Is there a link between language barriers and higher rates of aggression in people with dementia?

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Over 31% of aged care residents in Australian aged care facilities were born overseas. [Source: Shutterstock]

Key Points:

  • In 2019-2020, At least 54% of people living in residential aged care homes had a dementia diagnosis and 21% of those residents were immigrants from non-English speaking countries
  • 9.2% of people using aged care preferred a language other than English
  • International studies have reported that immigrants experience a higher prevalence of dementia due to differing life experiences including those related to trauma, low literacy, and socioeconomic status

A new study has found immigrants living with dementia were more likely to present with agitation and aggression compared with their non-immigrant counterparts.

Researchers from Edith Cowan University’s (ECU) Centre for Research in Aged Care and HammondCare’s The Dementia Centre noted that behaviours and psychological symptoms of dementia (BPSD), such as agitation and aggression, are common; however, its presentation may be influenced by the cultural background of the person.

Their study investigated differences in clinical and demographic characteristics and BPSD between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to Dementia Support Australia (DSA) programs. 

It found that immigrants were more likely to present with agitation or aggression, while non-immigrants were more likely to present with hallucinations and delusions.

BPSD were common in both immigrant and non-immigrant groups, but the language barriers and cultural differences frequently observed for immigrants added to the contributing factors. However, there were no differences in the prevalence of contributing factors between English-speaking immigrants and non-immigrants.

Lead researcher Pelden Chejor and his colleagues noted that loneliness, boredom, language barriers, and cultural considerations significantly contributed to BPSD for non-English-speaking immigrants compared with non-immigrants, with the largest significant differences being for language barriers and cultural considerations. 

“Cognitive decline can impair both the ability to express and comprehend spoken language and people living with dementia who have English as their additional language may lose their ability to communicate in English and subsequently use their first language as the primary language of communication,” Mr Chejor explained.

“Although our findings need to be confirmed by future studies, language is key to improving care for people living with dementia, particularly for those coming from culturally and linguistically diverse backgrounds.”

He suggested that aged care providers provide language support and alternatives in their routine care. 

What can aged care workers do?

With the results of this study in mind, researchers now call for increased awareness and education on the impact of culture and language on people receiving residential care and exhibiting BPSD, particularly informing aged care workers.

Head of DSA Marie Alford said the study reinforced the importance of understanding the person living with dementia, including their cultural background and experiences, likes, dislikes and routines when responding to BPSD.

“In many cases, this can mean responding with support without the need for a pharmacological intervention.”

Mr Chejoy told HelloCare that aged care workers need to understand that people living with dementia who may experience language reversion can communicate well if appropriate language support is provided. 

He said, “Assuming loss of language as a loss of ability to communicate for people living with dementia may further escalate BPSD leading to poor quality care experience for people living with dementia and their families.”

Researchers suggest that future studies explore related factors such as length of stay in Australia and English language proficiency to learn more about BPSD presentations for different immigrant groups to better prevent and manage distressing symptoms of dementia.

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