Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. Cultural Differences


Culture has been defined as a group's values, beliefs, traditions, symbols, language, and social organization (Harwood & Ownby, 2000). The United States model of health care, which values autonomy in medical decision making, contrasts with preferences for more family-based, physician-based, or shared physician and family-based decision making in other cultures. Moreover, although United States culture emphasizes full disclosure by providers, it is common for health care professionals in other countries to conceal serious diagnoses from patients because disclosure can be viewed as disrespectful, impolite, or even harmful to the patient (Searight & Gafford, 2005).

Cultural influences on African Americans that may affect disparities in treatment or access to medical care include the legacy of slavery and Jim Crow laws, the Tuskegee syphilis study, the interaction of religion with health care, the use of home remedies, distrust of the medical system, being of a different or the same race as one's medical provider, and health literacy (Eiser & Ellis, 2010). Some African Americans have strong religious beliefs, including the belief that illness can be cured or is controlled by God. Strong spirituality has been correlated with lower medication adherence and later stage cancer diagnosis (Eiser & Ellis, 2010). Similarly, some elderly African Americans and other non-White patients are more likely to use traditional or herbal medicines instead of, prior to, or alongside allopathic medicines.

Many individuals and cultures perceive dementia-related symptoms as a natural part of aging (Ayalon & Arean, 2004; Eiser & Ellis, 2010; Gelman, 2010; Gray et al., 2009; Jett, 2006). For example, one study asked participants whether the following statement is true: "Significant loss of memory/mental ability, commonly known as senility, is a normal part of aging." Of Whites, 23% agreed, compared to 55% of Hispanics and 33% of Chinese (Gray et al., 2009). An earlier study used different wording and found very different results: "Alzheimer's disease is a normal process of aging, like graying of hair or wrinkles." In that study, 66% of Whites, 50% of African Americans, 24% of Latinos, and 17% of Asians agreed with the statement (Ayalon & Arean, 2004).

Numerous cultural differences around caregiving for patients with Alzheimer's disease may also contribute to racial and ethnic disparities (Gray et al., 2009; Napoles et al., 2010). The most frequently documented cultural differences for both African American and Hispanic caregivers (compared to White caregivers) are more positive views of caregiving, greater spirituality, a stronger sense of duty to family, and higher value placed on extended family networks (Napoles et al., 2010). In a review of the literature, seven studies found evidence of worse mental health among Hispanic caregivers compared to Whites, whereas among African American caregivers, 11 studies found evidence of better mental health compared to Whites (Napoles et al., 2010). African American caregivers of people with Alzheimer's disease also appear to have more social support than White caregivers.

Research focused on Asian American caregivers is more limited, but there is evidence of a strong sense of filial responsibility in those communities (Napoles et al., 2010). Confucian cultures have a tradition of first-born sons and their wives being responsible for elder care (Janevic & Connell, 2001); people from these cultures may also be less likely to seek outside help in dealing with their family member and be less affected by the stress of caregiving.

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