Caring for Latinxs with Dementia in a Globalized World: Behavioral and Psychosocial Treatments

Preface
	References
Contents
List of Figures
List of Tables
Part I: Characterizing the Context: Latinxs and Dementia
	1: Demographics and the Epidemiological Risk Factors for Dementia in  Hispanic/Latino Populations
		Introduction
		Literature Review
		Growth and Aging of the Hispanic/Latino Population
		Epidemiology of Dementia in the Hispanic/Latino Population
			Age
			Low Education/Socioeconomic Status
			Cardiovascular Risk Factors
			Genetic Factors
			Health-Impacting Factors Associated with Lifestyle and Culture
		Prevalence of Dementia and Mortality Risks in the Hispanic/Latino Medicare Population
		Discussion
		Conclusion
		References
	2: Contextual, Cultural, and Sociopolitical Issues in Caring for Latinxs with Dementia: When the Mind Forgets and the Heart Remembers
		Contextual, Cultural, and Sociopolitical Issues in Caring for Latinxs with Dementia: When the Mind Forgets What the Heart Remembers
		Understanding Latinx Culture in Dementia Care
			Latinx Cultural Values
		Considering Nationality, Immigration, and Race: Diversity Within Latinxs
			Nationality
			Immigration
			Racial Diversity
		Systemic Challenges and Their Impact on Dementia Care for Latinxs
			Socioeconomic Status
			Xenophobia and the Rise in Anti-Latinx Sentiment
			Service Underutilization and Its Impact on Dementia Care for Latinxs
		Diagnosis and Dementia Symptom Management in the Latinx Patient
			Biopsychosocial Variables and Dementia Prevalence in Latinx Populations
			Making a Timely Diagnosis of Dementia
			Dementia Symptom Management
		The Latinx Culture, Context, and Caregiving
			Latinx Perceptions of Caregiver Burden
			Contextual and Cultural Beliefs in Caregiving
		The Mind May Forget but What If the Heart Remembers?
		References
	3: Meta-Analysis of Dementia Rates in Central America, South America, and the Caribbean
		Introduction
		Past Reviews of Dementia Prevalence
		Prevalence of Dementia Among Latinos in the USA
			Variation in Rates of Dementia and Its Subtypes
		Methods
			Search Strategies
			Data Extraction
			Analysis
		Results
			Evidence Base
			Quality of Studies
			Prevalence of Dementia
			Prevalence of Subtypes of Dementia in Adults 65 Years and Older
			Prevalence of Subtypes of Dementia in Adults 60 Years and Older
			Analysis of Sources of Heterogeneity in the Prevalence of Dementia
			Analysis of Sources of Heterogeneity in the Prevalence of Dementia Subtypes
		Discussion
			Prevalence of Dementia Among Latinos in the USA
			Variation in Dementia Prevalence
			Limitations
		Conclusion
		References
Part II: Evaluation, Assessment, and Diagnosis
	4: Treating Medical Comorbidities Associated with Dementia Among Latinos
		Introduction
		Comorbidities in Dementia
			Type 2 Diabetes Mellitus (T2DM)
			Hypothyroidism
			Infectious Diseases
			Hepatitis C (HCV)
			Obstructive Sleep Apnea (OSA)
			Depression
			Alcohol Abuse
			Nutritional Deficiencies
		Dementia Syndromes
			Alzheimer’s Disease (AD)
			Vascular Dementia (VaD)
			Medical Comorbidities Contributing to AD and VaD
			Frontotemporal Degeneration (FTD)
			Lewy Body Dementias
		References
	5: Functional Assessment in Latinos with Dementia: A Review of Tools and Cultural Considerations
		Introduction
		Questionnaire-Based Measures of Functional Abilities
			Brief Overview
			Strengths
			Limitations
			Cultural and Linguistic Considerations
		Performance-Based Measures of Functional Abilities
			Brief Overview
			Strengths
			Limitations
			Cultural and Linguistic Considerations
		Recommendations
		References
	6: Latinos with Dementia and Depression: Contemporary Issues and Assessment Challenges
		Introduction
		Depression and Older Latino Adults
			Impact of Acculturation
			Barriers to Medical Care Faced by Older Latinos
		Dementia and Depression
			Challenges of Screening for Depression and Dementia
				Measures of Depression
			Neuropsychological Assessment and Dementia
			Medications
		Caring for a Family Member with Dementia
		Future Directions
		References
	7: Neurological, Psychiatric, and Affective Aspects of Dementia in Latinxs
		Introduction
		Neuropsychiatric Symptom Presentation in Dementia
		Assessment of Neuropsychiatric Symptoms in Dementia
			Depression
			Apathy
			Anxiety
			Psychosis
			Hallucinations
			Delusions
			Disinhibition
			Aggression/Agitation/Irritability
			Sleep Disturbances
			The Impact of Neuropsychiatric Symptoms on Caregiver Burden in the Latinx Population
		Management of Neuropsychiatric Symptoms in Dementia and the Role of the Caregiver
		Conclusion
		References
Part III: Supportive Interventions and Services
	8: Latino Families Living with Dementia: Behavioral Issues and Placement Considerations
		Introduction
		The Case of Pilar
		Latinos in the United States and Dementia
		Dementia Common Behavioral Problems
		Existing Models of Dementia Care
			Three Basic Dementia Care Models: Internal, External, and Hybrid
			Attributions and Placement
		Culturally Sensitive Interventions for Behavioral Concerns
		Intersecting Cultural and Social Factors
			Collectivist Versus Individualist Worldviews
			Values
			Language and Acculturation
		Social Inequalities: Discrimination, Bias, Power, Privilege, Access, and Stigma
		Liberation, Community, and Mujerista Psychology Frameworks
			Liberation Psychology
			Community Psychology
			Mujerista Psychology
		Strengths, Implications, and Recommendations
		References
	9: Educational, Diagnostic, and Supportive Psychosocial Interventions for Latinos with Dementia
		Introduction
		A Large and Growing Population in Need of Psychosocial Supports
			Specific ADRD Presentation Requiring Tailored Interventions
			Significant Psychosocial Needs in Addition to ADRD
			Lack of Information About ADRD and ADRD Services
			Structural Barriers to Services
			Latinos’ Caregiving Burden
			Positive Aspects of Caregiving
			Understanding the Value of Familismo
		Culturally Competent Psychosocial Interventions for Older Latinos and Their Families: From Outreach to Caregiver Support
			Outreach, Engagement, and Health Communication Tools
			Comprehensive Evaluation and Diagnosis: Creating Pathways to Care
		El Barrio SHARE: Supporting Natural Helpers with ADRD Resources and Education
			Disease Management Services
			Caregiver-Focused Support and Education Services
		Conclusion
		References
	10: Cognitive Rehabilitation for Maintenance of Function in Latinos with Dementia
		Introduction
		Assessment and Identification of Dementia
		The Neuroscience of Cognitive Rehabilitation: How It Works
		Cognitive Rehabilitation for Dementia
			Application of Cognitive Rehabilitation to Latinos with Dementia
		Goals of Cognitive Rehabilitation
		Engagement in Cognitive Rehabilitation
		Stages of Cognitive Rehabilitation
		Cognitive Rehabilitation Strategies
			External Versus Internal
			Compensatory Versus Restorative
			Factors That Impact Cognitive Rehabilitation
		The Role of Caregivers
		Differences from Other Treatment Modalities for Cognitive Decline
		Conclusion
		References
	11: Behavioral Symptoms of Dementia in Latinos: Pharmacological, Non-pharmacological, and Ethnocultural Healthcare Interventions
		Introduction
		Cultural Factors of Behavioral Symptoms of Dementia
		Pharmacological Interventions
		The Use of Psychotropics in Dementia Treatment and the Role of Genetic Variation
		Epigenetic Factors Associated with Medications for BSD
		Non-pharmacological Interventions for BSD in Latinos with Dementia
			Non-pharmacological Interventions Directed Toward Persons with Dementia
			Examples of Non-pharmacological Interventions for BSD in Dementia
		Non-pharmacological Interventions for BSD Directed Toward the Family Caregiver
		Conclusion
		References
	12: Intersectionality as a Practice of Dementia Care for Sexual and Gender Minoritized Latinxs
		Introduction
		A Brief Introduction to Intersectionality Theory
		Aging Among Sexual and Gender Minoritized Communities: Context and Challenges
			Historical Context
			Challenges Related to Aging
			Challenges Related to Accurate Representation
			Challenges Unique to the Transgender Community
		The Aging Latinx Population in the USA
			Financial Challenges
			Health and Mortality Rates
		Older Sexual and Gender Minoritized Latinxs: The Cost of Experiencing Multiple Forms of Oppression
			Racism
			Ethnocentrism
			Nativism
		Dementia Among Sexual and Gender Minoritized Population
			Dementia Risk Factors
			Challenges and Unique Needs of Sexual and Gender Minorities with Dementia
		An Intersectional Approach to Caring for Sexual and Gender Minoritized Latinxs with Dementia
		Identity-Based Intersectionality (Weak): Interpersonal Interactions That Honor the Patient’s Authentic Self
			Healthcare’s Role in Working with Intersecting Identities
			Establishing Institutional Protocol
			Clinical Assessment: Inclusive Protocols for Intake and Preventative Screening
			Dementia Diagnosis: Next Steps for Healthcare Providers
			After Diagnosis: Considerations for Creating a Welcoming and Affirming Environment
		Strong Intersectionality: Structural Policies That Ensure Authentic Living
			Addressing Structural Oppression: Ways to Shift Healthcare Culture
		Transformative Intersectionality: Actions That Honor the Dignity and Right to a Life of Self-Determination
			Expanding the Role of Healthcare Providers into SGM Advocacy
		References
	13: Stress and Coping: Conceptual Models for Understanding Dementia Among Latinos
		Introduction
		Theories Associated with Dementia Caregiving Research
		Theory-Derived Programs for Caregivers
		Interventions for Latino Caregivers
		Caregiver Interventions Using Information and Communication Technology
		Community-Based Caregiver Interventions
		Summary and Future Research
		References
	14: Grief, Loss, and Depression in Latino Caregivers and Families Affected by Dementia
		Introduction
		Latino Caregivers and Caregiver Burden for Dementia
		Loss and Grief Among Caregivers
			Latino Caregivers: The Immigration Experience of Loss and Grief
			Latino Caregivers and Depression
			Latino Cultural Values Defined
			Latino Gender Roles Defined
			Other Key Latino Cultural Elements
		General Systems Theory as Applied to Latino Caregiving Burden
		Family and Caregiver-Based Interventions
			Latino Family-Based Interventions
			Individual Interventions: Cognitive-Behavioral Therapy (CBT)
			Group Interventions: Cognitive-Behavioral Therapy (CBT)
			Other Treatment Factors
		Closing Remarks
		References
Part IV: International Perspectives: The Americas and Beyond
	15: Behavioral and Psychosocial Treatments of Dementia in Mexico
		Introduction
		Prevalence of BPSD in Latinos
			Data from the Mexican Health and Aging Study
		BPSD Interventions and Their Applicability to Mexican Culture
		The Dementia Care System in Mexico
			Formal Support
			Informal Care
			Caregiver
			Quality of Care
			Cultural Context
			Health and Psychological Background
		Recommendations for Practitioners
		Conclusion
		References
	16: Dementia Care in Guatemala, Central America
		Introduction
		Demographic Characteristics of Guatemala
			Guatemala’s Aging Population
		Sociological Factors Impacting Mayan and Latino Guatemalan Families Affected by Dementia
		Spirituality and Alternative and Complementary Medicine
		Health-Care and Elder Care Systems in Guatemala
			Specific Examples of Guatemalan Elder Care Programs
			Centers for Comprehensive Medical Care for Pensioners (CAMIP)
			Summary of Health-Care Provision of Dementia Services in Guatemala
		Perceptions of the Elderly and of Dementia in Guatemala
		Recommendations for a Guatemalan Integrative Care Approach for Treatment of Dementia
			Role of Families
			Use of Language
			Explicit Consideration of the Use of Correct Medical Terminology
			Help-Seeking Behaviors of Patients and Their Families
		Conclusions and Future Directions for Dementia Care in Guatemala
		References
	17: Behavioral and Psychosocial Treatments of Dementia in the Caribbean: Cuba, Dominican Republic, and Puerto Rico
		Introduction
		Cultural and Historical Aspects of the Spanish Caribbean
			Racial Landscape
			Geographical and Social Landscape
		Study of Dementia in the Spanish Caribbean
		Healthcare Systems and Dementia Service Provision in the Spanish Caribbean
			Cuba
			Dominican Republic
			Puerto Rico
		Spanish Caribbean Cultural Influences in Dementia Management
		Caregiving in the Spanish-Speaking Islands of the Caribbean
			Addressing Behavioral and Psychological Symptoms of Dementia
		Conclusion
		References
	18: Dementia Treatment and Health Disparities Among Puerto Ricans: The Impact of Cultural and Political Histories
		Introduction
		Behavioral and Psychosocial Treatments of Dementia Utilized on the Island of Puerto Rico
			Alzheimer’s Disease and Other Dementias Among Puerto Ricans
		What Health Providers Need to Know About Puerto Ricans
			Geographical Dispersion
			Sociodemographic Profile
			General Health Profile
		The Political Matters: Dementia Care of Puerto Ricans
		Puerto Ricans and Colonialism
		Puerto Rican Migration and Its Impact on Health
		Puerto Rican Migration and Economics
		Conclusion
		References
	19: Dementia Diagnosis, Treatment, and Care in Colombia, South America
		Introduction
		The “Paisa” Mutation and Familial Alzheimer’s Disease
		National Colombian Policies for Dementia Patients
		Sociocultural Factors Impacting Dementia Diagnosis
		Pharmacological Treatments of Dementia
		Non-pharmacological Treatments of Dementia in Colombia
		Caregivers of Dementia Patients in Colombia
			Caregiver Burden
			Caregiver Anxiety and Depression
			Resilience as a Protective Factor for the Caregiver
		Psychosocial and Educational Interventions for Dementia Patients
		GNA’s Social Plan for Colombian Families Affected by Dementia
			GNA Support Groups for Colombian Patients with Mild Cognitive Impairment (MCI) and Early Dementia
			GNA Caregiving Skills Training
			GNA Educational Workshops for Children and Young Adults
			GNA’s Focus on Social Media as a Tool to Increase Awareness
			GNA Community Movie Forum
		Conclusion
		References
	20: Behavioral and Psychosocial Treatments of Dementia in Spain
		Introduction
		Demographic Context
		Prevalence of Dementia in Spain
		Costs Associated with Care and Treatment of Dementias
			Territorial Council of the System for Autonomy and Dependent Care
			Levels of Dependence
			Benefits and Funding
		Usual Care Situation for Those with Dementia
			Non-pharmacological Therapies
		Caregivers
			Support for Caregivers: Sources and Types of Support
			International Associations that Collaborate with Spain
			Regional and Cultural Considerations
		Caregiving and the Family
		Conclusion
		References
Part V: Social/Public Policy and Community Perspectives
	21: Community Partnerships and the Care of Latinos with Dementia: A Call for Action
		Introduction
		The Circumstances and Scope of Caregiving
		The Relationship of Different Levels of Service Provision
			The Family: The Basic Caregiving Institution
			The Role of Intermediate Organizations
			Community-Based Care
			Formal Sources of Caregiver Support
			Program Awareness and Outreach
		Additional Sources of Formal Community Care
			The Long-Term Care Ombudsman Program
			Aging and Disability Resource Centers
			State-Funded Home and Community-Based Programs
			Adult Day Services Centers
		The Potential Role of Civil Society
		Future Research and Social Policy Agenda for Dementia Caregiving and the Latino Community
		References
	22: Latinos and Dementia: Prescriptions for Policy and Programs that Empower Older Latinos and Their Families
		Introduction
		The Cost of Caring Among Latino Dementia Caregivers: The Importance of Policies that Empower Latino Caregiver’s Financial Stability
			Family Leave Policy
			Social Security Caregiver Credits
			Income Tax Credits for Caregiving
		Expanding and Integrating Long-Term Care for Older Latinos with Dementia: The Role of Medicaid and Medicare
			Medicaid
			Medicare
		Reducing Risk Factors for Dementia: Improving Access to Dementia Care and Health Care Among Latinos
			Improving Access to Dementia Care
			Improving Access to Health Care
		Conclusion
		References
Epilogue: Juntos Podemos
	References
About the Contributors
Index