Mental health of the ageing immigrant population

Abstract

About 6% of older people in the UK are immigrants. Concentrated in deprived inner-city areas, their numbers are rising rapidly, with the ageing of those arriving after the Second World War. Cultural, language and educational differences cause problems in studying this group's mental health. Idioms of distress may affect presentation, help-seeking behaviour and acceptability of treatment. Ethnic elders may be considered vulnerable to depression because of socio-economic deprivation, immigrant status and old age but studies are contradictory and may use inappropriate screening instruments. Relatively few consider immigrant status and dementia. Uncontrolled hypertension could relate to higher dementia rates in Black immigrants which are not reflected in the country of origin. No genetic risk has been found. There is potential for prevention in this population.

Common mental health problems in immigrants and refugees: general approach in primary care

“…Risk factors for psychological distress among newly arrived older immigrants include female sex, less education, unemployment, poor self-rated health, chronic diseases (heart disease, diabetes, asthma), widowhood or divorce, and lack of social support or living alone. [95][96][97] When seniors join an already settled family, issues can include slower rates of learning the language and acculturation; separation from extended family, peers and familiar surroundings; decreased social support and isolation because extended family and community networks are lost; increased dependency on others because of language and mobility difficulties; fewer opportunities for meaningful work and productivity; and loss of status as a respected elder in the new cultural context.…”

Demographic Changes among Ethnic Minority Elders in England and Wales: Implications for Development and Delivery of Old Age Psychiatry Services

“…International Journal of Migration, Health and Social Care Volume 3 Issue 2 October 2007 © Pavilion Journals (Brighton) Ltd Table 6 Cultural factors complicating diagnosis Communication difficulties George & Young, 1991;Shah, 1992bShah, , 1997aLivingston & Sembhi, 2003 Taboo topics Shah, 1992b Stigma attached to mental illness Barker, 1984;Livingston et al, 2002 Bias and prejudice of clinicians Solomon, 1992…”

“…Redelinghuys & Shah, 1997 old age Table 7 Factors affecting cognitive tests Culture Gurland et al, 1992;Teresi et al, 1995;Livingston & Sembhi, 2003;Prince et al, 2003Education Teresi et al, 1995Stewart et al, 2003;Kim et al, 2003a,b;Livingston & Sembhi, 2003;Prince et al, 2003Language McCracken et al, 1997Livingston & Sembhi, 2003;Prince et al, 2003 Literacy skills Kabir & Herlitz, 2000;Livingston & Sembhi, 2003;Prince et al, 2003 Numeracy skills Prince et al, 2003 Sensory impairments Lindesay et al, 1997b Unfamiliarity with test situations Richards & Brayne, 1996Anxiety Lindesay, 1998 Demographic Changes among Ethnic Minority Elders in England and Wales Good communication between the patient and the clinician is essential (Bhalia & Blakemore, 1981;ACHAHT, 1984;Shah, 1992bShah, , 1999Jones & Gill, 1998) because many BME elders do not speak English (Barker, 1984;Manthorpe & Hettiarchy, 1993;Lindesay et al, 1997b).Where possible, the clinician assessing the patient should belong to the same culture as the patient, but this may not always be possible. An alternative is the use of bilingual health workers, but they are uncommon (Phelan & Parkman, 1995).…”

Can the recognition of clinical features of mental illness at clinical presentation in ethnic elders be improved?

“…Emotional disorders, including depression, may present with different clinical features in the elderly from different ethnic minority groups in the UK (Abas, 1996;Abas et al, 1996Abas et al, , 1998Lindesay, 1998;Shah, 1999;Livingston and Sembhi, 2003). Emotional expression in different cultures can be influenced by several overlapping concepts: the context of disclosure, available vocabulary and language of emotional expression, selective expression of emotions and definition of self (Lindesay, 1998).…”