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African American, Chinese, and Latino Family Caregivers' Impressions of the Onset and Diagnosis of Dementia: Cross-Cultural Similarities and Differences

Correspondence: Address correspondence to Diane Feeney Mahoney, PhD, GNP, FGA, MGH Institute of Health Professions, Jacques Mohr Professor of Gerontological Nursing Research, Charlestown Navy Yard, 36 First Avenue, Boston, MA 02129. E-mail: dmahoney{at}mghihp.edu

Purpose: We explored cross-cultural similarities and differences in minority family caregivers' perceptions of the onset and diagnosis of Alzheimer's disease in their relatives, with specific attention to clinical encounters. Design and Methods: We performed a meta-synthesis of three qualitative studies conducted in Massachusetts with 22 African American, Latino, and Chinese caregivers. Results: All participants conveyed striking similarities of thought about normalization of cognitive symptoms until one critical event, usually relocation, precipitated family awareness that an elder's behavior was not the result of "normal aging." A lack of knowledge about Alzheimer's disease, rather than culturally influenced beliefs, was the major deterrent to having an elder's memory assessed. Community physicians' failure to recognize Alzheimer's disease or refer to specialists was more problematic than language or ethnic differences. Physicians' disrespect for caregivers' concerns about memory loss was particularly noted by African Americans, stigmatization of persons with Alzheimer's disease was noted by Chinese, and fears that acculturation would end family home care was noted by Latinos. Implications: Amid ethnocultural differences, there are many similarities in needs that offer providers the possibility to unify quality improvements in Alzheimer's disease outreach, education, and physicians' services. Suggestions include providing the public with more confidential access to Alzheimer's disease information, increasing dementia awareness among community physicians, motivating clinicians to adopt culturally sensitive communication patterns, and providing community education to reduce normalization by families and stigmatization of persons with Alzheimer's disease.

Key Words: Alzheimer's disease • Cultural competence • Race or ethnicity • Meta-synthesis

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