How is migration background considered in the treatment and care of people? A comparison of national dementia care guidelines in Europe

Abstract

Background People with a migration background are vulnerable to dementia. Due to problems such as underdiagnosis or access barriers, the care of this population is a public health challenge in Europe. Many countries are issuing care guidelines, but a systematic overview of their references to migration groups is lacking. This study aims to analyze national dementia care guidelines regarding their focus on people with a migration background, what specific actions to ensure healthcare have been undertaken at the national level, and whether recommendations for action are made for this population.Methods This study is a systematic analysis of national dementia care guidelines of the EU and EFTA (European Free Trade Association) countries. Using the discourse analysis model by Keller (2011), 43 documents from 24 EU and 3 EFTA countries were systematically screened for migration references via keyword and context analysis. The content of the migration-related section was paraphrased, memos and comments were added, and the individual text passages were coded using the strategy of open coding.Results Twenty-seven of the 35 EU and EFTA countries have guidelines or similar documents on care for people with dementia, and twelve refer to migration. Norway, Sweden, and Northern Ireland refer to this topic in detail. The focus of the migration-related guidelines is on the early detection and diagnosis of dementia. The main message is that standardized diagnostic tools such as the MMSE (Mini-Mental State Examination) or the clock test are not suitable for linguistic minorities. Nine countries make recommendations for the care of people with a migration background and dementia, but only Norway, Sweden, and Denmark point to available healthcare services. A key recommendation is that the linguistic and cultural background of people should be considered when selecting diagnostic tests. Several countries refer to the validity of the RUDAS (Rowland Universal Dementia Assessment Scale) for migrants.Conclusions The topic of migration plays a subordinate role in the dementia care guidelines of European countries. Almost all countries lack appropriate diagnostic tools and healthcare services for people with a migration background. Consequently, this group is vulnerable to underdiagnosis and a lower level of care.

Polish adaptation of the Mini-Cog

“…Badanie skalą Mini-Cog można przeprowadzać u pacjentów o dowolnym poziomie wykształcenia, posługujących się różnymi językami i pochodzących z odmiennych kultur. Ma to olbrzymie znaczenie w sytuacji, kiedy do gabinetów lekarskich trafiają imigranci, często bez tłumacza czy członka rodziny, który mógłby udzielić wiarygodnych informacji o funkcjonowaniu pacjenta (Barczak i Hintze, 2019;Schmachtenberg et al, 2020). Dostępne wyniki badań sugerują, że Mini-Cog wykrywa otępienie równie skutecznie jak skala Addenbrooke Cognitive Examination-Revised (ACE-R) (Sitek et al, 2017;Tsoi et al, 2015), a jednocześnie jest wyjątkowo niekłopotliwym narzędziem.…”

Socio-Economic Disparities in Access to Diagnostic Neuroimaging Services in the United Kingdom: A Systematic Review

“…While the use of MMSE allows for quantitative comparison of disease progression, the Northern Ireland Legislations have recognised that MMSE does not take language barriers and cultural differences into account. Therefore, it may not be an accurate measurement for cognition at diagnosis [35]. The addition of translators and varied testing materials could skew the results, favouring the notion that minority communities have lower cognitive scores at diagnosis.…”