The Older Chinese Patient ACMA 2014 Dr Yu-Min Lin Geriatrician, Middlemore Hospital
Overview Demographics and trends Barriers to health care Cognitive testing for Chinese patients
Changing age structure From Statistics NZ
Demographics “Asian” makes up ~12% of population Only 6% of Asian above the age of 65 Chinese may only make up 1.2% of total population (based on language spoken) Those above age 65 – only 0.1% of total population (4266) From Statistics NZ
Lincoln Tan Lincoln Tan is the New Zealand Herald’s diversity, ethnic affairs and immigration senior reporter. Ageing China migrants a 'major concern' 8:18 AM Tuesday Apr 23, 2013 Professor Paul Spoonley. Photo / Richard Robinson
Lincoln Tan Lincoln Tan is the New Zealand Herald’s diversity, ethnic affairs and immigration senior reporter. China overtakes UK as largest source of migrants 5:30 AM Friday Mar 7, 2014 Country now the biggest source of settlers, international students and visitors
Barriers for Chinese patient Language (client/ACC/doctor) Fear of western medicine Home remedy or alternative medicine Perception of “begging” – they can pay for themselves Lack of transportation Lack of interpreter service Lack of information about service Culturally inappropriate service Perception of discrimination Barriers experienced by Asians in accessing injury-related services and compensations J PRIMARY HEALTH CARE 2010;2(1):43–53.
Dementia
Cognitive testing – Mini-mental state examination (MMSE) First published in 1975 by Folstein Well validated Universally taught Score out of 30 Copyright 2000 with granting of exclusive licencing to psychological assessment resource (PAR) in 2001 Hot topic since copyright dispute of Sweet 16 in 2011 Sweet 16 since removed
C-MMSE Mandarin version first translated in 1988 Cantonese version 1991 Cut-off scores variable (17-20/30) Problems with illiteracy/degree of dementia/education level Sensitivity for MCI/early dementia may not be optimal
Cognitive testing Montreal cognitive assessment (MOCA) Score of out 30 Advantage with frontal type dementia Cut off is <26 but may need to be adjusted in Chinese Recent publication suggest cut off reduced to <23 There is also likely still variation due to education level Free to download online with easy access Using the Montreal Cognitive Assessment Scale to screen for dementia in Chinese patients with Parkinson’s disease; Shanghai Archives of Psychiatry, 2013, Vol. 25, No. 5 Chinese-Language Montreal Cognitive Assessment for Cantonese or Mandarin Speakers: Age, Education, and Gender Effects; Hindawi Publishing Corporation, International Journal of Alzheimer’s Disease, Volume 2012, Article ID , 10 pages doi: /2012/204623
Cognitive testing The Rowland Universal Dementia Assessment Scale (RUDAS) Developed in 2004 in Melbourne Score out of 30 Validated with cut off <23 Not effected by education or language Hasn’t been specific trial targeted at Chinese No Chinese version but easily translated directly Rowland JT, Basic D, Storey JE, Conforti DA. (2006) The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. International Psychogeriatrics, 18:
Cognitive testing Addenbrooke's Cognitive Examination Revised (ACE-R or ACE-III) Out of 100 points More sensitive for mild cognitive impairment or early dementia Cut off <82 for dementia, <88 for MCI Can vary with education level Cantonese version recently translated and validated Cut off however lower than English version A validation study of the Chinese-Cantonese Addenbrooke’s Cognitive Examination Revised (C-ACER) Neuropsychiatric Disease and Treatment 2013:9 731–737
Into the future Chinese population in New Zealand will continue to grow and possibly continue to rapidly age Remains multiple barriers for the Chinese population to access health cares Increasing numbers of Chinese health professionals will help break some of the barriers Improving health information also key to breaking barriers Dementia will become a very challenging aspect of health care in the near future