Dementia Care in First Nations Elderly
According to a 2016 census, First Nations and Idigenous people constitute approximately 5% of Canada’s population. It is expected that the number of First Nations’ people to be aged 65+ will triple in the future. With aging populations comes the need for elderly services, which include care for individuals living with dementia. Little is known about how First Nations people experience and receive care for dementia, thus furthering health care disparities experienced by this group. Risk factors for dementia include diabetes, hypertension, smoking, heart disease, and substance abuse problems; all of which are prevalent in First Nations communities.
One study aimed to close the knowledge gap regarding how First Nations people experience dementia care by examining three things: understanding the interactions care providers have with First Nations communities, identifying barriers to care experienced by patients and care providers alike, and learning what successes occur in the provision of care. In the study, semi-structured interviews were conducted with 7 people who interfaced with First Nations communities in the provision of care services. Participants consisted of a traditional healer, a social worker, personal support worker, registered practical nurse, community health worker, health educator, and a registered nurse. Participants were asked about their role, experiences, and potential solutions to address the gaps in caring for First Nations people with dementia.
Lack of Access and Collaboration
From the interviews, several key findings emerged. First, there is a lack of collaboration between care workers and care facilities serving First Nations people with dementia. For example, several participants were involved in transitioning patients from hospital stays back to their homes. These transitions never happened smoothly as the care workers were not given the necessary discharge information that informed the care worker about what services were provided to the patient. Because of this, there was lots of confusion about the roles and duties of healthcare providers. This lack of communication causes care providers working with individuals to not know if medication regimens change, the status of a patient’s dementia, medical or support equipment is needed for the patient, and if there are other patient safety concerns that may have arisen during the hospital stay.
Second, First Nations people with dementia may not access care services. This can be detrimental physically, mentally and emotionally for them. Several reasons are responsible for this. First, people with dementia may feel embarrassed about their diagnosis and the symptoms of dementia they experience. From the interviews, participants revealed that it is common in First Nations communities to keep the experience of dementia symptoms to themselves and not share with others. By not revealing the status of their diagnosis, patients may be put in situations that could be of harm to them. Because patients and sometimes family members may not disclose symptoms, patients and family members may not seek out care until a more severe incident occurs, such as the patient falling. Other reasons given regarding why First Nations people with dementia may not seek out care include denying symptoms, fear of losing independence, not understanding or recognizing symptoms, and lacking information about dementia.
Lastly, many of the interviewees experienced high mistrust from patients and community members. There can be a disconnect between the First Nations people and clinical workers due to varying lifestyles. Many patients and community members prefer to keep the nature of their condition to themselves, and the act of sharing this information with another person is something that is not common within their culture. Interviewees reported feeling like they were “walking on thin ice”, as patients and community members were unsure of where care services were going or distrusted the diagnosis given. When people do not trust their care providers or therapists, they may lie or avoid participating in therapy sessions or care services. It is important to build trust between care providers, patients, and family members, as each person plays a significant role in the care and maintenance of an individual’s health and dementia progression.
Disconnect Between Patients and Community
Lastly, many of the interviewees experienced high mistrust from patients and community members. There can be a disconnect between the First Nations people and clinical workers due to varying lifestyles. Many patients and community members prefer to keep the nature of their condition to themselves, and the act of sharing this information with another person is something that is not common within their culture. Interviewees reported feeling like they were “walking on thin ice”, as patients and community members were unsure of where care services were going or distrusted the diagnosis given. When people do not trust their care providers or therapists, they may lie or avoid participating in therapy sessions or care services. It is important to build trust between care providers, patients, and family members, as each person plays a significant role in the care and maintenance of an individual’s health and dementia progression.
Conclusion
What does this mean for clinical providers working with First Nations communities with and without dementia? It is important that when providing services, communication and collaboration occur between medical facilities, care providers, and patients to ensure success of care and reduction in risk of rehospitalization. Second, it is key that sensitivity is used when discussing a patient’s condition as people may feel shame or concern of potential life changes that may occur from being diagnosed with dementia. Lastly, it is common for patients in First Nations communities to not trust external care providers. In order to provide accessible and receptive care, it is important to build rapport and trust with patients, their families/caregivers, and their communities. When working with members of First Nations communities who have dementia, it is important that care providers are collaborative, sensitive, and trustworthy.
Source:
Finkelstein, Sara & Forbes, Dorothy & Richmond, Chantelle. (2012). Formal Dementia Care among First Nations in Southwestern Ontario. Canadian journal on aging = La revue canadienne du vieillissement. 31. 257-70. 10.1017/S0714980812000207.
