Providers are often unaware of the particular problems and obstacles that older refugees and immigrants face in accessing care. Further, factors such as sadness, agitation and cognitive symptoms are frequently attributed to “normal aging.” These are common symptoms among the aging population regardless of immigration status.

Older adults often lack knowledge and understanding of how to interpret mental health problems and illnesses (McCleary et al., 2013; Tieu et al., 2010). They may not recognize symptoms and, in cases such as dementia, they may view it as part of the normal aging process since they are unfamiliar with it (McCleary et al., 2013). In addition, clients sometimes mistake symptoms of common mental disorders, including depression and PTSD, for dementia. In some cultures and communities, mental health problems and illnesses manifest as physical issues (such as high blood pressure, high cholesterol and insomnia), and there is a belief the illness will go away on its own. There is also often stigma around mental problems and illnesses being contagious, especially among older immigrants (Chen et al., 2013).

As a result of misdiagnosis or a failure to recognize the connections between physical health problems and mental health problems, illnesses may be untreated, potentially leading to the development of serious mental health disorders, critical impairment and even death (McCleary et al., 2013). In people who do have dementia, depression and anxiety disorders can exacerbate the condition. Unrecognized or misdiagnosed problems can lower quality of life, leading to more serious consequences in older populations, such as suicide (Fiske et al., 2009).

Cultural beliefs and stigma can be extremely important in terms of recognizing a problem and seeking care (McCleary et al., 2013; Tieu & Konnert, 2014). For example, older Chinese immigrants often see the use of psychiatric services as a loss of respect or humiliation (loss of face). As a result, they are more likely to take care of problems themselves or seek help from a general practitioner rather than seeking help from close friends or psychologists (Tieu & Konnert, 2014). This could be a good alternative if the health care provider is well connected and versed in the health of aging for this specific population, but it cannot be a substitute to specialized care.

When people from different backgrounds do ask for help, providers should attempt to assess cultural beliefs related to the illness. When appropriate and available, they should use this knowledge to educate and promote mental health literacy. Consideration of cultural beliefs and potentially cultural treatments can also help support engagement and adherence to recommended treatment plans.

Resources on Alzheimer's disease:

Alzheimer Society - Help and support Alzheimer Society - Resources in other languages Finding Your Way