Report Brief 1 Older people from CALD backgrounds in general

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1 Report Brief 1 Older people from CALD backgrounds in general Highlights Preferences for ageing well, including options for care when ageing, vary from culture to culture. Language is a major barrier to accessing information and services for some older people from CALD backgrounds; cultural world views and expectations may also be important barriers. Social isolation of older people from CALD backgrounds can result from the assumption they will be cared for by their family members. Issue There are many commonalities across all older Australians in preferences for ageing well. These include, for example, the importance of maintaining health and independence. However, many older CALD Australians face circumstances that are different to those of other older Australians and this may have an impact on their ageing experience, and access to and use of aged care services. The unique situations, experiences and preferences of different CALD groups and individuals vary greatly. Notwithstanding this diversity, a number of challenges emerge consistently in the literature for some older CALD groups including: socio-economic disadvantage; English language barriers; cultural translation difficulties; lack of exposure to Australian services and systems; and lower rates of access to services. Additionally, those who migrated to Australia at an older age, or who are from refugee background, face a higher risk of mental and physical health issues. Project background This report brief highlights key findings from a review of research project undertaken by the University of Adelaide for FECCA. The aim of the project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of older CALD Australians as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. Four broad topic areas were covered in the review: 1. Older people from CALD backgrounds in general; 2. Older people from CALD backgrounds with dementia; 3. Ageing and mental health issues for older people from CALD backgrounds; and 4. CALD carers and carers of older people from CALD backgrounds. This report brief highlights findings on the older people from CALD backgrounds in general topic. The full report describing the findings of this review along with a comprehensive, searchable database of all research identified is available at

2 Language and cultural barriers The major barriers faced by older people from CALD backgrounds are language and cultural understandings. The following have been identified in the literature as strategies to overcome these challenges: provide information in preferred language; ensure high quality standard of translation of printed material; make available bilingual staff and/or interpreters; clarify aged care concepts and terms that may be unfamiliar, for example carer and respite ; and provide information through appropriate and preferred channels which may differ between communities. It is also important to acknowledge that many CALD groups also experience language barriers within their own communities and in their native language. Retaining culture, recognising the life course Multiple studies find that English language ability, level of acculturation and number of years living in Australia greatly influence wellbeing. Some migrants retain the cultural traditions of their country of origin, such as: retaining mourning rituals; utilising traditional medications; and maintaining food and nutrition practices. Challenges arise when these cultural traditions or preferences do not match Australian mainstream practices. For example, the research found inadequate access to culturally appropriate food through home support program services for some migrant groups, and a higher rate of medication mismanagement in some cultural groups as a result of blending traditional and western treatments. Reliance on family In general there is a strong reliance on family members for care and support as people age. However, the belief that people from CALD backgrounds always look after their own was identified as a myth. Some older people from CALD backgrounds risk social isolation if service providers and other people in the community assume that their care and social inclusion needs are met completely by their families. What are the research gaps? More extensive research is needed about certain older CALD groups including: older people from new and emerging communities; older people from a refugee background; people from CALD backgrounds who arrive in Australia at an older age; and older people from CALD backgrounds who live outside of the most populous states and metro areas. Resources for service providers Centre for Culture, Ethnicity and Health (search portal for resources): Centre for Cultural Diversity in Ageing (links to care practice guides and other resources): For more information please contact FECCA at admin@fecca.org.au or (02) This project was funded by the Australian Government Department of Social Services Federation of Ethnic Communities Councils of Australia. No part of this publication may be reproduced without the written permission of FECCA.

3 Report Brief 2 Older people from CALD backgrounds with dementia Highlights Poor understanding of dementia combined with cultural stigma attached to dementia leads to denial of the condition and/or delayed diagnosis for some older people from CALD backgrounds. Culture and ethnic background can have an impact on dementia diagnosis and culturally sensitive assessment tools are required and should be used where they exist. Older people from CALD backgrounds are often excluded from dementia research due to language barriers, leading to gaps in the evidence base. Issue The prevalence of dementia within the older CALD population in Australia is projected to increase more than three-fold, from approximately 35,000 in 2010 to 120,000 by While different cultural perceptions of dementia and provision of care to older people from CALD backgrounds are not yet well understood, the projected increase in the number with dementia highlights the need for communities and service providers to understand, develop services for and manage dementia from a CALD perspective. Project background This report brief highlights key findings from a review of research project undertaken by the University of Adelaide for FECCA. The aim of the project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of older CALD Australians as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. Four broad topic areas were covered in the review: 1. Older people from CALD backgrounds in general; 2. Older people from CALD backgrounds with dementia; 3. Ageing and mental health issues for older people from CALD backgrounds; and 4. CALD carers and carers of older people from CALD backgrounds. This report brief highlights findings on the dementia topic. The full report describing the findings of this review along with a comprehensive, searchable database of all research identified is available at

4 Understanding of dementia For some CALD communities, poor understanding of dementia and cultural stigma attached to dementia, leads to denial of the condition, and/or delayed diagnosis. Understanding of dementia could be improved by presenting information to: the general community; CALD community groups; family members who care for an older person with dementia; and older people from CALD backgrounds who are, or potentially will be, affected by dementia. Culturally sensitive assessment and diagnosis Aged care workers need to respond to CALD care recipients presenting with dementia symptoms by considering: language; religion/spirituality; culture; social support; and management strategies. Bilingual doctors and adult children of people from CALD backgrounds with dementia have a very important role as the major access points for information. Once an older person from a CALD background presents with symptoms, screening tools need to take culture into account to ensure an accurate diagnosis. Factors such as age, language and socio-economic status have been found to influence cognitive assessments. The Rowland Dementia Universal Access Screening tool (RUDAS) is now established as a culturally sensitive dementia assessment tool for use in Australia. People from CALD backgrounds with dementia at risk Some groups identified at risk include older people from CALD backgrounds with dementia living in mainstream residential care facilities. Risks include social isolation and disruptive behaviour because of communication barriers. Additionally, the research identifies a need for increased understanding of dementia among aged care nurses and support workers. Research gaps More research is needed in the area of older people from CALD backgrounds with dementia including: how different groups of older people from CALD backgrounds who have been diagnosed with dementia cope with and manage the disease; the inclusion of CALD participants in dementia research programs (they are often excluded from initial trials because of language barriers); and how language and cultural barriers for people from CALD backgrounds with dementia in residential care influence wellbeing outcomes. Resources for service providers Dementia collaborative research centres (searchable portal for dementia research): Alzheimer s Australia (dementia help sheets and other resources available in multiple languages): For more information please contact FECCA at admin@fecca.org.au or (02) This project was funded by the Australian Government Department of Social Services Federation of Ethnic Communities Councils of Australia. No part of this publication may be reproduced without the written permission of FECCA.

5 Report Brief 3 Ageing and mental health issues for older people from CALD backgrounds Highlights Older people from CALD backgrounds have a higher risk of mental health issues than the population born in Australia. The research shows an underuse of mental health services by older people from CALD backgrounds. Older people from CALD backgrounds tend to present at later stages of illness compared to other older people in Australia. Issue Mental health is a significant issue for all Australians. Older people from CALD backgrounds have been recognised as one of the groups at greatest risk of mental illness. Older people from CALD backgrounds may face a higher risk of mental health illness for a number of reasons that vary across cultural groups and individuals. These reasons include: traumatic circumstances at, or prior to, migration; a loss of identity or sense of disconnection as a result of migration; and lower socioeconomic status of some older people from CALD backgrounds that can lead to poor knowledge of mental illness and delayed diagnosis. Project background This report brief highlights key findings from a review of research project undertaken by the University of Adelaide for FECCA. The aim of the project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of older CALD Australians as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. Four broad topic areas were covered in the review: 1. Older people from CALD backgrounds in general; 2. Older people from CALD backgrounds with dementia; 3. Ageing and mental health issues for older people from CALD backgrounds; and 4. CALD carers and carers of older people from CALD backgrounds. This report brief highlights findings on the mental health topic. The full report describing the findings of this review along with a comprehensive, searchable database of all research identified is available at

6 Factors affecting the mental health of older people from CALD backgrounds The factors that affect mental health vary across individuals and birthplace groups. The research has identified the following issues: level of acculturation in Australia; cultural norms in the country of origin; whether children are present in Australia or still in the home country; English language ability; refugee experience either recent or in earlier life; and living in residential aged care. Access to mental health information and services The research shows an underuse of mental health services by older people from CALD backgrounds. A number of challenges have been identified for some CALD groups including: poor understanding of mental illness; cultural stigma attached to mental health issues; barriers in accessing bilingual health services or translated information; and delayed help-seeking behaviour leading to delayed diagnosis of mental illness. There is an identified need for more widely available mental health services that meet the language and cultural needs of older CALD Australians. Service providers including GPs, specialists, nursing, and allied health staff need to take a culturally inclusive approach to addressing mental health issues. Culturally sensitive care Cultural understanding needs to be included when diagnosing mental illness. A body of research explores the validity of mainstream tools used to screen and diagnose mental illness for people from different cultural backgrounds. Research shows there are differences in scores on mental health scales according to language and ethnicity. Responses and treatments to mental illness also need to be culturally sensitive. For example, consideration should be given to traditional therapies and medications. Research gaps There is a body of research about CALD understandings of mental health issues, the factors contributing to poorer mental health outcomes for some older CALD Australians and the importance of using culturally sensitive tools to assess mental health conditions. However, little research exists about: understanding of how the life course, family and community play a role in mental health; effective practices, treatments and care approaches for older people from CALD backgrounds after a mental health diagnosis has been made; and the cultural and socioeconomic dimensions that contribute to delayed diagnosis of mental illness. Resources for service providers NSW Transcultural Mental Health Centre: Mental Health in Multicultural Australia (MHIMA): For more information please contact FECCA at admin@fecca.org.au or (02) This project was funded by the Australian Government Department of Social Services Federation of Ethnic Communities Councils of Australia. No part of this publication may be reproduced without the written permission of FECCA.

7 Report Brief 4 CALD carers and carers of older people from CALD backgrounds Highlights In general, older people from CALD backgrounds have lower rates of use of care and carers support services compared to older Anglo-Australians. A collaborative approach between different ethno-specific, multicultural and mainstream aged care services and community groups is required to best meet the needs of older people from CALD backgrounds. Family members play an important role in access to information about available services and in making health and care decisions for older people from CALD backgrounds. Issue Research indicates older people from CALD backgrounds use fewer services compared to other older Australians. This is particularly true for low level care services such as home support services but also noted for dementia support services. Additionally, there are identified challenges to adequately meeting the residential care needs of older people from CALD backgrounds. To some extent the underuse of services by older people from CALD backgrounds is attributed to a heavier reliance on family members to provide care. This means a large number of CALD carers who also require support. Project background This report brief highlights key findings from a review of research project undertaken by the University of Adelaide for FECCA. The aim of the project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of older CALD Australians as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. Four broad topic areas were covered in the review: 1. Older people from CALD backgrounds in general; 2. Older people from CALD backgrounds with dementia; 3. Ageing and mental health issues for older people from CALD backgrounds; and 4. CALD carers and carers of older people from CALD backgrounds. This report brief highlights findings on the care and carers topic. The full report describing the findings of this review along with a comprehensive, searchable database of all research identified is available at

8 Providing culturally sensitive aged care There is an increasing demand for culturally competent aged care workers and a need for mainstream, multicultural and ethno-specific organisations to work together to ensure the needs of older people from CALD backgrounds are met. Training pathways for a growing number of people from CALD backgrounds entering the aged care workforce are being established and some of these CALD workers are well positioned to provide culturally sensitive care. However, it has been noted that problems can arise when carers and care recipients have language and communication difficulties, or differing cultural norms. Informal care and CALD carers Studies have shown that, in general, older people from CALD backgrounds have a heavier reliance on family members for: accessing information; making health, treatment and aged care decisions; and informal care. CALD carers are identified as a group at risk of isolation and poor health due to the strain of their care responsibilities and underuse of support services. Support needs vary across cultural groups and the condition of the person being cared for. Some common needs across groups include: education about the conditions of the person being cared for; bilingual doctors/services for each CALD group; and more support for CALD carers. Additional support needs for some cultural groups, such as financial support and doctor visits at home, were also identified. Residential care Some findings suggest older people from CALD backgrounds in ethno-specific residential care have a better quality of life than those in mainstream residential care. They require less medication and engage in more resident-to-resident communication. In addition to language, cultural aspects that need to be considered in residential care for older CALD populations include food, religious observances, and gender norms. Research gaps More research is needed in the area of care of older people from CALD backgrounds, including: the challenges associated with providing care when care recipients and service providers are not from the same cultural and language background; greater understanding of the impact of caring roles on CALD carers; and the impact of the limited number of ethno-specific residential care for older people from CALD backgrounds. Resources for service providers Queensland Health (resources for working with CALD groups): Carers Australia (resources for CALD carers): For more information please contact FECCA at admin@fecca.org.au or (02) This project was funded by the Australian Government Department of Social Services Federation of Ethnic Communities Councils of Australia. No part of this publication may be reproduced without the written permission of FECCA.

9 Report Brief 5 Gaps in research Highlights There is great diversity within the older CALD population and many of the differences in experiences, and aged care preferences within and between cultural groups are not well understood. It is important to identify how older CALD populations are similar to other older populations in Australia and therefore what mainstream services are also appropriate for older people from CALD backgrounds. Existing data available about older people from CALD backgrounds is not used to its full potential to provide information about the ageing and health care needs of this group. Issue The overall aim of this review project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of people from CALD backgrounds as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. An important part of this project was identifying the gaps in the current research base. These gaps were identified through collation and review of the currently available research on older people from CALD backgrounds and from service provider and researcher input. Although a large body of research on older people from CALD backgrounds does exist, there are many areas where more evidence is needed. Project background This report brief highlights key findings from a review of research project undertaken by the University of Adelaide for FECCA. The aim of the project was to identify current research about best practice in meeting the health, wellbeing and social inclusion needs of older CALD Australians as they age and to make this evidence accessible to aged care service providers, researchers and policy makers. Four broad topic areas were covered in the review: 1. Older people from CALD backgrounds in general; 2. Older people from CALD backgrounds with dementia; 3. Ageing and mental health issues for older people from CALD backgrounds; and 4. CALD carers and carers of older people from CALD backgrounds. Research and literature across these topic areas have been identified. This report brief highlights the identified research gaps. The full report describing the findings of this review along with a comprehensive, searchable database of all research identified is available at

10 CALD population groups requiring further research older people from new and emerging communities; smaller CALD population groups; older people from refugee backgrounds; people from CALD backgrounds who arrive in Australia at an older age; and older people from CALD backgrounds who live outside of the most populous states and metropolitan areas. Topic areas requiring more research There are many topics where further research is required including: religious, spiritual and faith considerations; CALD care workers as a part of the aged care workforce; an intergenerational perspective on CALD care and support needs and expectations and how this varies across generations; more in-depth understanding of treatment and approaches to care for older people from CALD backgrounds once a dementia or mental health diagnosis has been made; an understanding of how the experiences of older people from CALD backgrounds differ from those of older Anglo-Australian groups across a range of demographic factors; and more information about specific communities and directories of available services. Evaluations of programs and services Service providers and researchers who responded to calls for input to the review identified many gaps in evaluating the effectiveness of programs for older people from CALD backgrounds including the need for: wider dissemination of evidence of the effectiveness of programs trialled by service providers; more research around the effectiveness of services and programs in meeting the needs of older people from CALD backgrounds; and more evaluation studies about interventions and programs for CALD carers. Pathways to filling the gaps Identifying the research gaps will help guide a research agenda relating to older people from CALD backgrounds. Several recommendations are made as steps towards gaining greater understanding of older CALD populations. These are: continuing to grow the body of research about older people from CALD backgrounds; improving comparability of research results, datasets and data sources; increasing participation by older people from CALD backgrounds in research; mining existing data sources for more information about older people from CALD backgrounds; and updating available literature and resources about older CALD populations on a regular basis. For more information please contact FECCA at admin@fecca.org.au or (02) This project was funded by the Australian Government Department of Social Services Federation of Ethnic Communities Councils of Australia. No part of this publication may be reproduced without the written permission of FECCA.