Why Immidem

The Immidem project stems from a shared clinical observation among healthcare professionals in various Italian and European settings: “An increasing number of people with a migratory background are visiting our clinics due to cognitive disorders.” Socio-demographic data collected in Italy and other European countries reveal a progressive ageing trend, not only among the native population but also among individuals born abroad who later migrated to Italy. What do these data show? What insights do they provide at the national, regional, and local levels? What responses and care pathways do our healthcare system offer at these levels to address this phenomenon? What challenges arise?

Based on such observations and questions, Immidem reached the understanding that to create helpful know-hows and responses for the parties involved- patients, family members, and caregivers, healthcare staff, policymakers, and researchers- it is necessary to adopt a culturally sensitive and informed approach. It is required to have guidelines and good practices that are based on evidence and experience. Cross-cultural tools and pathways are essential. The project aims to enrich this context through a global and public health perspective, alongside a narrative that is culturally competent and sensitive to diversity.

More and more patients (and/or their families and caregivers) with a migration history are visiting clinics and centres for the assessment and treatment of cognitive disorders.

More broadly, contemporary society is, and will increasingly be, made up of individuals who, while living in the same country, were born in different nations and/or have grown up with diverse cultural backgrounds. The result is a society that is increasingly heterogeneous and diverse from a cultural standpoint. Additionally, due to the progressive ageing of the global population, this society includes and will continue to include more older adults with cognitive disorders, along with their caregivers, the communities that assist them, and their healthcare providers.

However, migrants with dementia or cognitive disorders and the social and healthcare workers who could support them often face linguistic and cultural barriers. Diagnosing such conditions requires tests that are frequently influenced by the person’s level of literacy and education, as well as their cultural and social background. Dementia, in fact, takes on profoundly different meanings in various cultures and, in certain contexts, it is still often subject to stigma and discrimination.

Migrants and ethnic minorities, due to these cultural and linguistic barriers, often face greater difficulty accessing local healthcare services. They are less likely to receive a timely dementia diagnosis, specialised treatment, and adequate support and assistance. Yet, ensuring these patients have access to available social and healthcare resources is essential to providing proper, albeit challenging, care for individuals affected by these conditions.

The term “migrant," according to the International Organisation for Migration (IOM), includes “any person who is moving or has moved across an international border away from their habitual place of residence, regardless of their legal status, the reason for their movement, or the length of their stay.” Often, individuals with a migration history also belong to ethnic minorities, which is defined as “any group numerically smaller than the rest of the population of a state, occupying a non-dominant position; whose members possess ethnic, religious, or linguistic characteristics distinct from the rest of the population and, even implicitly, maintain a sense of solidarity aimed at preserving their culture, religion, or language.”

Migration is a globally significant phenomenon. In 2019, 272 million international migrants were estimated worldwide. As of December 31, 2019, in Italy resided 5,039,637 foreign citizens, making up 8.4% of the total resident population. In the same year, it was estimated that migrants aged 60 or older accounted for 12% of the total migrant population. In Europe, for instance, the number of foreign-born individuals aged 65 or older has almost doubled in the past three decades, rising from 18.5 million in 1990 to 32.2 million in 2019. In Italy, during the same period, the number grew from 181,017 to 363,258.

Furthermore, it is estimated that by 2018, approximately 500,000 dementia cases and 700,000 cases of mild cognitive impairment in Europe will involve individuals with a migration history. The observed increase in older individuals with a migratory background facing cognitive disorders thus aligns with the trends of two significant phenomena: migration and population ageing. These trends are particularly pronounced in Italy and other Western countries.

The data and trends revealed by these phenomena highlight the need to quantify and identify the issue of cognitive disorders among migrants and ethnic minorities, and to adopt adequate healthcare policies, in line with the Global Action Plan on Dementia of the World Health Organisation. This shows that the public health approach to dementia should be centred around a diversity-sensitive lens, embracing the needs of vulnerable people, including refugees and migrants.

A cross-cultural approach to the diagnosis and treatment of cognitive disorders is a necessary goal to improve the way all patients are supported, regardless of their origins.

Adopting a culturally sensitive and informed approach means ensuring that communication, care, and management account for diversity among people and meet their cultural and social needs. Furthermore, the ability to communicate with each patient in a culturally sensitive manner and using appropriate language and tools can also improve the doctor-patient relationship and the healing process itself.

Tackling dementia among migrants with the adoption of a diversity-sensitive lens entails implementing health policies that:

• are based on the understanding of values and spiritual and cultural differences that may influence the expression of cognitive disorders among older people.

• account for and overcome the language and financial barriers that prevent this part of the population from accessing support services, and consider the tools to tackle these.

• can provide patients, caregivers, and healthcare staff with practical know-hows and tools .