Immidem study

Investigation and key findings

Dementia and cognitive disorders are likely to become significant public health challenges. According to some estimates, today about 500,000 European citizens with a migration history suffer from dementia, and approximately 650,000 have mild cognitive impairment. Beyond these estimates, it is necessary to collect information and data from the “real world” of services and local services to understand the extent of this phenomenon. Only a clear picture of the situation would enable the implementation of increasingly culturally sensitive services to adequately and effectively meet a demand that is expected to grow over time.

These reflections prompted Centres for Cognitive Disorders and Dementia (CDCDs) to conduct a national survey aimed at providing an overview of the services currently offered to people with a migration background. The Immidem group examined specific key parameters to assess the centres’ awareness of these new health needs, their preparedness to address them- through cross-cultural cognitive assessments or culturally and linguistically sensitive approaches and their ability to create pathways for the care of migrant patients. Finally, the survey also looked at the challenges faced by the centres and the best practices associated with higher standards of care.

In the survey, researchers asked CDCD representatives not only about the number of patients with a migration history but also about the availability of multilingual staff, social workers/cultural mediators/interpreters, translated materials for patients, the types of diagnostic and assessment tools used, and the social, cultural, or linguistic barriers encountered.

Findings and recommendations

The survey received responses from 343 Centres out of 570, which were contacted via email- a response rate of 60.2%: 161 in Northern Italy, 96 in Central Italy, and 86 in Southern Italy. In 2019, 4,527 migrant patients accessed these centres, of whom 2,040 underwent neuropsychological assessments. About three-quarters of the CDCDs visited at least one patient with a migration history, and over one-third reported that the number of migrant patients had increased over the past five years.

Overall, migrant patients accounted for 1% of the total patients seen by the centres. The survey responses revealed that Italian CDCDs are not yet adequately prepared to meet the health needs of this population.

More specifically, in most centres staff members speak more than one language, most commonly English, followed by French, German, Spanish, Albanian, Romanian, and Portuguese (the latter two languages reported in only one centre). More than 60% of centres can activate social worker services, with minimal regional differences. Conversely, only a few centres have staff members with a migration background , which is considered a facilitating factor. Just a minority of centres (37.3%) reported access to cultural mediators or interpreters (10.5%). These resources are more frequently available in centres located in Northern Italy than in those in Central and Southern Italy.

The survey also highlighted a lack of translated informational material on dementia for patients and families, as well as the use of tests that are not always suitable for cross-cultural assessment. These tools are often incapable of accurately measuring cognitive functions in people from diverse cultural backgrounds and are influenced by cultural and linguistic factors and patients’ educational levels. This likely reflects the limited number of tools currently developed, validated, and integrated into clinical practice. Studies and initiatives are therefore needed to expand the range of tools available to clinicians.

CDCD’s clinicians also reported significant difficulties in clearly communicating the diagnosis to patients with a migration background, involving family members, reaching a diagnosis, and conducting follow-ups to provide ongoing care. Lastly, the survey revealed a clear geographical gradient in the availability of culturally sensitive cognitive assessments: such evaluations are least likely to occur in centres in Southern Italy. While the survey does not explain the reasons for this disparity, it allows for hypotheses. One possibility is that, according to the data, culturally sensitive evaluations are more common in centres with higher numbers of migrant patients and those equipped with appropriate staff, materials, and tests- conditions rarely found in Southern centres. However, it remains unclear from this survey why fewer migrant patients seek access to services in Southern Italy, even when considering the comparable numbers of older migrants residing across the three macro-regions. Explaining this phenomenon will require further studies.

Strengths (and limitations) of the study

The Immidem survey has several strengths that make its results a solid foundation for implementing culturally sensitive clinical practices. Firstly, the survey questionnaire was already validated through previous pilot studies, benefiting from the experience gained by involving clinicians and healthcare workers who had already been active in this area.

Another key strength is the high response rate to the survey (60.2%) and the participation of centres from across the country, making the data obtained representative of the national context. This was made possible by building a strong network of collaboration between the research group, the centres, and regional representatives. This collaboration has the potential to positively impact the implementation of best practices for patient care and has already contributed to raising awareness among various stakeholders- clinicians, researchers, managers and policymakers- about this emerging healthcare need.

Read more