The Older Chinese PatientACMA 2014Dr Yu-Min Lin

Geriatrician, Middlemore Hospital

Overview

Demographics and trends

Barriers to health care

Cognitive testing for Chinese patients

Changing age structure

From Statistics NZ

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.

Dementia

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