Cultural-sensitive Memory Work in Finland

The starting points in cultural sensitive memory work in Finland

The Finnish population is approximately 5.5 million persons. According to a study in 2015, 200 000 people in Finland are living with mild cognitive impairment and 193 000 with progressive memory disorders (Viramo & Sulkava 2015, 35). According to Statistics Finland, there are approximately 458 000 foreign-language speakers in Finland. And almost 60 000 of them were over 55 years old. (Tilastokeskus, 2021). 

Language- and cultural minorities in Finland

As everywhere in the world, the number of older migrants in Finland is growing constantly. Many people who migrated to Europe in the 1960s to 1980s are reaching an age when the risk of developing dementia is higher.  The structure of Finnish migrants is affected by the dissolution of the Soviet Union in 1991 when the people from countries of the former Soviet Union became international migrants. That makes Russian- and Estonian-speaking people the largest migrant group in Finland. 

The personal situation and starting point of the people belonging to these language groups are slightly different compared to people migrating from outside of Europe. For example, the level of education can be quite high in those groups. But everything else related to knowledge about dementia or taboos – they are similar.

In our previous work, we developed knowledge about dementia with elderly from Russia-, Estonia-, Chinese-, Arabia-, and Somali-speaking groups. Also, one of our target groups – the Romany People – is an ethnic minority in Finland, who speaks Finnish, but 60% of the elderly in that group are illiterate.

Sensitive Memory work in Finland

Memory disorders do not care about language groups and it comes equally to everyone. That means that there are a lot of foreign-language speakers, living with mild cognitive impairment and with progressive memory disorders. That is a large and invisible group that is easily left out of services, for example, because of their poor Finnish language skills. However, their memory disorders should be treated as well. And it is the target group of our activity whose memory health we want to improve.

Pilots on Finnish memory work with ethnic minorities started in 2003 as a part of the IkäMAMU-activities of the Finnish Association for the Welfare of Older People. IkäMAMU mapped the situation of brain health among the Russian and Estonian-speaking residents of Helsinki. IkäMamu-activities also applied existing memory materials to work with the
Russian-speaking elderly with memory disorders and their family members. In 2004 services began for the Estonian and Russian-speaking customers at Kamppi service
center in Helsinki, where the Memory Clinic of the Helsinki Alzheimer’s Association operated. The memory clinic screened for memory impairments through assessment tests. Then, for the first time, a care pathway was created for the Estonian and the Russian-speaking elderly and their family members with social and health care professionals. At the time also a peer support group for Russian-speaking carers for the elderly with memory disorders was started.
The IkäMAMU-project was ended in the year 2005, and since then also the Memory Clinic of the Helsinki Alzheimer’s Association has stopped its services. The need for memory services in different languages, however, has not gone away – rather the opposite. Based on the feedback from different ethnic minority groups, the elderly would need and want to improve their brain health and gain more information about memory disorders in their native languages.

In order to meet such needs, Improving the Brain Health of Ethnic Minority Elderly, ETNIMUproject was started. In addition to the Estonian and Russian-speaking groups, that had already existed, new target groups included older Somali women and the Roma people.

Read an article about the Roma people in ETNIMU-project here: ROMA PEOPLE AS A TARGET GROUP IN THE BRAIN HEALTH PROMOTION PROJECT ETNIMU IN FINLAND

ETNIMU-project 2015-2017

The deterioration of brain health and memory disorders can affect us all regardless of our language, culture, or nationality. In Finland social and health services are equal for all. Nonetheless, not everyone in need of services can access them or find the kind of services that would meet their needs.

Finland has a population of approximately 5.5 million. 200 000 people are living with mild cognitive impairment and 193 000 with progressive memory disorders. According to Statistics Finland, there are approximately 310 000 foreign-language speakers in Finland. Memory disorders are as recurrent among this population as they are among the ethnic Finns. With prevalence rates adjusted to those of the ethnic Finns, this means that there are 11 200 foreign-language speakers living with mild cognitive impairment and 10 900 foreign-language speakers with progressive memory disorders. These people form a patient group who is easily left out of services, for example, because of their insufficient Finnish language skills. Their brain health, nevertheless, should be taken care of as well. When the baby boomers reach elderhood and the total number of the elderly increases, this question will become more pertinent.

Whether an ethnic Finn or a minority ethnic person, memory disorders proceed the same. Their treatment is in many ways the same. We need to highlight the issues that we should take into consideration when we meet an ethnic minority elderly person with memory problems. 

The most important issue is to remember that there is a human being behind her memory problems or memory disorder: this person has his/ her culture, personality, and wishes that should be taken into consideration.

Such an approach, which respects the person’s background and needs, is what we call cultural sensitivity as a way of work.

The Society for Memory Disorders Expertise in Finland’s ETNIMU-project was a development project that took place from 2015 until 2017with the support of Veikkaus Oy. It sought to increase information about brain health among ethnic minority elderly. The project created materials about brain health, memory, and memory disorders in the native languages of the project’s participant groups: Finnish, Estonian, Russian, Somali, and Roma People. The project also aimed to strengthen the cultural-sensitive skills of social and health care professionals and students.

ETNIMU-activity 2018-2020

ETNIMU-activity developed cultural sensitive memory work in Finland 2015-2020. The aim of ETNIMU activities was to secure that people from ethnic minority backgrounds with dementia get timely and accurate diagnoses.

The MMSE is the memory test most commonly used with people from ethnic minority backgrounds in Finland. The test is well suited to the native populations, but it falls short when used to map the situations of people from diverse ethnic minority backgrounds. To get the necessary information, the test needs to screen also for background information f.ex. about a person's daily life, skills, and social activities. Difficulties in language and insufficient understanding of the cultural specificities pose the biggest challenges to mapping. The social and health care professionals would benefit from an interpreter who can help them perceive the client’s possible memory problems and provide them assistance in memory test situations.

The pilot group of the Memory Interpreter training program has 17 participants of Estonian, Russian, Arabic, Chinese, and Roma backgrounds. All participants are volunteers. The training program consists of a theory part that covers f.ex. general information about dementia, interpreting skills, confidentiality, and GDPR. The training is completed by a practical session at a Memory Clinic. After completing the training, the memory interpreters act independently as interpreters in memory test situations and help the social and health care professionals in their interactions with clients from different ethnic minority backgrounds.

ETNIMU activities have developed a unique training program in Finland that supports culturally sensitive memory work in cooperation with memory clinics, universities, as well as experts working in various fields. The Memory Interpreter training program and the working tools can be adapted to work with different languages and cultural backgrounds and so help to secure timely and accurate diagnosis of dementia.