Barriers in providing primary care for immigrant patients with dementia: GPs’ perspectives

Abstract

BackgroundDementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention.AimTo describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs.Design & settingA mixed-method study, consisting of an online survey and focus groups.MethodAn online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care.ResultsGPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education.ConclusionImportant barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.

Barriers in screening for dementia in elderly migrants in primary care and the use of the Rowland Universal Dementia Assessment Scale. A mixed cross-sectional and qualitative study

“…Older migrants are a minor population group in Flanders and the migrant population is significantly younger than the native Belgian population (https://statbel.fgov.be/en). Most participating GPs experienced difficulties in the diagnostic process of dementia in migrants, consistent with the findings in a recent study [11]. In our study, language issues were the most frequently mentioned problems.…”

“…Despite the small sample size, the contribution rate of GPs' characteristics represents the Flemish GP population (Table 2) (https://www.inami.fgov.be/nl/statistieken/Paginas/ default.aspx). Second, in contrast to our survey, the GPs participating in the study by Vissenberg et al were all frequently working with migrants [11]. However, using experience as an inclusion criterion, selection bias heads up.…”

“…In our study, most GPs stated that they could not perform brief cognitive screening tests in migrants because of communication problems or illiteracy. Due to low educational levels and poor health literacy, migrant patients' knowledge about dementia often is too low to contribute to the assessment process [6,11].…”

“…Dementia is not a commonly used term among migrants and they prefer using forgetfulness as this term is less loaded and considered inherent to ageing. Migrant patients and their families might, therefore, doubt the usefulness of dementia screening [11]. Second, the perceived lack of time to apply the RUDAS contrasts with the actual time needed for the administration of a regular cognitive screening instrument, which also takes 10-15 min [12].…”

Effect of Dementia Training on Knowledge and Attitude Among Long-Term Care Staff in Yogyakarta, Indonesia

“…It is estimated that the number of people living with dementia in the world will reach 75 million by the year 2030. In addition, the number will continue to grow to 132 million by 2050 [2]. In the past 50 years , the percentage of elderly people in Indonesia approximately doubled.…”