Terminology
tem toob: Hmong word used to describe an older adult with severe memory impairment and chronic confusion.
Resources on Dementia
Findings of Gerdner’s 2001 study have launched efforts to establish resources for both family and health care providers.
Ethnicity and Dementias
A book chapter in Ethnicity and Dementias is devoted to assist health care providers in working with Hmong American families who have an elder with Alzheimer’s disease or related dementia (refer to Gerdner, Xiong, & Yang, 2006).
Grandfather’s Story Cloth
In addition, general themes from the life experiences of family caregivers in the ethnographic study were used to create a bilingual (English/Hmong), illustrated children’s book to promote understanding of Alzheimer’s disease (AD) (refer to Gerdner, 2008). The book, entitled Grandfather’s Story Cloth (Gerdner & Langford, 2008), is about a 10-year old boy named Chersheng and his grandfather, who has AD. The storyline was created to reflect and support the values identified as being important to Hmong American family members who were caring for an elder with AD. The book introduces the idea of using a story cloth to stimulate grandfather’s remote or long-term memory as a means of enhancing communication and understanding between Chersheng and his grandfather. Two sets of author notes are included at the back of the book. The first provides background information on the Hmong and story cloths. A second set of notes is used to inform readers about dementia and Alzheimer’s disease, The educational value of this book is augmented with discussion questions and answers that support a family-based approach to learning.
Cha (2003) explored mental health problems, but findings were not reported by age group. Overall, subjects reported:
- Worrying too much (45%)
- Forgetfulness (40%)
- Feelings of worthlessness (32%)
- High levels of anxiety (20%)
Dementia
There are no statistics on the prevalence of dementia within the Hmong American community. The Hmong do not have a word that directly translates to the meaning of dementia. Tem toob is the Hmong word that is used to describe an elder with severe memory impairment and chronic confusion. Gerdner (2001) conducted a focused ethnographic study to explore the health beliefs, behaviors, and informal/formal care structures for Hmong American elders with dementia. Participants included family caregivers, traditional healers, and community liaisons living in selected cities in Minnesota and Wisconsin. The majority of interviews were conducted in the Hmong language with the assistance of an interpreter. Community leaders identified dementia as a neglected health concern. Elders often lived in the home of either the eldest or youngest son, with the daughter-in-law providing the actual hands-on care. Conflicts with the traditional norm are emerging due to changing roles and lifestyles of Hmong living in America.
Caregiver View
The majority of caregivers viewed elder confusion as a normal aspect of aging, but sought treatment by a shaman to satisfy spiritual needs of the elder. Shaman reported treating numerous elders for chronic confusion and identified soul loss as the primary cause with advanced age as a risk factor. Some members of the Hmong community associate a negative stigma to elders with chronic confusion / dementia, referring to the elder as “crazy.”
Family Members’ Perspective
Family members identified a lack of culturally sensitive information on the topic of dementia in Hmong elders that would serve to educate the community on these misconceptions. (Gerdner, Tripp-Reimer, & Yang, 2008). Adult children, who served as primary caregivers, often had young children of their own. Informants often noted that these children had difficulty adjusting to a grandparent with dementia. Ultimately, this negatively affected the interaction between child and elder and their relationship (Gerdner, 2008).
Depression
Anecdotal evidence along with initial research efforts indicates a relatively high incidence of depression in Hmong American elders. This is attributed to the losses and traumas associated with war and adjustment to life in the U.S. (Gerdner, 2007).
Two Depression Screening Instruments
Two instruments have been adapted for use in screening Hmong persons for depression:
- The adapted version of the Beck Depression Inventory (Mouanoutaoua & Brown, 1991)
- An adapted version of the Hopkins Symptom Checklist 25 (Mouanoutaoua & Brown, 1995).
