Cultural and religious needs of people with dementia

Find out about a person’s cultural and religious background

When completing an assessment or admission form, it can be easy to tick a box (Hindu? Christian? Irish? Greek?) and think that the work of valuing a person’s background stops there. In fact, this is only a starting point. When thinking about activities and encouraging meaningful engagement, a person’s religion, nationality or culture are likely to have a major influence on their preferred music, food, clothes and everyday routines, to name a few things.

To what extent does a person’s cultural and religious identity need to be preserved as their dementia develops?

If you do not know much about a person’s religion or country of origin, be prepared to find out more, perhaps from the person, their family or local community representatives. The local library or the internet can offer a wealth of information.

When speaking with a person with dementia, the following questions might help: I don’t know very much about … (‘Nigeria’, ‘Poland’ , ‘Islam’, ‘Sikhism’ and so on) Please tell me a bit more about your … (country) (religion) Are there any specific pieces of music that remind you of home? What is a favourite food or meal from your childhood? What times of the year are most important in your religion? What do you do to observe this … (festival)(tradition)?

Be aware that questions can be challenging for people who have dementia. Showing pictures of a country or symbols of a religion or possibly objects related to that culture might prompt different responses. A rice bowl, Chinese fabrics or a picture of a rickshaw might provoke memories for a person from China or Hong Kong. Spices, saris or Bollywood star pictures could be good starting points for an Indian service user.

Link staff and users from the same background

If you have a member of staff from the same religion or culture, this can be a really helpful way of offering tailored support and spreading knowledge among the staff team.

Limetree Care Centre in south London is home to 92 residents, of whom 31 are from an African or Caribbean background, four are Irish and individual residents also come from places such as Spain, Cyprus and India. The staff team is also diverse – over half are from Africa or the Caribbean.

Oxana Nesterenco, the manager at Limetree, is pleased to make links between staff and residents. She says, ‘During induction, we make it clear that staff cannot speak their own language in front of residents who don’t speak their language. This would obviously be disrespectful. But where a resident can enjoy communicating with a staff member in their language, this is an important part of the care plan.’

The activity coordinator at Limetree, Devika Radhakissoon, is a Hindu from Mauritius and as such is able to give a Hindu resident, Mrs P, particularly individualised activities. When she arrives on shift in the morning, Devika will go to Mrs P’s room and spend a few minutes saying a prayer together. She will then henna her hands and do the bindu mark on her forehead in preparation for the day. Mrs P also enjoys a good rapport with the receptionist Sweetie and the visiting doctor, both of whom are also Asian. Because she lived in Kenya for many years, she relates well to the African staff as well. Be aware though that within some countries or faiths, there may be very different traditions according to the person’s particular background.

Pay attention to detail

Attending to small details can make a big difference to meeting a person’s cultural or religious needs. A Greek Orthodox woman living at Limetree Care Centre (introduced above) wears black all the time and likes to have her hair taken back in a particular way. She also likes to hold a cross in her hand. Mrs P (Limetree resident introduced above) has a table in her room with pictures and ornaments relating to her Hinduism including Ganesh the God and portraits of her guru. At Diwali, the activities coordinator will light a candle with her in her room.

Suna Tilley at the Alzheimer’s Society in Leicestershire and Rutland recruited a Hindi volunteer who befriended two Asian gentlemen who wanted her to accompany them to the temple. The volunteer pointed out that she would not be able to do this when she was having a period as this is not permitted in the temple.

Don’t assume or judge

The danger of any label is that we then make assumptions and say, for example, that ‘No Jewish or Muslim person likes to eat bacon’ or ‘African or Caribbean elders have strong and active Christian beliefs.’ Stereotypes do exist for particular cultures and religions, however it is important to find out what a person’s actual likes and dislikes are, rather than being led by our assumptions. Mrs P, the Indian resident at Limetree Care Centre (introduced above) prefers not to wear a sari, for example, as she is anxious about falling.

Some behaviours that are acceptable in particular cultures – for example, spitting or talking loudly – may seem strange or even rude to someone outside that culture. The challenge for care staff in a communal care environment is to recognise and respect that this is a normal activity for that individual, while looking after the needs of others who might find that behaviour anti-social.

Offer support for non-English speakers

If a person with dementia has very little or no spoken English, it will be important to think of a range of ways to support them. Consider recruiting a volunteer visitor who speaks their language – this may help the person feel less isolated.

If you want to find out more about a person’s wishes and interests or hold a review meeting, ideally a translator should be employed to ensure that you are not just relying on guess work. You may feel that a person’s relative can act as a translator, but some individuals will not have relatives and a translator will ensure a more impartial representation of the voice of the person with dementia in any case. Some translators will have little experience of dementia, so you may need to explain that the person’s communication may be less easy to follow.

Make links with local community organisations and offer support to attend external events. If you are in a multicultural urban area, it may be possible to visit a Greek or Chinese restaurant, a Polish delicatessen or an Indian sweet shop, for example. For a person with dementia, the pleasure of seeing, smelling and tasting familiar foods may provide enjoyment and comfort.

Some real examples of support for non-English speakers

At Limetree Care Centre (introduced above), a Spanish gentleman has struck up what seems a quite unlikely friendship with an English woman. They both appear to listen very carefully to each other, speaking in Spanish and English respectfully. The Spanish resident will sometimes serenade the woman with a song and they keep each other entertained for ages. Perhaps the language of love can transcend traditional communication barriers!

The Greek Orthodox resident at Limetree Care Centre (introduced above) is from Cyprus and has very little spoken English, but she enjoys a friendly rapport with the maintenance man who is Turkish, so they can understand each other. This makes a significant difference to her wellbeing.

Suna Tilley, befriending manager for the Alzheimer’s Society Leicestershire and Rutland branch, finds creative ways of linking volunteers with her clients with dementia. She says, ‘Sometimes the person who doesn’t speak much English, whether because of their cultural background or their dementia, can enjoy going out for a drive in the car or going window shopping with a volunteer. This provides a focus for them spending time together and doesn’t depend too much on talking.’

Host events to celebrate diversity

The Care Quality Commission (CQC) expects you to collect information about the ethnic origin and religions of your staff team and your service users. Use this information to think about how you might plan events in your activity calendar.

Do a general internet search under specific religions or events, such as ‘Jewish festivals’, ‘Chinese New Year’. Some events have a celebratory tradition while others such as ‘Lent’ in the Christian religion or ‘Ramadan’ in the Muslim faith have a more serious aspect around self-restraint and sacrifice. It is wise to consult people from that particular culture or religion and find out about what might be appropriate or inappropriate things to do to mark those periods of time.

For more celebratory events, choose food, music and possibly costumes and decorations to fit the event. Many events – such as Chinese New Year or the Jewish Hanukkah celebration – will have very enjoyable and colourful elements. Paint lanterns or dragons for the Chinese New Year or offer doughnuts or potato pancakes for Hanukkah, for example.

An event with a specific national theme such as a Caribbean evening or an Irish pub night will bring many possibilities for new and fun experiences for service users. Staff members may enjoy dressing in traditional clothes or bringing in food or music for an event with an African or Asian theme.

Music plays a vital role in events. For a person with dementia, include songs and rhythms that relate to their earlier lives rather than only choosing traditional English music. There may be opportunities to bring in children from different cultural backgrounds where songs can be remembered or learnt together.

Use reminiscence to learn more about other cultures

Reminiscence-related activities can provide ways of making connections between staff and service users of different cultural backgrounds. For example, you might want to have a discussion about the differences and similarities between wedding or funeral ceremonies in a range of countries, or the ways in which babies and children are brought up in different religions and cultures. Ask staff members or family members to bring in photographs, fabrics, CDs and DVDs or objects to help stimulate memories and personal stories.

For more on this, see the feature in this section, ‘Reminiscence’.

Recognise when a person’s preferences change

To what extent does a person’s cultural and religious identity need to be preserved as their dementia develops? Most likely, your first response to this question will be that it is critical to person-centred care to continue to maintain a person’s previous routines and observances. And yes, this is true. But the situation gets complicated if – as in the following examples – the person’s views or preferences change: a person who has never drunk alcohol or never eaten meat suddenly develops a taste for these as their illness progresses a person who has apparently always led a heterosexual lifestyle develops a gay relationship while living in a care home, or a person who would normally have played bridge and hated bingo suddenly starts to enjoy bingo.

Some of these changes might be considered less major than others. There can be few negative consequences of a person developing a new enjoyment of bingo, but the other two changes might have more impact on the person’s family and might represent a more fundamental change in the person’s identity.

It will be important to consider whether a person’s mental capacity is sufficient to make these decisions. Under the Mental Capacity Act, a person’s capacity is assessed for each situation and decision rather than a general statement made about their ability to make decisions overall. This issue is explored further in the activity below, and in the section on Dementia and decision-making.

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