The Changing Perception of Dementia Across Cultures

The Changing Perception of Dementia Across Cultures

Olivia Cozzetto
Western Washington University
Human Services 315: Human Development

The Changing Perception of Dementia Across Cultures

Abstract
This paper looks at how different cultures view individuals with dementia. Dementia is a
progressive disease including but not limiting memory loss, loss of communication skills and
ability to perform daily functions. By examining different cultures and how society and family
members view and value elders it will portray how different cultures view elders with
dementia. Using Bronfenbrenners ecological theory to understand how cultural contexts affect
every aspect of life from familial to larger cultural beliefs. Through understanding the value of
elders and applying Bronfenbrenners ecological theory and understanding different caregiving
strategies, the research of this paper helps to understand how across cultures elders and
dementia is viewed.

The Changing Perception of Dementia Across Cultures

Introduction
Throughout every life stage of human development, there are changes made to a
persons cognitive, social and personal characteristics that are transformed and altered
depending on their position in the life stage and cultural environment. In later adulthood, a
person is still undergoing life development changes. One big disorder of later adulthood is
memory loss which is associated with dementia. Dementia does not affect everyone in the later
adulthood stage; it depends on genetics as well as environmental factors. Dementia can affect a
persons position in society, their role within the family and how society and family members
view and value them. The authors of Lives Across Cultures, Gardiner and Kosmitzki state that
this stage of development can begin in the mid-sixties or earlier and continues till death (2011).
The purpose of this paper is to examine how the perception of dementia, an umbrella term for
the symptoms including impaired memory and thinking skills, varies across different cultures
and societies. By looking at the different cultures and societies, we can understand how and
why the perception and understanding of dementia changes throughout different cultures. By
applying Bronfenbrenners ecological theory to different societies and considering the ones
cultural beliefs, values, norms and systems we can assume how across cultures dementia is
viewed in different lights depending on their belief, values and systems.
What is Dementia?
According to the Alzheimers Association, dementia is the overlapping and general
terms for any of the following diseases: Alzheimers, Vasular dementia, dementia with lewy
bodies, Parkinson and Frontotemporal dementia. The symptoms of dementia include loss of

The Changing Perception of Dementia Across Cultures

memory, loss of communication and language skills, reasoning and judgment, and the inability
to focus and pay attention (Alzheimers Association, 2013). Dementia is a progressive disease,
meaning it can start out slow and proceed to get worst over years. From the review, What do
We Know About Quality of Life in Dementia?, the article communicates that the variety of
disorders that fall under the term of dementia has significant decline in the individuals global
intellectual, social and physical functioning (Banerjee et al., 2009). The article by Banerjee et al.,
proposes that dementia results in less global and community functioning which helps to
understand how to measure the impact of dementia on individuals and to study the effects of
intervention. Through measuring the impact of dementia and the effects of intervention, the
authors measured the health-rated quality of life of individuals with dementia; the article
expresss that there are few scientific findings to show how the quality of life changes with
intervention for dementia patients across different factors such as gender, socioeconomic
status and race. I believe that once individuals are diagnosed with dementia and begin to suffer
from the wide variety of symptoms they become less functional, which makes their family and
society step in to help with the care, this is something the article did not take into
consideration.
Ecological Theory
By using Bronfenbrenners ecological theory, we can understand how every aspect of
ones life is influenced by cultural context such as environments pertaining to ones life which
can include education intuitions, family and cultural beliefs. From the article, Crisis in Context
Theory, I believe the authors do an inadequate job describing how interconnected the

The Changing Perception of Dementia Across Cultures

ecological theory is (Myer & Moore, 2006). The authors of the article recognize that events and
personal decisions do not happen independently or without influence from cultural and social
contexts (Myer & Moore, 2006). The article looks at the crisis in context theory which is very
similar to Bronfenbrenners ecological theory. Although dementia would not been seen as a
crisis, the crisis in context theory overlaps and identifies similar aspects such as the
importance of culture, the individual and the interrelated layers which all play an important
part in the ecological theory.
Explanation of the Ecological Intertwined Layers
From the book Lives Across Cultures, the characteristics of the individual such as
biological factors and the larger historical contexts such as politics, media, economy and social
services also play a part in the ecological theory (Gardiner & Kosmitzki, 2011). Bronfenbrenners
ecological theory is split into four different layers, all intertwining and affecting each other.
From Bronfenbrenners article, Ecological Models of Human Development, outlines the
microsystem as the smallest layer which includes systems that directly influence the individual
(1994). Factors involved in this layer are family, peers, the workplace and school
(Bronfenbrenner, 1994). The next layer is the mesosystem which shows the interconnectedness
of the theory; it looks at how different structures within the microsystem can help develop the
individual. Bronfenbrenner calls the connecting structures linkages in his article, linkages take
place between two or more settings involving the individual (Bronfenbrenner, 1994). The third
layer is the exosystem which is filled with things that the individual interacts with at some
length, such as a parents workplace, the mass media, legal services and extended family. This

The Changing Perception of Dementia Across Cultures

layer also involves the linkage of two or more structures to demonstrate how overlapping
development is within the different layers (Bronfenbrenner, 1994). The largest layer is the
macrosystem which includes customs, values and laws of the culture which influences the
individual in a boarder scale, which the authors of Lives Across Cultures discuss at length
pertaining to what becomes acceptable and unacceptable behaviors in a culture (Gardiner &
Kosmitzki, 2011). By applying the ecological theory to families and individuals across culture,
we can understand how values and customs at the macrosystem affect family relations at the
microsystem and affect the perception of individuals with dementia.
Value of Elders and Ecological Theory
The value of elders varies across cultures and can influence the care of individuals with
dementia. The value placed on parents and elders is one big factor to the perception of
individuals with dementia. In some cultures, individuals in the later adulthood stage continue to
hold leadership roles and are seen as key leaders in their village and society. From the text of
Gardiner and Kosmitzki (2011), the passing of knowledge to younger members in the
community is one important role for elders in communal societies. Gardiner and Kosmitzki
identify these communities in parts of Asia, South America and Africa; I agree with their findings
from my knowledge of reading other articles and text. In other parts of the world, the value of a
person diminishes with age. As discussed from class in HSP:315, when individuals reach
adolescences they begin to contribute to the common good and develop an understanding of
their roles in the society, yet as individuals age and enter later adulthood, their input and role in
society is decreased (Bordoloi). The US, Britain and other developed cultures that value youth

The Changing Perception of Dementia Across Cultures

and the amount of involvement inputted, value elders less than communal communities who
depend on elders for passing knowledge and wisdom. Identifying the societys social standing
whether communal or individualistic helps determine how the general public and family
members view elders within the community and defines the cultures values and perception of
elders at the macrosystem of the ecological theory.
The Changing of Family Value
The value of a population is an important factor to consider when understanding how
cultures view dementia. Dementia often leaves elders helpless and unable to function in daily
life, family and outside help is needed to preserve the individuals lifestyle. Without the broader
cultural value of elders, families may turn their backs on their aging family members and
disregard them. From the article, Revisiting Family Values by Iruonagbe, Chiazor & Ajayi (2013),
this idea is presented through the belief that modernization and technology has changed family
dynamics for the worst. The article touches on the topics of the rising number of women ran
households, divorce rates and population growth which the article suggests that these factors
influence the family structure and relations. The authors point out that showing respect for
elders and placing value towards the aging population needs to start at the family level and
then move to the larger social norms. I disagree with the authors; I believe if the society
supports beliefs such as valuing the aging population than at the individual level, family
members will grow learning to value the elders. My opinion comes from studying the ecological
theory, if at the macrosystem a culture values the knowledge passed down by elders then at
the exosystem there might be more social and health services available for elders, creating an

The Changing Perception of Dementia Across Cultures

older aging population. At the microsystem layer, the individual may grow up learning new
experiences from their elders and for that reason would treat their elders with more respect
and see them as more valuable in the society and for survival. Since individuals would then
value elders, when elders age and begin showing signs of dementia, I believe more people
would be willing to assist the elderly and the view of dementia would be seen as a part of life
instead of a disease that makes the elderly population burdens for family and society to care
for. This shows how the value of elders can impact the perception of dementia.
East Asian Culture and Perception of Elders
The East Asian culture has a history of a communal belief system and is backed by a
cultural and historical approach to understanding the value of elders. According to the article,
Cultural Dissonance Among Generations: A Solution-Focuses Approach with East Asian Elders
and Their Families (Lee & Mossey, 2004), the term East Asian includes Chinese, Korean and
Japanese cultures which differs from other nearby Asian countries. The article recognizes that
East Asian individuals and familys place value on the community and family rather than ones
self. A persons self is less important and instead the focus is on meeting the expectations of
family members and the boarder societal norms (Lee & Mossey, 2004). Across the East Asian
cultures, the filial piety, a cultural and religious belief surrounding the creation of many family
values determines the importance of family relationships. The authors Lees and Mossey state
that the filial piety generates ideas towards caring for elders as well as the importance to obey
and honor elders. The filial piety also creates a strong tie between family members and upholds
the authority, power and the ability to pass knowledge and values. Because of the prescribed

The Changing Perception of Dementia Across Cultures

rules of the filial piety, children grow up understanding the importance of obeying parents
and elders and value the authoritative decision making power elders have within the family
(Lee & Mossey, 2004).
Applying the Ecological Theory to the East Asian Culture
By placing the presented East Asian culture from the article into Bronfenbrenners
ecological theory, the microsystem for an individual in the culture would be filled family, elders
apart of the family, school and religion. The macrosystems influence would heavily enforce
those values within the microsystem which shapes the individual. The mesosystem shows the
interconnectedness of the theory, the influences from family members imposing rules of the
filial piety such as obeying elders could have a positive or negative effect in the school setting,
creating a linkage between family and the school settings. By applying the ecological theory to
the article, Cultural Dissonance Among Generations (Lee & Mossey, 2004), we can understand
how cultural beliefs can affect the value of elders in societies. The degree of value which is
directed by the macrosystems beliefs towards elders can affect how cultures view dementia
and the elderly.
The Aging Influence in the Republic of Palau
The article, Aging and Caregiving in the Republic of Palau (Fernandes et al., 2013),
examines the Pacific Island called Palau. The article helps to understand how caregiving lessons
and other elder care training programs have improved the health of local elders as well as
caretakers on the island. The article informs that the population of Palau is centered on elder
care, and children consider taking care of parents as a blessing (Fernandes et al., 2013). The

The Changing Perception of Dementia Across Cultures

island even holds annual celebrations for seniors, something that might not ever happen in
other cultures. The local hospital holds community caregiving training programs to help teach
family caregivers to care for the elderly since there are no assisted or nursing homes on the
island. This article shows how the island of Palau builds a community open and educated in
elder care resulting in a better understanding of elders with diseases like dementia and how to
care of them.
Applying the Ecological Theory to the Republic of Palau
When we apply the ecological theory to caregiving of individuals with dementia on the
island of Palau, we can observe the different factors that are involved. Since there are limited
social services and organizations for the elderly, families rely on friends and neighbors instead
for help. Theres a strong bond between neighbors and friends which are both located in the
microsystem layer. Palau families with economic stability and income have more opportunities
to provide the aging individual with better care by hiring domestic help. When domestic help is
hired, the article states that less strain and stress is placed on the family, creating better family
functioning and relations (Fernandes et al., 2013).
Within the ecological theory, other factors like the microsystem of the family involving
wealth and resources correlates to whether formal care is possible for the family. This involves
interactions between outside caregivers and social services in their exosystem. The article
states that without domestic or formal care, families have a higher chance of caregiver burnout,
elder abuse and neglect (Fernandes et al., 2013). This is a troubling idea that families are lacking
skills to care property for elders resulting in elder neglect. As the article states, more

The Changing Perception of Dementia Across Cultures

educational programs are being presented to the community (Fernandes et al., 2013). If
individual become educated in elder caregiving through the islands resources and social
services such as educational programs and receive extra help through food distribution, then at
the microsystem the individual and family could have a better relationship and resulting in a
more relaxed and stable mesosystem.
This article shows how the island of Palau takes their elder care seriously and that they
value elders in their culture. Through community education and planning, the island is taking
care of their elderly population. The perception of dementia and the elderly on the island of
Palau has significant impacts to their community and the population values caring and loving
aging individuals.
Dementia Care
Care for individuals with dementia can be a difficult experience for family members.
From personal experience, family members often have conflicting standpoints on the type of
care for loved ones and often other factors such as wealth, location and transportation are
contributing causes. From the journal, Cultural Values and Family Caregiving for Persons with
Dementia by McCleary and Blain (2013), in most situations dealing with a family member with
dementia informal care is used. Informal care consists of family members and friends providing
the care for individuals with dementia, often in a home setting. Care for loved ones with
dementia may lead to stress between family, elder abuse and caregiver burnout (Fernandes et
al., 2013). From the journal, it states that the hours of informal care will rise tremendously to
756 million hours of informal care by 2038 (McCleary & Blain 2013). The increasing number of

The Changing Perception of Dementia Across Cultures

elders in the population impacts the growth of the informal hours and care that is needed. In
the study within the article, The Last Mile of the Way by Turner, Wallace, Anderson, and Bird
(2004), African Americans overall are less likely to use formal care because of the United States
historical background of treatment towards African Americans.
Ecological Application to African American Population
Using the ecological theory and the article The Last Mile of the Way, the African
American population feels suspicion about the US health care system because of the United
States history of segregation, racism and discrimination towards African Americans (Turner,
Wallace, Anderson & Bird, 2004). Attitudes towards African Americans in the US affect the
populations view and belief system. From my experience, the aging white population still
upholds racist and discriminating beliefs towards the African American population in the US.
But as the new generation grows up in a more accepting environment, less restricting and racist
attitudes are being presented towards the African American population. The opinions from the
past that African Americans were second class citizens influence how African Americans use
social services and legal services within their exosystem. Evidence from the study backs up the
idea, African Americans are less likely than are Whites to receive basic mental and physical
health-related preventative and wellness services, (Turner, Wallace, Anderson & Bird, 2004).
The overall attitudes towards African Americans in the US affect their ecological system. Since
African Americans have grown to distrust the health care system, when caring for elders with
dementia families turn to informal and family care instead of formal care. This is an example of
how the attitudes of the boarder society affect the care of individuals with dementia.

The Changing Perception of Dementia Across Cultures

An Increasing Elder Population
From the article A Model of Active Aging Through Elder Learning by Tam, looks at the
growing elder population and how the city of Hong Kong encounters efforts to make societal
and economic changes to protect and care for their aging population (2013). The article states
that the United Nations recognizes any country with a 7 or higher percentage of individuals
over 65 to be an aging nation. In the last years, Hong Kong has grown beyond that number and
is estimated to 28 percent by 2039 (Tam, 2013). Today people are living longer because of
better health care, food equality and technology causing the population of elders to rise at a
steady pace. With the average life expectancy in Hong Kong for women being 86, more
resources and public services are needed to protect and service elders (Tam, 2013). The article
presented the term positive and successful aging. The idea of positive aging revolves around
the notion that different factors are in place to benefit and maintain a healthy and independent
lifestyle for elders. Studies have shown that elders have experienced less decline in memory
and cognitive ability showing the benefits of maintaining the idea of a successful aging process
(Tam, 2013). This shows when the idea of the aging process is viewed in a more positive light
instead of viewing the growing aging population as a burden, elders actually benefit from the
positive terminology and it helps to prolong cognitive decline.
Conclusion
The number of elder is growing every year. People are living longer and healthier lives
yet still 35.6 million people have dementia (World Health Organization , 2013). Individuals who
have dementia lose their ability to contribute to the society and are sometimes viewed as a

The Changing Perception of Dementia Across Cultures

burden to families and society. Through the understanding of the East Asian cultures, the value
of elders depending on historically and religious factors influence the boarder attitudes and
beliefs of the culture. The attitudes created from religious factors and growing up in a society
that values elders create a larger value and respect for elders in East Asian cultures. Having the
knowledge and understanding that some African Americans struggle to find their place in the
US and still feel uncomfortable to trust the health care system shows how boarder attitudes
can affect at an individual level and control the care for individuals aging and with dementia.
This is related to dementia because if the overall culture of the US is discriminating against one
race, then that populations view on health care, social services and dementia changes from the
rest of the culture. Through the examination of the Palau Island, its interesting to see how
much community and society can affect the influence and resources people have to care for
elders and individuals with dementia. Through the research of the paper, I have a better
understanding how different influences and factors predict how cultures view the elderly and
individuals with dementia within their culture.

The Changing Perception of Dementia Across Cultures

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