1. Introduction

## 1.1 Background

Dementia has been identified as one of the leading issues concerning people over the age of 65. A number of Canadians aged 40 and older living with Alzheimer's disease and other forms of dementia are expected to increase over time. In fact, this increase will be from about 395,000 in 2016 to 674,000 in 2031 [1]. In the Statistics Canada 2016 report, it estimated that 35.6 million global citizens were living with dementia and that the number is expected to double within the next 20 years [2]. When diagnosing an individual with dementia, physicians refer to the Diagnostic Manual of Mental Disorders (DSM) as a guide when determining whether the individual shows progressive tendencies of dementia [3]. The manual that is currently in practice is the DSM-5, which classifies dementia as a neurocognitive disorder. Generally, dementia is an umbrella term that encompasses a variety of symptoms related to the decline of cognitive function, which influences a person's ability to execute everyday activities [3]. In order to be diagnosed with dementia, one must meet certain criterions listed in the DSM-5 when determining major neurocognitive disorders such as (a) showing evidence of significant mental decline that interferes with mundane daily routines or (b) for milder cases showing signs of modest cognitive decline with only little interference of daily active living [4]. The DSM-5 criteria for tendencies of dementia include (1) cognitive changes, including new forgetfulness and difficulty finding words; (2) psychiatric symptoms, such as withdrawal or apathy, depression, and anxiety; (3) personality changes, such as blunting and disinterest and social withdrawal; (4) problem behaviors, such as wandering, agitation, and restlessness; and (5) changes in day-to-day functioning, including difficulty driving, getting lost, neglecting self-care, and difficulty handling money [3].

strengthen their support network and with the aim of promoting living well with dementia [12]. Cultural diversity is one of the key characteristics that defines the current Canadian demographic shift. It is estimated that by 2031, visible minorities from multicultural backgrounds among whom majority have lived in Canada for less than 15 years will make up approximately 63% of the population in Toronto, the largest city in Canada [13]. Increasing the number of migrants will lead to an increasing number of persons with dementia from various cultural backgrounds. As the dementia community possesses increased cultural diversity, it is crucial to identify the relationship between sociocultural factors and access to support programs aimed at promoting living well with dementia [14, 15]. Similarly, refugee populations of every age group living in a foreign country often suffer from various challenges including language difficulties, acculturative stress, loneliness, and societal prejudice, leading to a depleted social network and barriers to accessing necessary services and supports [4]. In particular, a reduced level of participation is observed in dementia care and support programs among immigrants and refugees compared to their nonimmigrant counterparts [15]. There is a need to increase our understanding about the unique needs of the immigrants and refugees with dementia that would promote their timely and appropriate access to dementia

An Examination of Factors Influencing Equitable Access to Dementia Care and Support…

The purpose of this chapter is to review the existing literature related to the persons living with dementia who have migrated as a refugee or immigrant and to explore the sociocultural factors that contribute to the access to dementia care and support programs among these vulnerable populations. Our literature review will place special emphasis on the Southeast Asian population because the number of people living with dementia in the Asia Pacific region will triple between now and year 2050 with Alzheimer's disease being projected to rise by 300% among South-

1. identifying the sociocultural factors influencing access to and participation in dementia care and support programs among migrants and refugees, with

2. exploring knowledge gaps in the existing literature to identify further research opportunities in relation to improving access to dementia care and support

In order to address the above objectives, a literature review was conducted using a predetermined inclusion-exclusion criteria and search strategy as outlined below.

The search strategy for the literature review included journal articles and research papers that were published until May 2017. A preliminary search was conducted on this topic to determine the scope of the existing literature, which has revealed a lack of published research in the field of dementia care for migrants and refugees. As a result, no specific boundary was set on the date range of publication,

east Asians, the highest projected rise among other ethnic groups [31].

support services in the community.

DOI: http://dx.doi.org/10.5772/intechopen.84858

This literature review aims at:

2.1 Inclusion and exclusion criteria

emphasis on Southeast Asian populations;

programs for migrant and refugee populations.

1.2 Objective

2. Method

107

There are different forms of dementia due to variances in the distinct expression of symptoms in addition to structural brain abnormalities. One of the most common forms of dementia is Alzheimer's disease, followed closely then by vascular dementia [5]. Other known types of dementia include dementia with Lewy bodies (DLB) and frontotemporal dementia. Moreover, impaired mental functions that arise due to the neurodegenerative disease include memory, language and communication, judgment and reasoning, and attention span [3]. Even emotional control and social behavior and motivation are altered and may deteriorate as the disease progresses. Rates of dementia, including Alzheimer's disease and other forms of illness, are projected to increase continuously and double every 20 years [6]. It is estimated that in 2010, over 35 million people worldwide were living with dementia [7]. Dementia and Alzheimer's disease are considered as an abnormal process of aging. Common symptomology includes frequent memory loss and finding family members and friends unrecognizable [8]. It is believed that people first experience an asymptomatic period where neurodegenerative changes occur in the brain, while cognitive abilities remain stable. This preliminary phase occurs for a long duration and is followed by the progressive cognitive decline and the eventual, late-stage development of dementia [9].

Living with dementia means coping with the progressive loss of physical and mental abilities. It can have an overwhelming negative impact on the individual and those around them by progressively altering every part of their life until the individual becomes completely dependent on either their loved ones, paid caregivers, or a combination of both. Living with dementia imposes a large physical health, mental health, and economic burden on the patients, informal caregivers, and family member [10]. It can affect the patient in many ways starting from increased dependency on caregivers for daily life activities, inability to be engaged in activities that they were previously able to, leading to frustration and shorttemperedness, depression and anxiety, confusion, and fear [11]. Regardless of the availability of a strong support network, people with dementia have been identified to commonly face isolation, loneliness, and social exclusion. In order to improve the quality of life of individuals living with dementia and their caregivers, Canada is implementing national strategies and community level actions to improve and

An Examination of Factors Influencing Equitable Access to Dementia Care and Support… DOI: http://dx.doi.org/10.5772/intechopen.84858

strengthen their support network and with the aim of promoting living well with dementia [12]. Cultural diversity is one of the key characteristics that defines the current Canadian demographic shift. It is estimated that by 2031, visible minorities from multicultural backgrounds among whom majority have lived in Canada for less than 15 years will make up approximately 63% of the population in Toronto, the largest city in Canada [13]. Increasing the number of migrants will lead to an increasing number of persons with dementia from various cultural backgrounds. As the dementia community possesses increased cultural diversity, it is crucial to identify the relationship between sociocultural factors and access to support programs aimed at promoting living well with dementia [14, 15]. Similarly, refugee populations of every age group living in a foreign country often suffer from various challenges including language difficulties, acculturative stress, loneliness, and societal prejudice, leading to a depleted social network and barriers to accessing necessary services and supports [4]. In particular, a reduced level of participation is observed in dementia care and support programs among immigrants and refugees compared to their nonimmigrant counterparts [15]. There is a need to increase our understanding about the unique needs of the immigrants and refugees with dementia that would promote their timely and appropriate access to dementia support services in the community.

#### 1.2 Objective

increase will be from about 395,000 in 2016 to 674,000 in 2031 [1]. In the Statistics Canada 2016 report, it estimated that 35.6 million global citizens were living with dementia and that the number is expected to double within the next 20 years [2]. When diagnosing an individual with dementia, physicians refer to the Diagnostic Manual of Mental Disorders (DSM) as a guide when determining whether the individual shows progressive tendencies of dementia [3]. The manual that is currently in practice is the DSM-5, which classifies dementia as a neurocognitive disorder. Generally, dementia is an umbrella term that encompasses a variety of symptoms related to the decline of cognitive function, which influences a person's ability to execute everyday activities [3]. In order to be diagnosed with dementia, one must meet certain criterions listed in the DSM-5 when determining major neurocognitive disorders such as (a) showing evidence of significant mental decline that interferes with mundane daily routines or (b) for milder cases showing signs of modest cognitive decline with only little interference of daily active living [4]. The DSM-5 criteria for tendencies of dementia include (1) cognitive changes, including new forgetfulness and difficulty finding words; (2) psychiatric

Redirecting Alzheimer Strategy - Tracing Memory Loss to Self Pathology

symptoms, such as withdrawal or apathy, depression, and anxiety; (3) personality changes, such as blunting and disinterest and social withdrawal; (4) problem behaviors, such as wandering, agitation, and restlessness; and (5) changes in day-to-day functioning, including difficulty driving, getting lost, neglecting

There are different forms of dementia due to variances in the distinct expression of symptoms in addition to structural brain abnormalities. One of the most common

Living with dementia means coping with the progressive loss of physical and mental abilities. It can have an overwhelming negative impact on the individual and those around them by progressively altering every part of their life until the individual becomes completely dependent on either their loved ones, paid caregivers, or a combination of both. Living with dementia imposes a large physical health, mental health, and economic burden on the patients, informal caregivers, and family member [10]. It can affect the patient in many ways starting from increased dependency on caregivers for daily life activities, inability to be engaged in activi-

temperedness, depression and anxiety, confusion, and fear [11]. Regardless of the availability of a strong support network, people with dementia have been identified to commonly face isolation, loneliness, and social exclusion. In order to improve the quality of life of individuals living with dementia and their caregivers, Canada is implementing national strategies and community level actions to improve and

ties that they were previously able to, leading to frustration and short-

forms of dementia is Alzheimer's disease, followed closely then by vascular dementia [5]. Other known types of dementia include dementia with Lewy bodies (DLB) and frontotemporal dementia. Moreover, impaired mental functions that arise due to the neurodegenerative disease include memory, language and communication, judgment and reasoning, and attention span [3]. Even emotional control and social behavior and motivation are altered and may deteriorate as the disease progresses. Rates of dementia, including Alzheimer's disease and other forms of illness, are projected to increase continuously and double every 20 years [6]. It is estimated that in 2010, over 35 million people worldwide were living with dementia [7]. Dementia and Alzheimer's disease are considered as an abnormal process of aging. Common symptomology includes frequent memory loss and finding family members and friends unrecognizable [8]. It is believed that people first experience an asymptomatic period where neurodegenerative changes occur in the brain, while cognitive abilities remain stable. This preliminary phase occurs for a long duration and is followed by the progressive cognitive decline and the eventual, late-stage

self-care, and difficulty handling money [3].

development of dementia [9].

106

The purpose of this chapter is to review the existing literature related to the persons living with dementia who have migrated as a refugee or immigrant and to explore the sociocultural factors that contribute to the access to dementia care and support programs among these vulnerable populations. Our literature review will place special emphasis on the Southeast Asian population because the number of people living with dementia in the Asia Pacific region will triple between now and year 2050 with Alzheimer's disease being projected to rise by 300% among Southeast Asians, the highest projected rise among other ethnic groups [31].

This literature review aims at:

