The debate on ethnicity and dementia: from category fallacy to person-centred care?
The concept of ethnicity remains attractive and meaningful to service developers and professionals, although research suggests that this disguises other facets of identity and difference. An epidemiological perspective on the relationship between ethnicity and dementia supports the idea that ethnicity (defined as particular shared cultural characteristics) is not likely to influence unduly the emergence of dementia in individuals. Cultural factors may protect against dementia, impeding its recognition and influencing its course and these deserve further investigation. Ethnicity is a general concept that subsumes and conceals the impact of migration, education, health beliefs and socio-economic status on health, and therefore is problematic. Empirical research on dementia and ethnicity reveals that intra-ethnic group variation is greater than inter-ethnic group variation; supporting the view that ethnicity as a category may not have great explanatory power and may foster a category fallacy. However, the experiences of people with dementia and their carers show that the important issues for service providers to consider are language, religious belief and observance, cultural practices (including food and personal care practices) and social support and coping mechanisms. In this position paper we argue that these issues are applicable to all individuals with dementia, independent of apparent ethnicity, and that promotion of cultural competence in service provision should not be relegated to an ethnic minority agenda. The task for health and social care providers is therefore to recognise the diversity of users and to increase access to appropriate quality mainstream person-centred services, rather than to develop segregated or specialized services.
Iliffe
S
S
Royal Free & UCL Medical School, London, UK. s.iliffe@pcps.ucl.ac.uk
Manthorpe
J
J
D000223:Adaptation, Psychological; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003466:Cultural Characteristics; D003704:Dementia / Q000208:ethnology* / Q000628:therapy*; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007802:Language; D008019:Life Style / Q000208:ethnology; D008605:Mental Health Services / Q000458:organization & administration*; D018802:Patient-Centered Care; D012944:Social Support; D012959:Socioeconomic Factors; D006113:United Kingdom