the older chinese patient acma 2014 dr yu-min lin geriatrician, middlemore hospital
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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 TanLincoln 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
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Professor Paul Spoonley. Photo / Richard Robinson
Lincoln TanLincoln Tan is the New Zealand Herald’s diversity, ethnic affairs and immigration senior reporter.
China overtakes UK as largest source of migrants5:30 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.
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 204623, 10 pages
doi:10.1155/2012/204623
Cognitive testingThe 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, 18:111-120.
Cognitive testingAddenbrooke'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