Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada

Abstract

Background and Objectives Dementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this project was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada. Research Design We used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n=15) and a focus group consultation with local health professionals (n=7). Results Each question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes. Discussion and Implications The research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.

Culturally safe dementia care: Building nursing capacity to care for First Nation Elders with memory loss

“…The ADQ Person-Centred score not having increased (insignificant decrease) is not an uncommon result in dementia education programmes that use it as an outcome measure (Sheaff et al, 2018). This is also unsurprising given that PCC may be incongruous with culturally safe care (Hulko & Stern, 2009), with McMillan et al (2010) suggesting Indigenous Elders' connection to country needs to be incorporated into PCC and Canadian and Australian researchers long having called for culturally safe approaches to dementia care for Indigenous Elders (Halseth, 2018;Hulko et al, 2010Hulko et al, , 2019Jacklin, 2019;Jacklin et al, 2020;Jacklin & Walker, 2019;Smith et al, 2011). Despite this, CSDC is the first such initiative involving the development and evaluation of a culturally safe dementia care education programme.…”

“…This means that PCC needs to be modified, if used at all, for Indigenous Elders; this could include reframing PCC as ‘caring for country’ in Australia (McMillan et al, 2010) or ‘going through the full circle of life’ for various First Nations in Canada (Hulko et al, 2010; Jacklin & Walker, 2019; Lanting et al, 2011). Recent research with a variety of First Nations in Ontario has resulted in a culturally sensitive approach to dementia knowledge sharing (Forbes et al, 2013), culturally appropriate information materials (Webkamagid et al, 2020), an intergenerativity model of healthy brain ageing (Cornect‐Benoit et al, 2020) and a culturally safe assessment tool for use with Anishnaabe older adults (Jacklin et al, 2020); however, a culturally safe approach to dementia care has yet to be developed, let alone one that reflects the diversity and specificity of Indigenous nations. Further, the concepts of sensitivity, appropriateness and relevancy are more often appended to culture than is safety.…”

“…Recent research with a variety of First Nations in Ontario has resulted in a culturally sensitive approach to dementia knowledge sharing (Forbes et al, 2013), culturally appropriate information materials (Webkamagid et al, 2020), an intergenerativity model of healthy brain ageing (Cornect-Benoit et al, 2020) and a culturally safe assessment tool for use with Anishnaabe older adults (Jacklin et al, 2020); however, a culturally safe approach to dementia care has yet to be developed, let alone one that reflects the diversity and specificity of Indigenous nations. Further, the concepts of 1 A.N.A.C.…”

Canadian Indigenous Cognitive Assessment (CICA): Inter‐rater reliability and criterion validity in Anishinaabe communities on Manitoulin Island, Canada

“…11,12 Qualitative work with Indigenous communities characterized existing tools as culturally inappropriate. 12 The lack of appropriate tests has led to care providers improvising or adapting existing methods without verification of the reliability and validity of their modifications. 11 Providers may use popular clinical tests such as the Mini-Mental State Examination (MMSE) as a "template" around which they use conversation and select portions, but not fully scored administrations, of the test.…”

Critiquing the Canadian Model of Client-Centered Enablement (CMCE) for Indigenous Contexts

“…Examples of this work currently underway include the development of a cognitive assessment for Indigenous Australians and Torres Strait Islanders ( Westphal, 2013 ), and an Australian interprofessional therapy outcome tool ( Hill et al, 2020 ; Sheahan et al, 2019 ). Canada has seen the development of an assessment for mental health and addictions (the Native Wellness Assessment, https://thunderbirdpf.org/about-tpf/scope-of-work/native-wellness-assessment/ ) and a cognitive assessment for older Anishinaabe adults ( Jacklin et al, 2020 ). In the absence of tools and interventions grounded in and derived from Indigenous epistemologies, however, occupational therapists are having to get creative and adapt current resources to the best of their abilities until the profession can truly make a meaningful shift toward more culturally relevant models and tools for use with Indigenous communities.…”