Factors impacting on early detection of dementia in older people of Asian background in primary healthcare

Introduction: The prevalence of dementia in people from Culturally and Linguistically Diverse (CALD) backgrounds is predicted to increase. By 2026, Chinese and Vietnamese languages are projected to be the first and fourth most prevalent languages spoken by older people from CALD backgrounds living in Australia. Varying expressions of dementia literacy within these groups sometimes result in presentation to health services at a later stage of the disease. 

Methods: This paper aims to present a literature review on factors impacting on the early diagnosis of dementia in primary care. Cultural factors pertaining to older people of Chinese and Vietnamese backgrounds are identified and described. 

Results: The review found that despite the benefits and emphasis on early diagnosis of dementia, GPs' uncertainty, insufficient training, ambivalent attitude and therapeutic nihilism have contributed to delayed diagnosis of dementia in CALD populations in primary care. Other factors included time pressures, poor remuneration and lack of CALD appropriate diagnostic tools and services. From the older Chinese and Vietnamese people and their families' perspective, living arrangements, level of dementia literacy, symptom interpretation, stigma associated with dementia and their concept of morality significantly impacted on health-seeking behaviour, contributing to delayed presentation to GPs. Language barriers and lack of bilingual GPs were also found to be deterring factors. 

Discussion: There is a need to remove barriers impacting on the timely diagnosis of dementia in primary healthcare for older people from CALD backgrounds. Increasing CALD-appropriate services, workforce training, public awareness and removing stigma may assist.