Services for older people from ethnic minorities

Until recently there was little research into the mental health needs of older people from ethnic minorities in the UK. But the number of over 65’s in these groups is increasing, and consequently research into social care and health is finding out more about the needs of this group, the support available and the approaches those planning and delivering services should take.

It is difficult to confirm whether some ethnic groups are more likely to experience certain mental health problems than others. Differences are reported, but there is no standard definition of ethnic groups, and there are a large number of other contributing factors – including income, housing, age and gender – that can also influence a person’s mental health .

Some evidence suggests that older people from black Caribbean and Asian communities are more likely to have dementia because of higher rates of hypertension (high blood pressure) than white people. They also face extra barriers that can lead to poorer assessments of their needs. These include a lack of awareness of mental health problems within communities and service providers, language barriers, unfamiliarity with social care services, and a general lack of cultural awareness on the part of assessors.

Increasing awareness of the mental health needs of older people from black and minority ethnic backgrounds has posed many questions for service providers: should we  focus on separate or integrated services? Is it appropriate to use family members as interpreters? How can service providers adapt for cultural and religious differences? Here we look at some of the evidence available to help answer these questions.

There is insufficient evidence about whether integrated or separate services are most effective, but it is clear that there is a need for more culturally appropriate and sensitive services. Research generally shows that a lack of awareness among practitioners makes it less likely that people from ethnic minority groups will receive all the help that they need. Although people from these groups often fear that services won’t be culturally sensitive, many practitioners also assume that mainstream services will be rejected and so fail to offer or explain them.

Language can also be an issue and act as a barrier to gaining access or understanding services. Evidence shows that while families and friends are essential sources of information about the older person, and will have many valuable insights, they should not be put in the position of interpreting for an older person’s assessment.

Research shows that older people prefer to be supported within their own home. Where older people use residential care, they respond better to more homely  environments. This means that such care must take account of a person’s cultural and ethnic background, such as employing staff who speak their language, ensuring religious festivals are observed and that meals are culturally appropriate. Such measures are a crucial means of enhancing a person’s quality of life, health and well-being.

Practitioners’ Messages

Find out as much as you can about the culture and religious beliefs of the older person you are assessing. Make links with people from their local community who can help you by explaining things and who can tell you about local sources of support within the community. Remember to maintain confidentiality.

● Don’t assume that mainstream services will not be acceptable to older people from minority ethnic communities. Offer them and discuss what might need to be done to ensure they are culturally acceptable.
● Find out the older person’s preferred language, and arrange for a professional independent interpreter to be present at all meetings with the older person.
● Make sure that the older person and their family has all the information they need in an appropriate format. If material in the right language is not available, or the older  person would have difficulty reading it, consider making an audio tape of essential information in the person’s own language.
● Talk to service providers about what they can do to make their services more culturally sensitive. Make sure that specific requirements are detailed in the care plan and any contract, so that they can be monitored and reviewed.
● Get information about your services and how  to access help out into the local community through the services and points of contact which are trusted and used by people from minority ethnic communities, for instance GPs and places of worship.

FURTHER INFORMATION

● Scie Practice guide 2: Assessing the Mental Health Needs of Older People
● Nice/Scie guideline on Dementia: supporting people with dementia and their carers in health and social care
● Developing Services for Minority Ethnic Older People: the audit tool
● Age Concern Black and Minority Ethnic Elders Initiative
● Bhopal, R (2004), “Glossary of terms relating to ethnicity and race: for reflection and debate”, Journal of Epidemiology and Community Health, 58 (6): 441-445
● Brugha, T, Jenkins, R, Bebbington, P, Meltzer, H, Lewis, G & Farrell, M (2004), “Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain”, Social Psychiatry and Psychiatric Epidemiology, 39 (12): 939
● Livingston, G, Leavey, G, Kitchen, G, Manela, M, Sembhi, S & Katona, C (2001), “Mental health of migrant elders: the Islington study”, British Journal of Psychiatry, 179 (4): 361-366
● Daker-White, G., Beattie, A.M., Gilliard, J. & Means, R. (2002), “Minority ethnic groups in dementia care: a review of service needs, service provision and models of good practice,” Aging & Mental Health, 6 (2): 101-108
● Ahmad, WI-U & Atkin, K (1996), Race and Community Care (pp. 187), Buckingham: Open University Press
● McKevitt, C, Baldock, J, Hadlow, J, Moriarty, J & Butt, J. (2005), “Identity, Meaning and Social Support”, in A. Walker & C.H. Hennessy (Eds), Understanding Quality of Life in Old Age (pp. 130- 145), Maidenhead: Open University Press
● Cohen-Mansfield, J & Werner, P (1998), “The effects of an enhanced environment on nursing home residents who pace”, The Gerontologist, 38, 199–208