Abstract
This article explores the cultural clashes that occurred when Chinese patients at an Alzheimer’s center in California were evaluated for dementia. Lack of familiarity with Chinese culture made the culturally mainstream American clinicians at this center more likely to misinterpret the behavior of elderly Chinese-speaking patients and their families and, thereby, more likely to misdiagnose such patients and suggest culturally inappropriate recommendations. This tendency was reduced when relevant cultural knowledge was incorporated into the clinical evaluation. The evaluation process at this clinic and two patient examples are discussed to illustrate that familiarity with a patient’s cultural background is essential for accurate diagnosis and referral. This ethnographic case study places the evaluation process in one particular clinic in cultural context and is suggestive in the way that exploratory qualitative research is meant to be, rather than broadly representative of dementia clinics or clinicians as a whole. However, problems created by cultural clashes at this clinic do suggest that what may be happening at other dementia clinics as they encounter increasingly more patients from diverse cultural backgrounds is an important empirical question worthy of further research, using both qualitative and quantitative methods.
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Notes
This NIA-funded research project was proposed and carried out because little was known about providing dementia-related health and outreach services to Chinese communities in the United States. Because the researchers were entering what was essentially uncharted territory, a priori assumptions were avoided and open-ended, qualitative approaches were used to identify and explore cultural factors that became salient as clinicians, outreach staff and researchers worked “on the front lines” with Chinese patients and families and with the Chinese community in San Francisco. The strength of this qualitative research was the opportunity to observe both diagnostic and outreach process in action and to relate process to the sociocultural context in which it was occurring. However, as a case study of only one clinic’s efforts with one specific Chinese-American community, the research results clearly cannot be extrapolated in any statistically representative way to all dementia clinics, which would certainly vary in a number of ways, or to work done with all Chinese-American communities, especially in light of the diversity among and within such communities. The intended contribution of the research as a whole, and of the part of it discussed here, lies instead in the identification and exploration of salient cultural factors. It is hoped that future qualitative and quantitative research will further explore, refine and test the results reported here in other clinical settings and communities.
Ikels (1998) discusses a variety of reasons why symptoms associated with dementia are perceived as normal in the People’s Republic of China.
References
Albrecht, G., Freeman, S., & Higginbotham, N. (1998). Complexity and human health: The case for a transdisciplinary paradigm. Culture, Medicine and Psychiatry, 22, 55–92.
Baker, F. M. (1996). Issues in assessing dementia in African American elders. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 59–76). Washington, D.C.: Taylor & Francis.
Baldwin, D. M. (1998). A joint demonstration project to improve the care of patients with dementia: A partnership between a staff model HMO and the Alzheimer’s Association. Practicing Anthropology, 20, 17–20.
Bloomfield, F. (1983). The book of Chinese beliefs: A journey into the Chinese inner world. London: Arrow.
Braun, K. L., Takamura, J. C., & Mougeot, T. (1996). Perceptions of dementia, caregiving, and help-seeking among recent Vietnamese immigrants. Journal of Cross-cultural Gerontology, 11, 213–228.
Chee, Y. K., & Levkoff, S. E. (2001). Culture and dementia: Accounts by family caregivers and health professionals for dementia-affected elders in South Korea. Journal of Cross-cultural Gerontology, 16, 111–125.
Chow, N. W. S. (1992). Family care of the elderly in Hong Kong. In J. I. Kosberg (Ed.), Family care of the elderly: Social and cultural changes (pp. 123–138). Newbury Park, CA: Sage.
Chuanyi, Z., & Qin, X. (1992). Family care of the elderly in China: Changes and problems. In J. I. Kosberg (Ed.), Family care of the elderly: Social and cultural changes (pp. 123–138). Newbury Park, CA: Sage.
Drinka, T. J. K. (2000). Interdisciplinary health care in the Twenty-first century: Fantasy or fundamental? In J. M. Clair & R. M. Allman (Eds.), The gerontological prism: Developing interdisciplinary bridges (pp. 149–168). Amityville, NY: Baywood.
Elliott, K. J. (1995). Dementia, outreach “inreach,” and Chinese culture. Association for Anthropology and Gerontology Newsletter, 16, 4–6.
Elliott, K. S., Di Minno, M., Lam, D., & Tu, A. M. (1996). Working with Chinese families in the context of dementia. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 89–108). Washington, D.C.: Taylor & Francis.
Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus and Giroux.
Gould-Martin, K., & Ngin, C. (1981). Chinese Americans. In A. Harwood (Ed.), Ethnicity and medical care (pp. 130–171). Cambridge, MA: Harvard University Press.
Green, J. W. (1999). Cultural awareness in the human services: A multi-ethnic approach. Boston: Allyn and Bacon.
Helman, C. G. (2001). Culture, health and illness (4th ed.). London: Arnold.
Henderson, J. N. (1996). Cultural dynamics of dementia in a Cuban and Puerto Rican population in the United States. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 153–166). Washington, D.C.: Taylor & Francis.
Henderson, J. N. (1997). Dementia in cultural context: Development and decline of a caregiver support group in a Latin population. In J. Sokolovsky (Ed.), The cultural context of aging: Worldwide perspectives (pp. 425–442). Westport, CT: Bergin & Garvey.
Henderson, J. N., & Henderson, L. C. (2002). Cultural construction of disease: A “supernormal” construct of dementia in an American Indian tribe. Journal of Cross-cultural Gerontology, 17, 197–212.
Hinton, L., Guo, Z., Hillygus, J., & Levkoff, S. (2000). Working with culture: A qualitative analysis of barriers to the recruitment of Chinese-American family caregivers for dementia research. Journal of Cross-cultural Gerontology, 15, 119–137.
Hooyman, N. R., & Kiyak, H. A. (2002). Social gerontology: A multidisciplinary perspective (6th ed.). Boston: Allyn and Bacon.
Ikels, C. (1991). Aging and disability in China: Cultural issues in measurement and interpretation. Social Science and Medicine, 32, 649–665.
Ikels, C. (1998). The experience of dementia in China. Culture, Medicine and Psychiatry, 22, 257–283.
Ikels, C. (2002). Constructing and deconstructing the self: Dementia in China. Journal of Cross-cultural Gerontology, 17, 233–251.
Iris, M. A., & Berman, R. L. H. (1998). Developing an aging services agenda: Applied anthropology’s contribution to planning and development in a community foundation. Practicing Anthropology, 20, 7–10.
Keith, J., Fry, C. L., Glascock, A. P., Ikels, C., Dickerson-Putman, J., Harpending, H. C., et al. (1994). The aging experience: Diversity and commonality across cultures. Thousand Oaks, CA: Sage.
Kramer, B. J. (1996). Dementia and American Indian populations. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 175–181). Washington, D.C.: Taylor & Francis.
Larson, E. B., & Imai, Y. (1996). An overview of dementia and ethnicity with special emphasis on the epidemiology of dementia. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 9–20). Washington, D.C.: Taylor & Francis.
Leibing, A. (2002). Flexible hips? On Alzheimer’s disease and aging in Brazil. Journal of Cross-cultural Gerontology, 17, 213–232.
Loustaunau, M. O., & Sobo, E. J. (1997). The cultural context of health, illness, and medicine. Westport, Ct: Bergin & Garvey.
Lowenstein, A. (1999). Caring for parents with Alzheimer’s: Comparing perceptions of physical and mental health in the Jewish and Arab sectors in Israel. Journal of Cross-cultural Gerontology, 14, 65–76.
Markides, K. S., & Miranda, M. R. (Eds.) (1997). Minorities, aging, and health. Thousand Oaks, CA: Sage.
Moody, H. R. (2002). Aging: Concepts and controversies (4th ed.). Thousand Oaks, CA: Pine Forge.
Mungas, D. (1996). The process of development of valid and reliable neuropsychological assessment measures for English- and Spanish-speaking elderly persons. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 33–46). Washington, D.C.: Taylor & Francis.
Olson, L. K. (2001). Multiculturalism and long-term care: The aged and their caregivers. In L. K. Olson (Ed.), Age through ethnic lenses: Caring for the elderly in a multicultural society (pp. 1–16). Lanham, MD: Rowman & Littlefield.
Rodin, M. B. (1998). Practicing medicine and practicing anthropology can be complementary: A physician–anthropologist in academic geriatric practice. Practicing Anthropology, 20, 21–25.
Rodin, M. B., & Iris, M. (1998). Introduction: Applied anthropologists in aging. Practicing Anthropology, 20, 2–3.
Rush, J. A. (1996). Clinical anthropology: An application of anthropological concepts within clinical settings. Westport, CT: Praeger.
Salguero, R. H., Kohn, R., Salguero, L. F., & Marotta, C. A. (1998). Caregivers of persons with Alzheimer’s Disease: Cultural differences in perceived caregiver burden in Guatemala and Rhode Island. Journal of Cross-cultural Gerontology, 13, 229–240.
Shield, R. R. (1998). Real world anthropology in two settings: A nursing home and a health care policy project. Practicing Anthropology, 20, 11–13.
Shimkin, D. B., & Golde, P. (Eds.) (1983). Clinical anthropology: A new approach to American health problems? Lanham, MD: University Press of America.
Slorah, P. (1998). Grandparents, gray power and grassroots organizing: Implications for anthropologists. Practicing Anthropology, 20, 4–6.
Stoller, E. P., & Gibson, R. C. (Eds.) (2000). Worlds of difference: Inequality in the aging experience (3rd ed.). Thousand Oaks, CA: Pine Forge.
Taussig, I. M., & Ponton, M. (1996). Issues in neuropsychological assessment for Hispanic older adults: Cultural and linguistic factors. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 47–58). Washington, D.C.: Taylor & Francis.
Teng, E. L. (1996). Cross-cultural testing and the cognitive abilities creening instruments. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity & the dementias (pp. 77–85). Washington, D.C.: Taylor & Francis.
Traphagan, J. W. (1998). Localizing senility: Illness and agency among older Japanese. Journal of Cross-cultural Gerontology, 13, 81–98.
Traphagan, J. W. (2000). Taming oblivion: Aging bodies and the fear of senility in Japan. Albany, NY: State University of New York Press.
Traphagan, J. W. (2002). Senility as disintegrated person in Japan. Journal of Cross-Cultural Gerontology, 17, 213–232.
Valle, R. (1998). Caregiving across cultures: Working with dementing illness and ethnically diverse populations. Washington, D.C.: Taylor & Francis.
Wong, B. (1985). Family, kinship, and ethnic identity of the Chinese in New York City, with comparative remarks on the Chinese in Lima, Peru, Manila, Philippines. Journal of Comparative Family Studies, 16, 231–254.
Wong, M. G. (2001). The Chinese elderly: Values and issues in receiving adequate care. In L. K. Olson (Ed.), Age through ethnic lenses: Caring for the elderly in a multiculturalm society (pp. 17–32). Lanham, MD: Rowman & Littlefield.
Wu, F. Y. T. (1975). Mandarin-speaking aged Chinese in the Los Angeles area. The Gerontologist, 15, 271–275.
Yu, L. C. (1983). Patterns of filial belief and behavior within the contemporary Chinese American family. International Journal of Sociology of the Family, 13, 17–36.
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Elliott, K.S., Di Minno, M. Unruly Grandmothers, Ghosts and Ancestors: Chinese Elders and the Importance of Culture in Dementia Evaluations. J Cross Cult Gerontol 21, 157–177 (2006). https://doi.org/10.1007/s10823-006-9030-2
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DOI: https://doi.org/10.1007/s10823-006-9030-2