Language background may contribute to BPSB in people with dementia

New research has found that immigrants originally from non-English speaking countries who are living with dementia were more likely to present with agitation and aggression compared to their non-immigrant counterparts, who were more likely to present with hallucinations and delusions.

Researchers from Edith Cowan University (ECU) and HammondCare found that behaviours and psychological symptoms of dementia (BPSD) may be influenced by the cultural background of a person.

Lead researcher Pelden Chejor said loneliness, boredom, language barriers, and cultural considerations contributed to the higher rates of BPSD.

"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," Mr Chejor said.

"The higher severity of agitation or aggression is likely driven by communication difficulties as there was no difference for the English-speaking immigrants.

"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.”

The study investigated differences in clinical and demographic characteristics and BPSD in residential aged care homes who were referred to Dementia Support Australia (DSA) programs.

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

"For every one-point increase in agitation and aggression, it was 1.08 times more likely that a person was an immigrant," the study revealed.

"Conversely, for every one-point increase in hallucinations, it was 1.07 times less likely that a person was an immigrant."

Although agitation and aggression frequently presented for immigrant and non-immigrant groups at 87.9 per cent and 86.5 per cent respectively, a difference was observed for the prevalence of hallucinations at 16 per cent and 18.3 per cent.

BPSD was common in both immigrant and non-immigrant groups, but language barriers and cultural differences were contributing factors to the higher rate.

Around 37 per cent of Australians aged 65 and over were born overseas.

According to the Australian Institute of Health and Welfare, 33 per cent of Australians accessing aged care services were born overseas.

Home care also had the largest proportion of people with a preferred language other than English at 18 per cent.

The Australian Institute of Health and Welfare reported that 67 per cent of people with dementia were born in non-English-speaking countries and had limitations in the community they resided in.

The report also found that 47 per cent of people with dementia from a culturally and linguistically diverse (CALD) background relied heavily on informal carers rather than formal services.

A report by the Aged Care Quality and Safety Commission stated the importance of services being designed with CALD backgrounds in mind due to cultural and language barriers.

Mr Chejor said awareness and education were important, as well as training workers.

“Our study calls for increased awareness and education on the impact of culture and language for people receiving residential care and exhibiting BPSD," he said.

"Future research should explore related factors such as length of stay in Australia and English language proficiency to learn more about BPSD presentations for different immigrant groups.

"By doing so, we can better prevent and manage these distressing symptoms."

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