Family Caregiving in Dementia: The Asian Perspective of a Global Problem

Abstract

Background/Aims: With an increasing life expectancy, the number of people suffering from dementia globally will rise to about 115.4 million by 2050. It is projected that in the 21st century, the majority of the world’s older people will be living in Asia. This paper examines the global issues of family caregiving for older persons with dementia from an Asian perspective. Methods: Literature review of published empirical studies from 1990 to October 2010. Results: A full understanding of the specific way that culture could influence family caregivers’ burdens may play an important part in the development of a holistic model for family-centered care. Well-designed psychoeducation interventions or multicomponent interventions could help in reducing caregivers’ burden. With socio-economical and demographical changes, families need to be supported when taking on the caregiving role and be offered alternatives of care. Conclusion: There is a need for future trials with more rigorous randomization and longitudinal follow-up to assess family caregiver burdens at different illness stages. Future studies could focus on protective factors that promote caregivers’ resilience. It is essential to develop psychometrically robust measures for family caregiver burden and gain.

“Tangled wires in the head”: older migrant Chinese's perception of mental illness in Britain

“…Culture may also determine how they talk about mental illness (Helman, 1990). A review of cross-cultural psychiatry revealed that the use of cultural idioms, albeit scant, was found in insightful studies of schizophrenia (Yang, 2007;Yang & Kleinman, 2008;Yang, Phillips, Lo, Chou, Zhang & Hopper, 2010); dementia (Ikels, 1998) and Alzheimer's disease (Chan, 2010). Yang and colleagues (2010) reported that cultural idioms were functional in helping participants to express culturally relevant feelings and recognize culturally abnormal behaviors.…”

“…Dementia was identified as a 'mind stealer' (Ikels, 1998, p. 257). It was perceived as a result of not being open-minded enough (Chan, 2010). According to Chan (2012), Alzheimer's disease was considered by some people in Hong Kong as the destiny of heaven (tien ming) (p. 472).…”

“…It carried deep stigma of fear and shame for the sufferers and their families (Littlewood, 1988;Ikels, 1998;Burr & Chapman, 2004;Lee, Lee, Chiu & Kleinman, 2005; Collins, Johnston, Fang, Fung, Kwan & Lo, 2006;Zhan, 2006;Yang, 2007;Liu, Hinton, Tran, Hinton & Barker, 2008;Blignault, Ponzio, Rong & Eisebruch, 2008;Yang & Kleinman, 2008;CMHA, 2009;Gallois, Cheneny & Smith, 2010;Chan, 2010;Yang, Phillips, Lo, Chou, Zhang & Hopper, 2010;Olafsdottir & Pescosolido, 2011;Liu, Ma & Zhao, 2012). For example, mental illness was purported to be caused by bad nerves and bad genes in the family (Blignault, Ponzio, Rong & Eisebruch, 2008).…”

“…A diagnosis of depression (Burr & Chapman, 2004;Liang, Gong, Wen, Guan, Li, Yin & Wang, 2012), and dementia (Ikels, 1998;Liu, Hinton, Tran, Hinton, & Barker, J.2008;Chan, 2010), often implied a weak will in a person's constitution. Goffman (1968) called this weakness 'abomination of the body ' (p. 14).…”

“…Chinese families would then build a 'protective capsule' around their loved one with mental health problems (Goffman, 1968, p. 46), or an invisible barrier to protect and shield their family members from shame and loss of face associated with such illness (Chan, 2010;Yang, Phillips, Lo, Chou, Zhang & Hopper, 2010;Liu, Ma & Zhao, 2012). Since social interaction in Chinese groups was organized by a strict network of social relations (Yang & Kleinman, 2008;CMHA, 2009;Yang, Phillips, Lo, Chou, Zhang & Hopper, 2010), the loss of face would lead to discrimination and social isolation of the sufferers and their close associates.…”