Elderly migrants in outpatient and inpatient care services in Baden-Württemberg/Germany.

OBJECTIVE: Given the expected underrepresentation of elderly migrant populations in healthcare utilization we examined their proportion in nursing homes and care services for the elderly. We expected that cultural aspects were rarely addressed in the services´ concepts. METHODS: A questionnaire was administered to all care providers; 66.3% of 2724 in- and outpatient services in Baden-Württemberg, Germany participated. RESULTS: 78% of the services provided healthcare to migrants, who accounted for 14.1% of the clientele. This proportion was higher in urban (e.g. Heilbronn: 16.1%) than in rural areas (e.g. Lake Constance: 7.7%) and was significantly (r = 0.545, p < .05) correlated with the proportion of migrants in the general population. 39.1% of the migrants came from Russia, Poland and Turkey. Migrants from Turkey preferred outpatients´ rather than inpatients´ services. While 87.4% of services employed migrants, only 20% of services provided measures to increase intercultural competency to their employees. CONCLUSIONS: Migrants utilize inpatient and outpatient services regularly as their proportion was closely associated to that of the general population. Although their number will likely increase in the near future, the vast majority of nursing facilities did not provide specialized measures to better meet the demands of residents with a migration background.

Neuropsychological profiles and verbal abilities in lifelong bilinguals with mild cognitive impairment and Alzheimer's disease.

Bilingualism is associated with enhanced executive functioning and delayed onset of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Here, we investigated neuropsychological differences between mono- and bilingual patients with MCI and AD as well as the respective effects of dementia on the dominant and non-dominant language of bilinguals. 69 patients with MCI (n = 22) or AD (n = 47) and 17 healthy controls were included. 41 subjects were classified as lifelong bilinguals (mean age: 73.6; SD = 11.5) and 45 as monolinguals (mean age: 78.1; SD = 10.9). Neuropsychological performance was assessed on the CERAD-NP, the clock-drawing test, and the logical memory subscale of the Wechsler Memory Scale. Neuropsychological profiles showed only minor nonsignificant differences between mono- and bilingual subjects when compared between diagnostic groups. Bilingual MCI patients scored significantly lower on the verbal fluency and picture naming task in their dominant language than bilingual controls. Bilingual AD patients showed a reduced performance in their nondominant language when compared to bilingual MCI patients and bilingual controls (main effect language dominance: verbal fluency task p < 0.001; BNT p < 0.001). Bilingual MCI and AD patients show a similar pattern of neuropsychological deficits as monolingual patients do. The dominant language appears to be compromised first in bilingual MCI patients, while severe deficits of the nondominant language develop later in the course with manifestation of AD. These findings are important for the diagnostic work up of bilingual patients and the development of improved care concepts for bilingual patients such as migrant populations.