Barriers in screening for dementia in elderly migrants in primary care and the use of the Rowland Universal Dementia Assessment Scale. A mixed cross-sectional and qualitative study

Abstract

Background

In the migrant population, there is a higher risk of dementia. However, dementia is underdiagnosed in this population due to the underuse of appropriate screening tools. The Rowland Universal Dementia Assessment Scale (RUDAS) is designed for culturally and linguistically diverse populations.

Objectives

To gain insights into the primary care cognitive screening strategy for dementia in migrants and to evaluate the experiences with the RUDAS tool by general practitioners (GPs).

Methods

GPs were questioned about barriers in dementia screening in the migrant population and asked to apply the RUDAS. A mixed-methods study was conducted among Flemish GPs. In an online survey, the currently used methods for screening for dementia in migrants and the barriers were investigated. In a qualitative pilot study, the user experience of the RUDAS scale was explored.

Results

A total of 122/322 GPs participated (response rate 38%), 102 (83.6%) of all responding GPs mentioned language problems as the most apparent barrier. Most GPs believed the Mini Mental State Examination was inappropriate for migrants but they were unaware of an alternative. Due to lack of time and target population, only two GPs effectively applied the RUDAS. The tool was found easy to understand and less challenging in case of language problems. The main reason for not using RUDAS was the suspected time consumption.

Conclusion

GPs find screening for dementia in migrant patients a challenging act, mainly due to language barriers. GPs are not confident enough with the appropriate screening strategies and tools adjusted to the needs of migrant patients. Abbreviations: GP: general practitioner; RUDAS: Rowland Universal Dementia Assessment Scale; MMSE: Mini Mental State Examination.

Keywords:

• Cognitive disorders
• dementia
• quality of care
• primary care
• migrant population

Acknowledgements

The authors would like to express their appreciation to the GPs who participated in this study.

Ethical approval

The present study was approved by the Medical Ethical Board of the University Hospitals of the University of Leuven.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Data availability statement

The complete dataset is available on request and will be sent as a link to a google-drive directory