+ General Country Information
+ History
+ Concept of Time
+ Family and friends
+ Gender
+ I or We Attitudes
+ Manners and Taboos
+ Spiritual care
+ Greetings
+ Language and Communication
+ Non-verbal Communication - Eye contact
+ Non-verbal Communication - Gestures
+ Non-verbal Communication - Personal Space
+ Attitudes and understanding of dementia and other health issues
+ Attitudes to end of life care
+ Attitudes to pain
+ Attitudes to residential care
+ Care information
+ Cultural Activities
+ Cultural Traits
+ Food and Diet
+ Music
+ Special Days - Christmas
+ Special Days - Easter
+ Special Days - New Year
+ Special Days - Other
+ Superstitions

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Generalist

Overview

  • China is located in the continent of Asia.
  • Beijing is the capital city of China.
  • China shares borders with 16 other countries including; Afghanistan, Bhutan, Burma, India, Kazakhstan, Kyrgyzstan, Hong Kong, Lao People's Democratic Republic, Macao, Mongolia, Nepal, North Korea, Pakistan, Russia, Tajikstan and Vietnam.
  • China (the fourth largest nation in the world) has a total area of 9,596,961 km2.
  • The population of China stands at approximately 1,367,485,388 people. (Central Intelligence Agency, 2015).
  • Major ethnic groups include; Han Chinese 91.9%, Buyi, Hui, Korean, Manchu, Miao, Mongol, Tibetan, Uygur, Yi, Zhuang, and various other nationalities 8.1% (Central Intelligence Agency, 2015).
  • The climate in China ranges from tropical in the south with high temperatures and high rainfall, to sub-arctic in the north where the weather is very cold in winter and summers are short, cool and mild.

Tips

  • Understand that a person’s country of birth does not define their culture. Whilst we are “born into culture” we are not “born with culture”. A person’s “culture” is something that is learnt from our environment and by our individual experiences. It continuously adapts to our changing circumstances throughout our lives.
  • Determine what culture or cultures your care recipient identifies with.
  • Keep in mind that the culture in metropolitan areas varies with culture in rural areas and that culture in different regions within a country may also vary significantly.
  • Learn about your care recipient’s life history, and who they identify with, to determine their individual cultural traits. Document any significant details.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities.

Resources

Generalist

History of Migration to Australia

  • Chinese people came to Australia initially to escape civil disorder, famine and floods.
  • Large number of Chinese men were indentured as labourers in the 1840’s. This cheap labour was heavily mixed with racism.
  • In the 1850’s, Chinese people came to Australia in large numbers for the gold rush.
  • After the gold rush ended, many Chinese became market gardeners or farm hands. Some set up small grocery stores or fruit and vegetable businesses. Others became involved in import-export businesses, laundry operations, cabinet making and some in medicine.
  • The Colonial Census conducted in 1861 revealed that 3.4% of the population of Australia were Chinese. This was the second largest immigrant group after those from the British Isles (Australian Government, 2015).
  • From 1901 the “Immigration Restriction Act”, often called the “White Australia Policy” significantly hindered the entry of non-Europeans, including the Chinese.
  • The Chinese community actively protested against prejudice, and highlighted the important economic and social contributions made by members of their community.
  • The first wave of ethnic Chinese refugee arrivals took place during the 1970’s.
  • The number of Chinese immigrants to Australia increased rapidly in 1970’s due to the end of the Immigration Restriction Act.
  • Today Chinese people make up one of the largest populations of people born outside of Australia.

History of China

  • Refer to the History Resources section

Tips

  • Determine exactly where your care recipient was born and where they lived. For example; was your care recipient born in Australia, or did they migrate to Australia? If they migrated, how and why did your care recipient migrate to Australia? What experiences and associations do they have of their home country? If they have lived in other countries; where have they lived? How long did they spend in other countries and what did they do whilst they were there?
  • Be aware and sensitive to any stress that may have been experienced as a result of their history (this may include; family separation, homesickness, conflict, depression and isolation).
  • The knowledge of a person’s history may assist with a better understanding of the care recipient as well as any associated psychological issues resulting from their past.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities and document any significant details.

Resources

Generalist

  • China is defined as a “collectivist” culture. This means that Chinese people act primarily in the interests of the group (The Hofstede Centre).
  • China scores 20 on the Individualism versus Collectivism (IDV) index. (Hofstede centre).
  • The index scale ranges from 0-100 with 50 as a mid-level. The low numbers indicate “collectivist” cultures, and high numbers indicate “individualist” cultures.

Tips

  • Identify and document if your care recipient is an “individualist” with an “I” attitude of self and immediate family, or a “collectivist” with a “we” or group attitude, or if they have both “collectivist” and “individualist” traits.
  • Allow for a “collectivist” person to feel the comfort of doing most things in a group setting and for an “individualist” person to have more opportunities for themselves.

Resources

Generalist

In Australia

  • The major religions of China-born people living in Australia are Buddhism and Catholicism (Australian Bureau of Statistics, 2011).
  • A large proportion (63.2%) of China-born people in Australia stated that they had ‘no religion’ (Australian Bureau of Statistics, 2011).
  • China-born people may practice a mixture of belief systems.

In China

  • The Chinese population in China consists of the following religious affiliations:
  • Buddhist 18.2%, Christian 5.1%, Muslim 1.8%, folk religion 21.9%, Hindu < 0.1%, Jewish < 0.1%, other 0.7% - includes Daoist Taoist. (Central Intelligence Agency, 2010)
  • 52.2% of the population are unaffiliated with a religion (Central Intelligence Agency, 2010)

General

  • Chinese may practice a mixture of beliefs.
  • The practice of ancestor worshipping may remain in some Chinese families. Worshippers generally offer prayers with food and light candles and incense at their shrines. Only family members may touch and clean these sacred spaces.
  • Different cultures and religions have different expectations of care in regards to toileting, dressing and feeding.
  • Every culture and religion vary greatly in spiritual needs and this may impact on the acceptability of certain treatments and medications. Therefore, it is paramount to identify the care recipient’s religion and cultural background to appropriately address the supports and services required.
  • For further information, refer to Spiritual care resources.

Tips

  • Accept and respect that customs, religious and spiritual beliefs vary from one culture to another and that the beliefs of your care recipient may significantly differ to your own beliefs.
  • Utilise resources and attend training sessions to increase your own knowledge about different religious and spiritual beliefs.
  • It is useful to ask care recipients a range of questions such as; ‘what helps you cope in difficult times’ and ‘what is important to you’ to determine ways to enhance their care.
  • Be aware of the significance of spiritual needs to your care recipient. Identify and document their religious beliefs and spiritual needs such as; any special requirements regarding food, personal care, linguistic needs or religious impacts towards treatments and/or medication.
  • Identify and provide access to relevant religious literature, radio, TV, live stream services, DVDs and CDs.
  • Support care recipients to maintain religious networks and religious representation and facilitate outings to places of worship.
  • Acknowledge and observe days of religious significance to your care recipients in a culturally appropriate manner.

Resources

Generalist

  • Family is important in Chinese culture and the extended family has a significant role.
  • One of the most important topics in Confucian ethics is the five human relations, of which the following three belong to “family”. These are; father-son, elder brother- younger brother, husband-wife. The remaining two are; sovereign-subject - which has similarities to father-son, and friend-friend - which has similarities to elder brother-younger brother.  
  • Chinese men usually hold a dominant position in the family in terms of decision-making.
  • Chinese people highly value their elderly and the concept of ‘filial piety’ (a virtue of respect for one’s father, elders and ancestors).
  • The traditional concept of filial piety includes completely obeying parents and caring well for them as they grow older.
  • Generally, Chinese believe that elderly people have great wisdom and it is most common for Chinese to show a great amount of respect to their elderly family members.
  • Elderly Chinese often expect their children to take care of them.
  • Conflict may arise between Chinese elderly, Australian-born children and their grandchildren, as differences in values and expectations may exist.

Tips

  • Be aware and sensitive to the fact that some people may have become separated from family for a range of reasons including; Stolen Generations, war, conflict, disaster or migration.
  • Families and friends from different cultures will have a different understanding of dementia and their expectation of care for their loved one may vary significantly.
  • Provide communication and information in accordance with their language and literacy level and facilitate all achievable care expectations.
  • Gain an understanding of the dynamics of your care recipient’s family and friends and engage with them whenever required/needed.
  • Ensure that roles in decision-making about care of the person with dementia have been clearly established and documented.
  • Research indicates that carers of people living with dementia experience greater strain and distress than carers of other people.
  • It is important to be sensitive to the feelings of shame and guilt that family members and friends may be experiencing.

“Family and friends” resources

  • A range of information to help support family and friends is available in the “Family and friends, resources” section below.
  • A range of health information helpsheets in various Chinese languages are available in the “Language and communication, resources” section of this app

Resources

Generalist

Australia

  • China-born people in Australia predominately speak Mandarin, Cantonese and Chinese at home (Australian Bureau of Statistics, 2011).
  • The majority of China-born people speak English well or very well (67.1%), whilst approximately 32% do not speak English well or at all (Australian Bureau of Statistics, 2011).

China

  • Mandarin is the official language of the People’s Republic of China and Taiwan. (Central Intelligence Agency, 2015).
  • Chinese people from Hong Kong and the Guangdong province of the People’s Republic of China speak Cantonese.
  • Chinese language includes over 20 different dialects, such as; Wu (Shanghainese), Minbei (Fuzhou), Minnan (Hokkien-Taiwanese), Xiang, Gan, Hakka dialects). (Central Intelligence Agency, 2015).
  • Mongolian is the official language in Nei Mongol, Uighur is the official language in Xinjiang Uygur, and Tibetan is the official language in Xizang (Tibet). (Central Intelligence Agency, 2015).

Writing Chinese

  • There are two ways of writing in Chinese - “old Traditional” and “new Simplified”.
  • “Simplified Chinese” may also be referred to as “Mandarin”.
  • The Mandarin language is spoken in the Chinese mainland and Singapore.
  • “Traditional Chinese” may also be referred to as “Cantonese”.
  • Cantonese is spoken in Taiwan, Hong Kong, Macau and by most overseas Chinese. 

Chinese Naming conventions

  • It is traditional for Chinese names to be written with their surname first, followed by their given names.
  • Traditionally when Chinese people get married, the woman will keep her own name. Sometimes the woman will add her husband’s surname to her own.
  • When Chinese people living in Australia get married, they may adopt the Australian naming tradition and use their given name(s) followed by their surname.

Tips

  • Being able to communicate effectively is crucial to the physical and emotional well-being of the care recipient.
  • Be careful not to underestimate or assume the communication capacity of a person with dementia.
  • Ensure that the care recipient has participation in decisions that affect them.
  • The words you use when speaking to, and about, a person with dementia matters. It is important to always use positive and enabling language and to not use words that may cause offense.
  • Ensure the health care and personal care plans and reviews identify and support the linguistic needs of your care recipient and their family.  Be mindful that linguistic considerations should include the care recipients’ menu choices, food services, their religious and spiritual needs, and their ability to participate in activities. Determine what language(s) they are able to speak, read and write. Communicate with them and provide information according to their language preference and literacy level.
  • Identify and record and health issues such as poor hearing, poor eyesight, dehydration or problems with dentures to ensure there is no miscommunication with your care recipient.
  • Be aware that most people with dementia will revert back to their native tongue and/or other languages they have learnt.
  • Care recipients should always be given the choice to use professional translators and interpreters. Provide professional translators and interpreters to your care recipients and/or to their family whenever they request the need, when the care plan is developed, when the care plan is reviewed and at any time when “informed consent” is required.
  • Care recipients often prefer to communicate with a care worker from their own cultural background therefore the use of bilingual staff or volunteers should be always be considered and provided whenever possible. The care recipient should however be given this choice rather than it be assumed that this is their preference.
  • Provide visual aids, use gestures and physical prompts, and learn and use key words in the person’s own language to improve communication during routine care and other simple service interventions.
  • Ensure that communication is adapted to the care recipient’s level of dementia and understand the importance of allowing more time for those in later stages to understand and respond to you.
  • Support your care recipients' individual choices by providing access to media such as radio, TV, live stream services, DVDs, CDs and books in their preferred language.
  • All staff and volunteers should undertake training in cultural awareness, appropriate communication and the correct use of telephone and on-site interpreting services.

Language and Communication resources

  • Refer to the “Language and Communication, Resources” section below for a wide range of information (including communication cards, signage, health information in community languages, etc.)
  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Formality is important.
  • Chinese people generally prefer to be addressed by their title. For example, Mr, Mrs, Dr, Sir.
  • Chinese people may look to the ground when greeting and when speaking to elderly or to respectful officials. This is more common with the older generation.
  • It is considered respectful to lower one’s head when speaking to an unfamiliar elderly person.              

Man greeting man

  • Generally, men shake hands when meeting and departing.

Woman greeting woman

  • Generally, women shake hands when meeting and departing.
  • Friends may give each other a light hug.

Man greeting woman

  • A handshake or nod of acknowledgment is usual at a first meeting.

Tips

  • Start building trust and rapport from the first time you meet your care recipient. Ensure you correctly pronounce their name. Smile and speak clearly. Be respectful and make sure the care recipient understands you.
  • Establish and document how your care recipient prefers to be greeted. Take into account; formality, titles, preferred name(s), any different greeting expectations from different genders or from people from a different generation, and the way(s) they like and dislike to be greeted. 
  • Understand that a person with severe dementia will think that each time they see you during the day is for the first time. Therefore ensure that you greet them in an appropriate, friendly and caring manner each time you meet.

Language and Communication resources

  •  A wide range resources such as language apps, language guides, translating and interpreting services etc. are available in the “Links” section of this app.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Not maintaining eye contact is a very old Chinese practice which traditional Chinese people follow therefore they prefer the use of indirect eye contact.
  • Eye contact is not considered essential for social interaction and is often considered inappropriate.
  • Some Chinese people may avoid eye contact in crowded places to allow for privacy.
  • Shyness and passivity is considered a sign of respect for some Chinese people.
  • Out of respect, a Chinese person may lower their head when speaking with someone they consider has a superior position.
  • Chinese people with less traditional views tend to favour direct eye contact.
  • The use of direct eye contact may be considered polite, but staring should be avoided.

Tips

  • Determine and document if the care recipient prefers direct or indirect eye contact and if there are any different expectations from different genders or from people from a different generation.

Resources

Generalist

  • The population density of China has a great effect on personal space. Chinese people are familiar with shared spaces and crowded areas.
  • It is common for generations of family to live together in small areas.
  • Generally, Chinese people are comfortable standing about an arms-length or slightly less from each other when conversing. This distance may however be farther if they are meeting strangers.
  • It is common for a person to be shoulder to shoulder with crowds of people when walking down the street in China.
  • Touch is not common when Chinese people interact, unless it is between families, good friends or partners. For example, women who are friends may hold or link arms when walking together.

Tips

  • Determine and document how the care recipient feels about their personal space and if there are any different expectations from different genders or from people from a different generation.
  • Allow for a “collectivist” person (with a “we” or group attitude) to feel the comfort of doing most things in the space with others (group settings) and for an “individualist” person (with an “I” attitude of self and immediate family) to have opportunities to have personal space for themselves.

Resources

Generalist

  • Chinese like to keep harmony. Therefore, non-verbal communication such as expression, tone and posture is important as it provides an understanding of how others are feeling.
  • Frowning is a sign of disagreement when speaking.
  • It is respectful to lower one’s head when speaking to an unfamiliar elderly person.              
  • Touch is not always appropriate with Chinese care recipients, for example; touching the head is offensive.
  • When gesturing for someone to come closer, it is rude to point with the index finger. Instead, use of a flat palm flat and a scratching motion with each of your fingers is more acceptable.
  • It is quite common for Chinese to spit on the ground to clear their throat.

Tips

  • Any gestures you use need to be respectful to the person with dementia.
  • Body language can provide important clues and increased understanding for both the carer and the care recipient. However many gestures have different meanings in different cultures therefore take care to ensure there is no miscommunication.
  • Document any gestures that the care recipient prefers to use or any gestures they find offensive.
  • Determine if the care recipient has expectations from different genders or from people from a different generation in relation to the use of touch. For example; if they find it appropriate/comforting for someone to hold their hand when they are upset or in pain.

Resources

Generalist

  • Chinese people are generally not punctual.  Instead, they tend to practice flexibility with time.
  • Chinese culture, influenced by Confucianism, holds an open-minded attitude towards time.
  • Chinese people often consider time as relative, limitless, and flexible.
  • Although punctuality may be valued, greater emphasis is usually on people and relationships.
  • It is common for someone with a high social or political status, to be late.
  • Chinese people may be more orientated on the present and therefore be late for appointments.
  • Lateness in a social setting is more acceptable than being late in a business setting.

Tips

  • Determine and document how the care recipient and the family view “the concept of time”. For example; do they like to be punctual? Do they expect others to be punctual?
  • Ensure the care recipient's concept of time does not adversely impact on meal times, activities and other scheduled events.
  • Be mindful that shaming and blaming someone for being late can cause feelings of guilt and low self-esteem. Instead, use positive communication. For example; you might ask “Would a different time would be more suitable”?

Resources

Generalist

Global Gender Gap Index 2016 rankings

  • China was ranked 99th on a global index measuring gender equality out of 144 countries. (World Economic Forum, Global Gender Gap Report 2016).

Marriage

  • As part of the Marriage Act, there is shared parental authority. This means that in the event of a divorce, the parent without custody has a legal right to continue contact with their child, as well as financial responsibility.

Same Sex Relationships

  • In 1997, homosexuality was decriminalised in China.
  • Homosexuality is a sensitive topic as traditional family values are strongly ingrained in Chinese culture.

Inheritance

  • Traditionally, women had limited inheritance rights. Today there is legislation for equal inheritance, however this is not always a reality, and women may lose their rights to inherit to their brothers.

Male ratio

  • The ratio of men to women in China is abnormally high due to the now outdated one-child policy and the social preference for sons.
  • The Chinese Government has taken measures to try to reduce the imbalance and bias towards sons.

Tips

  • For many people with dementia the gender of the care workers is important, particularly in sensitive situations. Determine and document if they have any preferences, concerns or expectations regarding care provided by someone of a different gender.
  • Accept and respect that male-female roles in families may vary significantly among different cultures.

Lesbian, gay, bisexual, transgender or intersexed (LGBTI) people with dementia

  • Don’t assume the gender preference of the person with dementia.
  • Recognise that even those that have children may not be completely heterosexual and understand that it could take some time for a care recipient to gain enough trust to share personal information about their gender preference.
  • Begin by evaluating yourself and any assumptions, phobias, biases or beliefs that you might hold internally.
  • Utilise resources and attend training sessions to increase your own knowledge about LGBTI people.
  • Understand the importance of your first and immediate reaction or response. Be aware of your own reactions - not only what you think, but also be aware of what you say and what body language you use.
  • Most LGBTI people have experienced rejection, stigma, discrimination and abuse and therefore have a fear of receiving inadequate treatment, being denied services or facing further discrimination or prejudice. It is vitally important to create a non-judgmental open and caring atmosphere free from discrimination. Confidentiality is also a vital aspect of care for LGBTI care recipients.
  • Be careful with the terminology you use to the care recipient and their partners.
  • Provide partners of LGBTI care recipients with the same respect and privileges that you would give to a spouse or relative.      

Resources

Generalist

World Alzheimer’s Day

  • Alzheimer associations around the world unite for World Alzheimer’s Day on the 21st of September, to make a difference for people with dementia and their families and carers worldwide.

Attitudes to Disability and Mental Illness

  • A strong cultural sigma is associated with mental illness.
  • Many Chinese people regard disability as shameful and they may not be willing to discuss this topic (due to the concept of face – honour/respect).
  • Disability may be viewed as a punishment (or debt owed) for wrongdoing in a previous life.

Perceptions of dementia

  • There are varying levels of understanding of dementia within the Chinese community.
  • The traditional Chinese community does not have a very good understanding of the causes of dementia.
  • Dementia is a taboo topic. Friends and family may avoid a person with the disease, creating social isolation (Alzheimer's Australia Victoria).
  • Dementia is often stigmatised as a type of mental illness.
  • Forgetfulness and memory loss may be put down to old age and considered as a normal part of ageing.

Diagnosis and treatment

  • People may try to hide symptoms from their family. This can delay diagnosis.
  • The Chinese community is generally very accepting of Western medicine. Some people may prefer to combine with traditional Chinese medicine (e.g. Chinese herbs).

Attitudes towards counselling

  • Many Chinese people consider counselling worthwhile for conditions such as mental illness and depression. However, Chinese families affected by dementia may be reluctant to seek counselling.
  • Chinese families may have a preference to deal with issues within their families.
  • A Chinese-speaking counsellor is usually preferred if counselling is considered.

Lack of public awareness of dementia in China

  • There is a widespread belief within Asian culture that ‘suffering is part of life’. This may cause delays in seeking treatment.

Tips

  • The amount of understanding and acceptance of dementia may vary significantly among different cultures, families and individuals. Determine the understanding of dementia of the care recipient and their family, if they accept dementia and if stigma is associated.
  • Provide information to the care recipient and their family according to their language preference and literacy level.
  • Ensure that people with dementia and their families are aware of dementia information and of support services available.

Dementia resources

  • A wide range of information is available in the Attitudes and understanding of dementia disability and illness, resources section below.
  • Contact details for Alzheimer’s Australia offices are available in the “Links, Alzheimer’s Australia offices” section of this app.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

Attitudes towards care

  • There is a negative view towards Residential aged care, because most elderly parents believe their son/or daughter should look after them.
  • If the situation permits, older Chinese people would generally rather stay with their adult children as they approach their end of life. Support provided at home is usually welcome, especially if provided by people who speak their native language.
  • Chinese culture places great importance on peer support.
  • Social activity groups such as Senior Citizens groups are valued in Chinese culture.

Attitudes to sickness and hospitals

  • Some elderly Chinese people, particularly those from rural areas, may not view hospital very favourably. Specifically, some may view it as the end or that ‘there is no hope’ or that they are there ‘to die.’ 
  • Hospitalisation can cause depression, anxiety, loneliness and feelings of anxiety.

In China

  • Residential care facilities and hostels do not exist in China in rural areas, however some do now exist in Chinese cities.
  • The family is the main source of financial, emotional and physical support. This follows the philosophy of ‘Filial piety’ (the virtue of respect for one’s father, elders and ancestors) and the respect for older generations.

Tips

  • The meaning or value of residential or community care may vary greatly among cultures.
  • Be aware that many people will not want to hear about or talk about residential care until crisis point.
  • Understand that families and friends from different cultures will have different expectations for the care of people, particularly in regards to toileting, dressing, feeding and other self-help skills.
  • Allow the care recipient and their family to make choices to suit the individual’s care needs.
  • Ask care recipients questions about what can be done to achieve quality of life and help them have meaningful lives that enable them to pursue their cultural interests and passions in accordance with any frailty, disability or cognitive impairment.
  • Understand and facilitate all achievable care expectations of the care recipient and their family.

Resources

Generalist

  • In Chinese culture, people believe that blocked Qi (life energy or force) causes pain. The blockage must be removed to relieve the pain and then the person can return to a state of harmony with the universe. 
  • The use of Feng Shui is commonly believed to restore balance and to help remedy sickness and pain.
  • Traditional Asian cultures believe individuals should not draw attention to themselves, despite feeling pain or sadness. It is culturally important to behave in a dignified manner.
  • Many Asian societies may also be reluctant to make demands of health care professionals as they are regarded as being of high status and therefore should not be questioned or bothered with complaints.
  • Most Chinese accept painkillers. Other traditional remedies such as “balm” or “oleum” may also be used to ease pain.
  • Buddhists are often stoic when faced with pain, as a way to demonstrate strong self-conduct.
  • Pain behaviour studies suggest there is a need to be cautious of ethnic or cultural stereotypes. Therefore, even though there are findings of general cultural differences it is considered very important to evaluate the pain of each person individually.
  • Clinical recommendations regarding pain treatment are available in the “Attitudes to pain Resources” section of this app

Tips

  • Research indicates that pain and discomfort are frequently under reported and under treated amongst people with dementia.
  • Ensure care recipients and their family understand pain relief medication and treatment options by providing information in their preferred language and in accordance with their language ability.
  • Religion and culture may influence your care recipients pain experience including; their pain expression, pain language, remedies for pain, social roles and expectations and perceptions of the medical care system.
  • Understand that for some religious or spiritual beliefs, fate and/or karma may mean that your care recipient also believes their illness and pain are caused by a higher power.
  • Care recipients may feel it is important to accept their pain in order to demonstrate their religious / spiritual faith. This may also impact their request for pain medication and treatment.
  • Identify and support the cultural and religious impact on the acceptability of certain treatments and medications.
  • Identify, respect and document how your care recipient and their family view and express pain.
  • Pay particular attention to verbal expressions of pain during later stages of dementia and ensure adequate treatment is provided.

Resources

Generalist

  • Beliefs and traditions surrounding death and burial vary between religion and individual families.
  • Some families will set up a vigil by the sick person’s bedside, to create calm for the individual.
  • The main aim of loved ones is to create a calm state of mind, help the individual overcome any fears and to focus on the positive things the person achieved during their life.
  • Buddhist people may put up a shrine and have a monk attend and bless the dying person. Before, at the moment of death and for a period of time after the death the monk, nun or others may chant from Buddhist scriptures.
  • Chinese people with Taoist belief may prefer to lie on the floor as death approaches.
  • For some Chinese people, a ‘good’ death is one that takes place at home near the family alter with family present, their pain controlled and a clear conscience. However, other Chinese people consider it bad luck to die at home.
  • White is the colour commonly worn by mourners in South-East Asia. Wearing the colour red is forbidden as it is considered a colour of happiness.
  • A sound understanding of the dying patient’s meaning of end of life care is imperative to truly deliver individualised palliative care.

Tips

  • Understand that attitudes to end of life care, death and dying are diverse and may include a range of factors such as cultural and religious beliefs.
  • Be aware that the acceptance of certain treatments and medications are likely to be impacted upon by cultural and religious factors.
  • Identify and support “end of life choices” of care recipients and their family. Note: these are formally known as “Advanced Care Directives” or “Advanced Care Planning” depending on the state or territory in Australia that you are in. Ensure their choices are documented and strictly followed.
  • Ensure the linguistic needs of care recipients are addressed in end of life religious and spiritual support.
  • Ensure family members have access to appropriate resources and support in their preferred language and in accordance with their language ability.

Resources

Generalist

A Chinse person may feel the following applies;

  • It is rude to place your feet onto furniture.
  • Using your feet to move an item is offensive.
  • It is rude to bite or suck on chopsticks.
  • The placing of chopsticks upright in a bowl of rice is reserved for funerals so should this practice should otherwise be avoided.
  • Snapping your fingers or whistling at someone is impolite.

Taboo topics

  • Subjects to avoid include; sex, family planning, female reproductive health issues and mental health problems. As these topics are considered to be very personal they are not appropriate for discussion in public.

Tips

  • “Manners” and “taboo” expectations and beliefs may vary greatly among cultures resulting in differing emotions and behaviours in your care recipient.
  • Be aware of your own beliefs and expectations of “manners” and “taboo” beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's behaviour, expectations and beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your behaviour according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of “manners” and “taboo” expectations and beliefs of your care recipient and their family.

Resources

Generalist

Common beliefs

  • Cutting your finger or toenails at night will bring ghosts.
  • Eating uncut noodles in soup will increase longevity.
  • It is unlucky for males to have an unshaven face or ungroomed facial hair.
  • If a dog howls for hours at night, someone has died.
  • A dream that includes teeth or snow suggests that the dreamer’s parents are dead.
  • A baby that is crying for no apparent reason suggests that there are ghosts present and that is why the child is disturbed.
  • It is bad luck to get married to someone either three or six years older or younger. To do so will bring bad luck.
  • If you point at the moon with your finger, your ear may fall off.
  • Sweeping should not be done on New Year should as it will sweep away good fortune.

Beliefs around colours

  • Yellow: The colour of royalty, resembles higher social status, is also the main colour of Buddhism and represents being free from worldly cares.
  • Red: Represents happiness and joy.
  • Blue-green: The colour of spring, representing vigour and vitality. People decorate with blue and green colours when they are hoping for longevity and harmony.
  • White: Symbolises the unknown and purity. The colour white is use at times such as mourning, death and ghost festivals.
  • Black: The colour of winter and westerly skies is for unknown times, as well as for the winter months.

Beliefs around numbers

Lucky numbers

  • Eight is a lucky number as the Chinese words for ‘eight’ and ‘prosperity’ are similar. When people have a choice for a number, they will often choose eight.
  • Other lucky numbers include 18, 13, 88 and 168.

Unlucky numbers

  • Four is an unlucky number as the Chinese words for ‘four’ and ‘death’ are similar. It is considered unacceptable to have a house number or registration with the number four in it.

Tips

  • Superstitions may be considered as old wives’ tales, family traditions or have a significant meaning and be taken seriously.
  • Be aware of your own beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's superstitious beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your beliefs according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of superstitious beliefs.

Resources

Generalist

  • Cuisine in China is diverse and each province in China has its own unique cooking style.
  • The most well-known Chinese cuisine includes Cantonese and Szechwan.
  • Szechwan cuisine contains many spices such as chilli paste, red pepper and chilli oil for cooking.
  • Chinese meals generally consist of rice, soup and side dishes (such as vegetables, seafood or meat).
  • Rice and noodles are staple parts of the Chinese diet, similar to the significance of potato and pasta in the western diet, and they accompany almost every meal.
  • Traditionally, the Chinese diet does not include many dairy products. High calcium and protein alternatives include tofu and soymilk.

Yin and Yang and Diet

  • A key part of the Chinese culture is centered on the balance of energies within the universe.
  • Foods are categorised into ‘Yin’ (cold) and ‘Yang’ (hot). Chinese people believe that these foods should be in balance to create harmony, health and to avoid illness.

Popular dishes among the sick and elderly

  • Soup (particularly fish/bone marrow soup).
  • Rice porridge, known as ‘Congee’ with minced meat such as pork/beef.
  • Warm or hot water to drink (in preference to cold).
  • Fruit juice (particularly orange juice).

Dinner etiquette

  • If invited for a meal, it is polite to bring a small gift for the host and arrive on time.
  • Take off shoes before entering the home and wait to be directed where to sit before sitting down.
  • The most honourable table position is facing the door.
  • Wait until the host starts eating before beginning the meal.
  • Use chopsticks.
  • Hold the food bowl close to your mouth whilst eating.
  • Place chopsticks on the chopstick stand every few mouthfuls to have a drink or to speak.
  • Try a bit of everything that is on offer.
  • When eating meat with bones, avoid placing the bones in your food bowl. Instead, put them on the table or in a separate bowl.
  • In Chinese culture, slurping or belching during a meal are not rude but rather signs of enjoyment.
  • Eat well to show that you are enjoying the meal.

Tips

  • Food is an important aspect of cultural identity, therefore it is important to identify food preferences, likes and dislikes including eating habits, meal times, preferred setting, preferred eating utensils etc.
  • Identify and facilitate cultural food when possible and ensure the impact of religion on food services is documented, adhered to and regularly reviewed.
  • Provide menu choices and food services information in the preferred language of care recipients, or with pictures if the person has difficulty reading. 
  • Consider alternative ways to facilitate culturally appropriate food such as; obtaining recipes from family/friends, specific meal delivery services, community groups, seniors’ clubs, or and/or other clubs.
  • Ensure that the care recipient is given food choices throughout all stages of dementia.

Food and diet resources

  • A wide range of information (including religious food requirements, nutrition information and recipes) is available in the “Food and diet resources” section below.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799

Resources

Generalist

  • A person-centred care approach helps organisations provide accessible, responsive and flexible services that meet the diverse needs and preferences of people living with dementia in our community. 
  • Many people with dementia want to remain independent for as long as possible and rely on the community care system to help them achieve this.

Additional care considerations for Chinese people

Health Beliefs and Practices

  • For the Chinese, health is a state of harmony between the forces of Yin and Yang and Feng Shui.
  • Many Chinese people believe disharmony or imbalance between Yin and Yang results in illness and the aim of treatments is to restore the balance between Yin and Yang.
  • Traditional Chinese treatments include acupuncture, acupressure, cupping and Chinese herbs.
  • Some practices such as cupping (a therapy that involves applying heated glass cups to the skin) may result in bruises or marks on the body. It is important not to mistake marks caused by this practice as a sign of abuse.
  • Traditionally in China, children and family members care for the elderly.

Beds

  • Chinese people generally prefer hard mattresses.
  • Traditionally, bamboo matting and bamboo pillows are used and water is put on the matting in summer to keep them cool.

Tips

  • Identify and document the care needs of your care recipient and continuously re-evaluate how their dementia progression affects their care needs.
  • Make every effort to understand a dementia behaviour before attempting to manage it, as you will often discover that what lies behind it is a genuine attempt to communicate an unmet need.  

Care information resources

  • A wide range of information is available (e.g. personal hygiene, sleeping, incontinence etc.) in the “Care information, resources” below.
  • Advice and Support - Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.
  • Employee/employer resources - A range of information is available under “Links – Other useful weblinks”.

Resources

Generalist

Collectivist society

  • As a collectivist society, Chinese people have a need to be connected to a group.

Cultural family traits

  • Chinese people do what they can to support the honour of their family.
  • Chinese families are typically hierarchal and the oldest male usually takes the role of the key decision maker.
  • Family matters are private, and not discussed with others outside the family.
  • Elders are valued and respected.

Confucianism

  • Chinese culture is heavily influenced by Confucianism, a system of behaviours and ethics that stress the obligations of people towards one another based upon their relationship.

Saving ‘Face’

  • The concept of ‘face’, which roughly translate to 'honour', 'good reputation' or 'respect', is very important in Chinese culture.
     

Feng Shui

Feng Shui is the traditional Chinese art of placement to allow the flow of Ch’i or energy. This ensures that people live in harmony with their surroundings.

Tips

  • Everyone has “culture”. This includes a number of factors such as ethnicity, identity, age, gender, education, sexual orientation, ability/disability, values, beliefs, attitudes etc.
  • Recognise your own cultural traits and influences and be mindful not to judge other people’s behaviour and beliefs according to the standard of your own culture.
  • Be aware that your care recipient may judge your behaviour and beliefs according to the standard of their own culture.
  • Your care recipient may be “similar to others” but “no two people are the same” so take care not to generalise or make assumptions about them. Gain general cultural information from resources to assist with conversations to allow you to identify your care recipient’s individual cultural traits.
  • Understand and document how your care recipient’s individual cultural traits impact their care needs.
  • Increase your knowledge about different cultural practices and issues through resources, cultural background information sessions and/or cultural awareness training.

Cultural Traits resources

  • Find information (such as guides and cultural profiles created by other organisations) in the “Cultural Traits, resources” section below.
  • You will also find information including; links to community contacts, cultural profiles, useful weblinks etc. in the “Links” section of the app.

Resources

Generalist

  • Unless the Chinese person is Christian, they do not celebrate Easter. 
  • In China, Easter is only a special holiday for Catholics, Orthodox and established Christian churches.
  • There are no specific Chinese Easter traditions.
  • Many Chinese people participate in western traditions such as ‘Easter egg hunts for children’ simply for the purpose of having fun.

Tips

  • Understand the importance of Easter to your care recipient and accept and respect that customs and beliefs about Easter are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Chinese may or may not celebrate Christmas.
  • An elderly Chinese person that is not Christian generally does not celebrate Christmas.
  • Younger Chinese with modern attitudes generally celebrate Christmas on the 25th December. 
  • Only a very small percentage of people in China are Christians.
  • Christians usually attend services in China.
  • In China, Christmas day is a day of observance. It is not a public holiday.
  • People in China that are not Christian know little about Christmas.
  • There are no specific Chinese Christmas traditions.

Tips

  • Understand the importance of Christmas to your care recipient and accept and respect that customs and beliefs about Christmas are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • New Year is celebrated by Chinese people. Celebrations used to continue from the first to the fifteenth day of the first lunar month (usually February). New Year in China nowadays is celebrated from the 1st January (New Year’s Day) to 3rd day of the first lunar month.
  • Chinese New Year, referred to as ‘Chunjie’ translates to the Spring Festival.
  • New Year is a very social time. Family and friends catch up and wish each other a prosperous New Year, exchange gifts and share a meal.
  • The New Year’s Eve meal is the most important dinner of the year. A range of traditional food is enjoyed. Dumplings and fish are common as they represent prosperity. Food chosen depends on personal taste.
  • Gifts include; ‘hong bao’ (a red envelope that contains lucky money), oranges and/or mandarins, which represent gold nuggets.
  • Chinese calendars that include the lunar calendar dates are important to Chinese people.
  • The dragon is present in many cultural celebrations. It represents prosperity, good luck and good fortune.

Tips

  • Understand the importance of New Year to your care recipient and accept and respect that customs and beliefs about New Year are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

Traditionally, Chinese people follow the lunar calendar. The following dates are significant:

  • Around February – The Lantern Festival:  - Celebrated on the 15th day of the first lunar month. Lighting up and appreciating lanterns is the main activity. It also is a time that traditionally ends the Chinese New Year period.
  • Around April (usually falls on the 4th, 5th or 6th of April) - 'Qingming' (Pure brightness): A day for sweeping tomb/graves, paying respect to ancestors and a time for people to enjoy the greenery of spring.
  • Around June - 'Duan Wu'/'Duanwujie' (Dragon Boat Festival): 5th day of the 5th lunar month (around June). It is a sporting event as well as a day of remembrance and worship.
  • Around August 'Yulanjie' (Hungry Ghost Festival): – Held on the 15th day of the 7th lunar month, for Cantonese and Hakka speaking people to worship ancestors.
  • 1 October - National Day: A day when people of China celebrate their national day.
  • Around October - 'Zhongqiujie' (Mid-Autumn Festival or Full Moon Festival): - the 15th day of the 8th lunar month. At the end of the harvest season, family gathers to celebrate and appreciate the autumn moon.                                                                                                                        

Tips

  • Understand the importance of any significant days to your care recipient and accept and respect that customs and beliefs about special days are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Chinese people enjoy group settings activities and games that allow group interaction.
  • Outdoor activities generally enjoyed include; walking, exercises such as tai chi and gardening.
  • Common indoor activities include; playing games (such as chess), listening to music and watching movies.
  • Other activities that may be of interest include; “Mahjong”, Shadow puppetry, Storytelling, Chinese calligraphy and Chinese paper-cut.

Reminiscence                                                                                                                                                     

  • Smell or taste - Using smell kits, different cultural foods/spices such as ginger, garlic, sesame oil, chilies and coriander.
  • Sight - Cultural photographs, cookbooks, slides, films, painting pictures, traditional costumes, looking at objects. (Refer to the “Cultural activities resources” section for some visual ideas). 
  • Touch - Touching cultural objects, feeling textures, painting and pottery. Pampering, massage hands, etc. if it is considered culturally appropriate by the care recipient and they trust you to do this.
  • Sound - Personalised playlists, listening to familiar tunes from the radio, C.D's, YouTube, listening to cultural performances, or making music using various instruments. (Refer to the “Music resources” section for some music ideas).

Tips

  • It is important to understand your care recipient’s activity likes and dislikes and their personal history to plan appropriate activities for them.
  • Your care recipient should be provided with a choice of activities to participate in.
  • Participating in suitable activities can help a person with dementia to achieve purpose and pleasure, help to improve their mood, responses, memory function, increase social interaction, sleep, improve verbal and non-verbal communication and restore a sense of identity. Activities also play a significant part in increasing the person’s wellbeing and confidence which will decrease responsive behaviours or ill-being.
  • It is important that activities are suitable to the level of ability of the person with dementia. People with dementia should be encouraged to participate as independently as possible and be given the choice to participate or to watch others.
  •  Always talk to the person’s doctor before starting them on a new exercise program and ensure the program designed for them takes into account their current health and ability.
  • Alzheimer’s Australia SA, local council libraries or community organisations may be able to loan suitable cultural activities such as music, games, videos etc.

Cultural activity resources

  • For cultural activity information and ideas refer to the “Cultural activities, resources” section below.
  • For local community contact details refer to the “Links, Community Contacts” section of this app.

Resources

Generalist

  • Music has a long history in China and is very important for Chinese people.
  • General types of traditional music that are common include; Chinese opera, orchestra music, solo instrumental performances.
  • People often like to listen to music from a particular era, such as the 50s or 60s.
  • For Chinese Buddhists; the monk, nun or others may chant from Buddhist scriptures or recorded chanting may be played.

Tips

  • Music is the most powerful universal language.
  • Music provides an external rhythm and can restore a person back to themselves, and to others, at least for a while.
  • People tend to remain contactable as musical beings on some level right up to the very end of life.
  • It is important to understand your care recipient’s music likes and dislikes and to provide them with their choice of music to listen to.
  • Create a personalised music playlist for your care recipient for their maximum benefit and enjoyment.
  • Provide opportunities for the person with dementia to watch live music performances.
  • Providing music a person relates to can have a wide range of benefits to the care recipient. Benefits may include; helping to improve their mood, responses, memory function, increase social interaction, improve verbal and non-verbal communication and restore a sense of identity.

Resources