1. Perceptions of Dementia in the Macedonian Community

2. Agenda Dementia and the Macedonian Culture Dementia and the Macedonian Culture Macedonian beliefs Macedonian beliefs Macedonian lifestyle and Dementia Macedonian lifestyle and Dementia Understanding of Dementia in the Macedonian Community Understanding of Dementia in the Macedonian Community Evidence of attitude towards Dementia Evidence of attitude towards Dementia

3. Dementia and the Macedonian Culture The role and status of the elders in the family The role and status of the elders in the family Living arrangements Living arrangements Provision of carer support Provision of carer support

4. Macedonian Beliefs Christian-Orthodox religion Christian-Orthodox religion Approach to health Approach to health “if it is written it is written – you cannot escape from whatever is written” “if it is written it is written – you cannot escape from whatever is written”

5. Macedonian Lifestyle and Dementia Liberal consumption of alcohol and fatty diet Liberal consumption of alcohol and fatty diet Age groups affected by Dementia Age groups affected by Dementia - Evidence of both older and younger members of the community being affected by Dementia Lack of awareness of the relationship between Dementia and lifestyle and diet by the younger members of the community Lack of awareness of the relationship between Dementia and lifestyle and diet by the younger members of the community

6. Understanding of Dementia in the Macedonia Community Highly stigmatised and misunderstood illness Highly stigmatised and misunderstood illness No word in Macedonian language to describe Dementia No word in Macedonian language to describe Dementia In the Macedonian language Dementia is described as “sclerosis” or “old people illness”. In the Macedonian language Dementia is described as “sclerosis” or “old people illness”. Family members tend to ignore or minimise the problem Family members tend to ignore or minimise the problem People often try to deal with problem in their own way, without seeking assistance from health professionals. People often try to deal with problem in their own way, without seeking assistance from health professionals. People generally prefere treatments to be given in the form of injections, rather than ongoing counselling or psychological intervention. People generally prefere treatments to be given in the form of injections, rather than ongoing counselling or psychological intervention. Professional help is usually sought at very late stages of Dementia Professional help is usually sought at very late stages of Dementia People tend to seek help through a hospital rather than from GP or mental health services, People tend to seek help through a hospital rather than from GP or mental health services, Reasons to hide the presence of Dementia by older people. Reasons to hide the presence of Dementia by older people.

7. Attitudes Towards Dementia Quotations from community members directly affected by Dementia Female carer about 60 yrs: “When you have Dementia, or other kinds of mental illnesses, Macedonian lose all respect for you. They don’t accept you anymore, they don’t even give you a chance. It is their mentality. When one finds out the word starts spreading and then the whole family suffers from shame, especially the children. Macedonian people can be very cruel”. Female carer about 60 yrs: “When you have Dementia, or other kinds of mental illnesses, Macedonian lose all respect for you. They don’t accept you anymore, they don’t even give you a chance. It is their mentality. When one finds out the word starts spreading and then the whole family suffers from shame, especially the children. Macedonian people can be very cruel”. Female carer 65 yrs: “They should only share this information with family members and friends who are strong and smart enough to understand. Not everyone should know… People in the family or friends they can trust and people who can take this calmly… People who will not be very disturbed with the news. Don’t tell people who are weak and can not handle the truth or people who will ridicule them later on”. Female carer 65 yrs: “They should only share this information with family members and friends who are strong and smart enough to understand. Not everyone should know… People in the family or friends they can trust and people who can take this calmly… People who will not be very disturbed with the news. Don’t tell people who are weak and can not handle the truth or people who will ridicule them later on”. Female community member 55 yrs: “People or friends would start avoiding them. Many people are afraid to associate with people with Dementia. They would not know how to communicate with people like them”. Female community member 55 yrs: “People or friends would start avoiding them. Many people are afraid to associate with people with Dementia. They would not know how to communicate with people like them”. Male community member 65 yrs: “Yes they would avoid the person and gossip especially if he/she is Macedonian- everyone will find out”. Male community member 65 yrs: “Yes they would avoid the person and gossip especially if he/she is Macedonian- everyone will find out”.