1. The Older Chinese Patient ACMA 2014 Dr Yu-Min Lin Geriatrician, Middlemore Hospital

2. Overview  Demographics and trends  Barriers to health care  Cognitive testing for Chinese patients

3. Changing age structure  From Statistics NZ

5. Demographics  “Asian” makes up ~12% of population  Only 6% of Asian above the age of 65  Chinese may only make up 1.2% of total population (based on language spoken)  Those above age 65 – only 0.1% of total population (4266)  From Statistics NZ

6. Lincoln Tan Lincoln Tan is the New Zealand Herald’s diversity, ethnic affairs and immigration senior reporter. Ageing China migrants a 'major concern' 8:18 AM Tuesday Apr 23, 2013 Professor Paul Spoonley. Photo / Richard Robinson

7. Lincoln Tan Lincoln Tan is the New Zealand Herald’s diversity, ethnic affairs and immigration senior reporter. China overtakes UK as largest source of migrants 5:30 AM Friday Mar 7, 2014 Country now the biggest source of settlers, international students and visitors

8. Barriers for Chinese patient  Language (client/ACC/doctor)  Fear of western medicine  Home remedy or alternative medicine  Perception of “begging” – they can pay for themselves  Lack of transportation  Lack of interpreter service  Lack of information about service  Culturally inappropriate service  Perception of discrimination Barriers experienced by Asians in accessing injury-related services and compensations J PRIMARY HEALTH CARE 2010;2(1):43–53.

9. Dementia

10. Cognitive testing – Mini-mental state examination (MMSE)  First published in 1975 by Folstein  Well validated  Universally taught  Score out of 30  Copyright 2000 with granting of exclusive licencing to psychological assessment resource (PAR) in 2001  Hot topic since copyright dispute of Sweet 16 in 2011  Sweet 16 since removed

11. C-MMSE  Mandarin version first translated in 1988  Cantonese version 1991  Cut-off scores variable (17-20/30)  Problems with illiteracy/degree of dementia/education level  Sensitivity for MCI/early dementia may not be optimal

13. Cognitive testing Montreal cognitive assessment (MOCA)  Score of out 30  Advantage with frontal type dementia  Cut off is <26 but may need to be adjusted in Chinese  Recent publication suggest cut off reduced to <23  There is also likely still variation due to education level  Free to download online with easy access Using the Montreal Cognitive Assessment Scale to screen for dementia in Chinese patients with Parkinson’s disease; Shanghai Archives of Psychiatry, 2013, Vol. 25, No. 5 Chinese-Language Montreal Cognitive Assessment for Cantonese or Mandarin Speakers: Age, Education, and Gender Effects; Hindawi Publishing Corporation, International Journal of Alzheimer’s Disease, Volume 2012, Article ID 204623, 10 pages doi:10.1155/2012/204623

14. Cognitive testing The Rowland Universal Dementia Assessment Scale (RUDAS)  Developed in 2004 in Melbourne  Score out of 30  Validated with cut off <23  Not effected by education or language  Hasn’t been specific trial targeted at Chinese  No Chinese version but easily translated directly Rowland JT, Basic D, Storey JE, Conforti DA. (2006) The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. International Psychogeriatrics, 18:111-120.

15. Cognitive testing Addenbrooke's Cognitive Examination Revised (ACE-R or ACE-III)  Out of 100 points  More sensitive for mild cognitive impairment or early dementia  Cut off <82 for dementia, <88 for MCI  Can vary with education level  Cantonese version recently translated and validated  Cut off however lower than English version A validation study of the Chinese-Cantonese Addenbrooke’s Cognitive Examination Revised (C-ACER) Neuropsychiatric Disease and Treatment 2013:9 731–737

16. Into the future  Chinese population in New Zealand will continue to grow and possibly continue to rapidly age  Remains multiple barriers for the Chinese population to access health cares  Increasing numbers of Chinese health professionals will help break some of the barriers  Improving health information also key to breaking barriers  Dementia will become a very challenging aspect of health care in the near future