Interpreter-mediated Cognitive Assessments: Who Wins and Who Loses?

Abstract

This study highlights the need for clinicians and interpreters education of roles of all parties in interpreter-mediated cognitive assessment. Areas to be covered in education could include: common misunderstandings of interpreters roles, and practice tips on how to improve communications in assessments, such as briefing before and after the assessment. Such education will enable more accurate assessment and less stress for patients and their families.

The Importance of Attention to Cultural Factors in the Approach to Dementia Care Services for Older Persons

“…Assessment of those with dementia who are from a culturally or linguistically diverse background is an important area. A qualitative study of interpreter-mediated dementia assessments from the perspectives of clinicians, interpreters and caregivers was undertaken by Haralambous, Tinney, LoGiudice, Lee, and Lin (2017). Their study highlights the importance of having professional interpreters available, along with the different perceptions of the role of the interpreter that, if unaddressed, can fuel tensions between clinicians and interpreters.…”

Using interpreters with culturally and linguistically diverse older adults: What do we need to know?

“…Similarly, it is not known how such training for interpreters might improve the accuracy of cognitive assessments, which are complex, multilayered psychological processes affected by relational factors. 2,4 Even non-verbal tests which reduce linguistic demands may be unfamiliar to older migrants and performance affected by cultural factors and test instruction, delivery and interpretation. Cognitive screening tests such as the Montreal Cognitive Examination are available in several languages but translations infrequently validated in migrant populations.…”

“…5 In Australia, clinicians and interpreters rarely receive training in working together and may have different objectives for the same clinical interaction. 4 Although there appears to be consensus that clearly defining the role of the interpreter, and having pre-and postinterview discussions between clinicians and interpreters to identify the goals of assessment and cultural, linguistic and interpersonal issues in the interaction are important, 2,6 it is not known whether this is common practice or even taught to health-care professionals. It is unknown whether the focus should be upon training clinicians or training interpreters, or shared learning.…”

“…2 These concerns have not been adequately investigated, although a few studies indicate factors such as the relational context between the interpreter and the older person have to be taken into account as there may be culturally defined roles and expectations, a family hierarchy, power differentials and gender norms of which the clinician is unaware. [2][3][4]6 The needs of community-dwelling CALD older adults vary from acute and primary health care, with specific issues such as assessment of care needs, quality of life, decision-making and advance planning for treatment and care especially pertinent and more complex to evaluate with interpreters. 1,2 Assessment of decision-making capacity needs to be undertaken in the older adult's language using the appropriate vocabulary to present key concepts and questions, and with clinician and interpreter understanding the nuances of coercion and undue influence, which may be affected by relationships between interpreter, clinician, patient and family, and aspects of ageing.…”

Including ethnic and cultural diversity in dementia research

“… the Moving Pictures study ( https://movingpictures.org.au), which seeks to increase dementia awareness through films and comics that document the lived experience of carers across Australia who speak Hindi, Tamil, Arabic, Mandarin and Cantonese; the potential of using technologies such as Skype or Zoom to facilitate timely interpreter‐mediated cognitive assessments and dementia diagnosis in older CALD patients; and the codesign of mobile phone applications to enable everyday conversations about care delivery between hospital and home case workers and CALD people with dementia and their families …”