Taking factors like family and culture into account when treating Black dementia patients

Compared to their white counterparts, Black Canadians living with dementia are less likely to be institutionalized and more likely to rely on family caregivers. That's according to a 2021 qualitative study by researchers who looked at the experience of dementia patients from Black, African and Caribbean backgrounds in the U.S. and U.K. Dr. Mireille Norris, a geriatrician at Toronto’s Sunnybrook Health Sciences Centre, presented these and other key findings at the Black Physicians Association of Ontario’s (BPAO) 16th annual Health Symposium in February. “There is more financial and resource constraint [for Black Canadians],” said Dr. Norris. For physicians looking to give culturally sensitive care to their Black dementia patients, Dr. Norris recommends psychosocial interventions, which should address cultural attitudes, distrust, perceived discrimination, reticence towards having strangers in the home and an understanding that many people in the community may prefer to take care of elders without support from outside the family. Physicians, she said, should provide information and address barriers to supportive home care services and be prepared for families that may ask for help “navigating the system.”Prevalence of dementia among Black Canadians expected to growIn Canada, Dr. Norris noted the burden of dementia is expected to increase in the Black community because of improved longevity, and a high prevalence of cardiovascular risk factors like high blood pressure, diabetes and high cholesterol among the Black population, which can increase the risk of blood clots and bleeding in the brain. A study published in Nature in January this year found that the number of adults in the U.S. who develop dementia will double from approximately 514,000 in 2020 to approximately one-million in 2060. Among Black Americans, the number of new cases is expected to triple in those 35 years. “It’s important that we, as physicians, apply patient-centred care that considers language, gender, religion, ethnicity and culture to our patients, and avoid generalization,” said Dr. Norris. In her own practice, she found that patients and their caregivers preferred doctors who address the person that is affiliated with dementia, rather than speaking about the disease process.“Many Black caregivers attribute their motivations for caregiving to external reasons like cultural or familial expectations,” said Dr. Norris, who said that the added responsibility could lead to increased caregiver stress among them. In her experience, Dr. Norris found that there is a need for more Francophone services for Black patients whose native language is French. In Toronto, for example, where there is a significant population of Black people for whom French is their first language, there is a lack of Francophone services for dementia patients, who may revert to their primary language. Tips for providing holistic careWhen providing care to patients, Dr. Norris typically encourages the family to keep a diary. “I tell them to identify a symptom that the family wants to see changed,” said Dr. Norris, “For example, a caregiver might say that ‘Mom doesn’t remember my name’.”Identifying the symptom could help motivate the caregiver to keep a journal of the patients’ symptoms day-to-day, which could help physicians avoid constantly repeating the Montreal Cognitive Assessment (MoCA) test for dementia, she said. When prescribing medication to patients, Dr. Norris said that she encourages her patients to start the medication on a Monday, rather than closer to the weekend, so that she is available for patients who experience side effects (1 in 10). She also recommends that physicians look for parasomnia when they interview the patient and treat what’s impacting their sleep and other modifiable risk factors like depression and anxiety.“Some sleep interventions alone can improve the symptoms of dementia,” she said.

Taking factors like family and culture into account when treating Black dementia patients

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