs和少数族裔中为受痴呆症影响的人群实施文化适宜的治疗。循证干预措施需要针对不同环境进行文化适应，同时保留治疗成分。如果它们是可接受的、可行的且仍然有效，那么就无需进行全面的有效性试验。
