+ General Country Information
+ History
+ Concept of Time
+ Family and friends
+ Gender
+ I or We Attitudes
+ Manners and Taboos
+ Spiritual care
+ Communication Style
+ 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

  • India is located in the content of Asia, specifically in Southern Asia.
  • New Delhi is the capital of India.
  • Countries that share land borders with India include; Bangladesh, Bhutan, Burma, China, Nepal and Pakistan.
  • India has a total area of 3,287,263 square kilometres and is the 7th largest country in the world.
  • The population of India is 1,266,883,598 (Central Intelligence Agency, 2016).
  • According to the 2011 Census, India rated second among the most populous nations of the world, with Mumbai, Delhi and Kolkata having the highest metropolitan population areas.
  • The major ethnic groups in India include; Indo-Aryan, Dravidian and Mongoloid.
  • The climate in India includes tropical monsoons in the south and temperate weather in the north.

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

  • Early Indian migration took place between 1800 and 1860, when they were brought to Australia as labourers and domestic workers. Others arrived later as agricultural labourers, salespeople and gold miners during the gold rush. Many were of Sikh or Muslim faith.
  • Restrictions to immigration were introduced in 1901 and this curbed the number of Australian immigrants.
  • After India’s independence from Britain in 1947, Anglo-Indians and Indian-born British citizen numbers increased.
  • Changes to immigration laws in the late 1960s led to an increase in the number of non-European Indian migrants that belonged to a range of religious, linguistic and cultural groups.
  • Skilled migrants, including; doctors, computer programmers, engineers and teachers began migrating to Australia in 1981.
  • People with an Indian background may be from; India, Africa, Fiji, Malaysia, Singapore, or Sri Lanka.
  • Indians are one of the largest migrant groups in Australia.

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

  • India is defined both as a “collectivist” and “individualist” culture.
  • India scores 48 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.
  • This means that whilst there may be some preference to working for the greater good of one’s group, there is also an element of individualism.
  • Individualism, with respect to the Indian culture arises from the country’s main religion of Hinduism. Specifically, Hindu’s believe that the cycle of life, death, and rebirth is subject to how one lives in their previous life. Therefore, individuals are responsible for how they live their lives.
  • In other respects, Indian culture interacts with collectivist tendencies.

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

  • Religion is an important aspect for all Indian communities and it brings people together for social and cultural events.

Religious scriptures of different religions

  • Hindus - The Ramayana and Mahabhartah
  • Muslims - The Quran (Qur’an, Koran)
  • Christians - The Bible
  • Sikhs - The Guru Granth Sahib

In India

  • The main religion in India is Hindu (79.8% of the population). Other prominent religions include; Muslim (14.2%), Christian (2.3%) and Sikh (1.7%) (Central Intelligence Agency, 2011).

In Australia

  • The main religions of Indian-born Australians include; Hinduism, Sikhism and Catholicism.
  • A small proportion (2.7%) of Indian-born Australians state that they do not have a religion (Australian Bureau of Statistics, 2011).

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 Indian culture and the extended family holds a significant role.
  • Indians tend to define themselves according to the group in which they belong, rather than by their individual status. For example; the state or city in which they live, their family, religion, career path, etc.
  • The extended family provides; a deep-rooted trust, rules, structure and mutual obligations amongst relatives.
  • The extended family (including immediate family, relatives and close friends) commonly provides support in the case of illness.
  • Generally, the diagnosis and prognosis should be given to the head of the family, and then this will then be passed on to other members of the community.
  • Treatment decisions are usually dependent on the wishes of the patient as well as their family.

Tips

  • Be aware and sensitive to the fact that some people may have become separated from family for a range of reasons including; 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 languages are available in the “Language and communication, resources” section of this app.

Resources

Generalist

Australia

  • The primary languages spoken by Indian-born people in Australia is English, Hindi and Punjabi.
  • For Indian-born people who speak a language at home other than English, the majority (93.3%) speak English very well or well. Smaller numbers (5.3%) do not speak English well or not at all (Australian Bureau of Statistics, 2011).

India

  • The main language of India is Hindi spoken by 41% of the population.
  • Other official languages spoken in India include; Assamese, Bengali, Gujarati, Kannada, Kashmiri, Maithili, Malayalam, Marathi, Oriya, Punjabi, Sindhi, Sanskrit Tamil, Telugu and Urdu (Central Intelligence Agency, 2001).
  • There are different official languages in different states in India, however some of these are not recognized by the central government. Speakers from some of these languages are running political struggles to gain this recognition.
  • English is still used for official purposes such as; parliamentary proceedings, government communications etc.

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

Meeting Etiquette

  • In India, greetings are influenced by religion, education and social class.
  • India has a hierarchical culture where the eldest, or most senior person, should be greeted first.
  • When departing, individual farewells should be given to each person in the group.
  • Namaste is a greeting that involves pressing both palms together around the chest and saying “Namaste” or “Namaskar” (the more formal version). People may also nod or bow at the same time. It is used in most settings.
  • Shaking hands is also common, particularly amongst the more educated and those that live in city areas.

Naming Conventions

  • Names are influenced by religion, as well as social class and the region of the country. Although there may be some exceptions to the rule, there are some basic guidelines as listed below:

Hindu naming convention

  • People from the north of India generally have a given name and a surname.
  • People from the south of India may not have a surname and instead they may use the initial of their father’s name before their own name.
  • For a man, his formal name is his name “s/o” (son of) and the father’s name.
  • For a woman, her formal name is her name “d/o” (daughter of) and the father’s name.
  • Upon marriage, women will use their husband’s first name in place of their father’s name.

Muslim naming convention

  • Muslims may not have a surname.
  • Men will add their father’s name to their first name with the word “bin.” For example; Abdullah bin Ahmend means Abdullah is the son of Ahmad. Women will follow the same convention, but will use the connector word “binti” instead of “bin.”
  • Muslims will often use specific titles - “Hajji” (for men) and “Hajjah” (for women), as a way to indicate that they have made their pilgrimage to Mecca.

Sikh naming convention

  • The name “Singh” (Lion) is often used by Sikhs, either as a surname or as a connector to their surname.
  • Sikh naming conventions may (but also may not) also include Kaur (Princess) for a female surname.
     

Titles

  • Titles such as Professor, Doctor or Engineer are highly respected within the Indian culture as they are status defining.
  • Titles should be used unless there is an invitation to refer to someone by their first name by itself.
  • If someone has no professional title, the title of “Sir” or “Madam” should be used instead.
     

Man greeting Man

  • A gentle handshake following an initial “Namaste” is common.
  • “Namaste” may also be used on its own.

Woman greeting Woman

  • A gentle handshake following an initial “Namaste” is common.
  • “Namaste” may also be used on its own.

Greetings between Men & Women

  • “Namaste” is the common greeting.
  • Formal and business situations may involve a light handshake, however, this should always be initiated by the woman first as there are many Indian women who avoid contact with men in public situations.

Other notes about greetings

  • Greetings of an elder usually begin by touching of the feet of the elderly person (with their right hand), then the greeter will touch their own chest, and then press their palms together. This is not expected from people who are not Indian.
  • Hugs and kisses as a type of greeting that are not the norm in India and should be avoided.

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

  • 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

  • Relationships with Indians are built upon mutual trust and respect. For example; having a third party introduction gives you immediate credibility.
  • Indian people generally favour a more indirect style of communication over direct, where they say what they think the other person wants to hear as a way to be polite.
  • Actions and non-verbal communication may be a good indicator of what is meant.

Tips

Care recipient

  • Identify the communication style of your care recipient.
  • Be aware that communication styles vary from one culture to another.
  • Realise that physical, sensory, psychological and social issues can impact on the ability to communicate effectively. Make a note of any that are relevant to your care recipient.

Care worker

  • To ensure that the care recipient can understand you avoid speaking too quickly or using slang, acronyms or jargon. Also try not to give too much information at one time.
  • Be aware not to use patronising speech or a demeaning tone as this can lead to a communication breakdown.
  • Remember than non-verbal communication such as body language is just as important as verbal communication. Ensure that your tone matches your body language to avoid miscommunication.
  • Be kind and caring in your communication with the care recipient. Remember the person with dementia has a lifetime of experiences and is a person with feelings, even though may have lost the capacity to think or behave like they used to.

Language and Communication resources

  • 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

  • Indirect eye contact is predominately preferred by Indians, particularly when communicating with elderly people or when a woman is looking at a man, however there are some exceptions.
  • Direct eye contact is not uncommon when doing business, but it is generally only brief eye contact.
  • Direct eye contact is becoming more acceptable within cities in India, but it is often considered rude and inappropriate in rural areas.
  • Women, particularly those that live in cities, are generally expected to give direct eye contact to their husbands.

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

  • Shoes are generally removed before entering someone’s home, a place of worship and certain shops and businesses. If shoes are arranged near the door, it is a sign that it is appropriate to remove shoes before entering.
  • To summon another person, people extend an arm and make a scratching motion with their fingers.
  • The head wobble is a common gesture in India. This can mean yes instead of no, depending on the angle, speed, and expression on the persons’ face.
  • Pointing is relatively common.
  • As with some other Asian cultures, crossing legs and pointing the foot at individuals may be considered insulting.

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

  • Indians generally value personal space and most allow an arm's length distance between themselves and others.
  • Personal space does not apply when it comes to public transport in India, as large crowds of people are usually squashed together.
  • Touch is not a usual part of communication, however Indian men sometimes walk holding hands, or arms in arm, as a sign of friendship.
  • Men and women rarely display any physical affection in public as any touch may be viewed as flirting.
  • Within families, people may cup the face of their relative with their hands to show affection. This is common between mothers and children.

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

  • Indians are not generally punctual. Instead, they tend to practice flexibility with time.
  • Time is believed to be eternal by Indian people and they often have a relaxed attitude, therefore it is not generally considered rude to be late in social settings.
  • There is a commonly accepted joke amongst Indians that there is Indian Standard Time (IST), meaning Indian people will usually arrive late.

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

  • On a global index measuring gender equality out of 144 countries, India ranked 87th. (World Economic Forum, Global Gender Gap Report 2016).

Women

  • Women’s rights vary within India, depending on the area.
  • Within rural areas, women are often viewed as caregivers and mothers, however within some states that are more progressive, such as Kerala, women have comparable roles to men.
  • Traditionally, women do not drink or smoke.
  • In regards to medical examinations, it may be distressing for Indian women to be examined by members of the opposite sex, so this should be avoided whenever possible.

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

Dementia in India

  • It is estimated that there are 9.5 million people with dementia in India (World Alzheimer Report 2015).
  • Awareness of dementia by the general population in India is limited, and there is often the misconception that signs and symptoms are a normal part of ageing.
  • Dementia may be given different names such as; “Chinnan” which means “childishness” in Malayalam language, “nerva frakese” which means “tired brain” in Konkani language.
  • There may also be the belief that dementia is caused by a higher power, family neglect, abuse, tension or a lack of love. It may also be attributed to bad karma.
  • Similar to other Asian cultures, there may be the belief that suffering is part of life which may result in a delay with Indian people seeking treatment.

World Alzheimer’s Day

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

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

  • In India, residential care is generally reserved for the very poor and consequently it may cause distress to Indian born elders living in Australia.
  • Indian elders may experience feelings of distress and abandonment by being separated from their family to be placed in residential care.
  • Indian males may display traits of pride and dominance whilst Indian women may be very timid.
  • Generally, preference is given to care at home, support services and then residential care.

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

  • Generally, medications and treatments are accepted by Indian people.
  • However, Indians that are vegetarian may not wish to take medications derived from animal products.
  • Similarly, if a person is Muslim, they will usually want to take medications which are considered Halal.
  • The traditional system of medicine is known as “Ayruveda” and is the principal means that some Indian people rely on to prevent and cure illness. Others may prefer to use a combination of traditional and western medicine.
  • Pain and discomfort experienced by some elderly Indian people may be audibly expressed, and they may be quite demanding.
  • Other Indian people, such as those with Buddhist beliefs, may be stoic in order to retain self-conduct.
  • Status is also observed by some Asian patients, so they may avoid making any demands to health professionals.
  • 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

  • Death is a sensitive topic in the Indian culture. Verbal condolences rather than cards or gifts are usually considered more appropriate.
  • The words death and cancer may be taboo to some members of the Indian community.
  • The end of life is a time which involves all the family and community.
  • Indian people are often emotional and expressive with their feelings for the dying person and sensitivity from others is appreciated.
  • Following death, it is traditional for the body to be laid out in the persons’ home before burial. This is not possible in Australia, but there are some funeral directors who are able to make alternative arrangements that may be more suitable for the Indian community.
  • Hindus usually prefer to be cremated whilst Christians and Muslims often have a preference to be buried.

Hinduism

  • Hindus believe in reincarnation and that the soul (known as ‘Atman’) comes back in another form based on the Karma the person gave during their previous life on earth.
  • Traditionally, a dying person is given water from the River Ganges and the holy books of Hinduism are read by a priest in the company of family.
  • Upon death, the body is placed on the ground with the head pointing south, and the body is rubbed with sacred items including; sandalwood paste, holy ashes, basil leaves and water from the River Ganges.
  • It is believed that the body should receive minimal contact, and should be cremated within 24 hours after death to prevent impurity and hindrance in the passage to the afterlife.
  • Funerals are considered the final ritual of life.
  • Following cremation, it is ritual for family members to take a bath to purify themselves, before they observe a 12 day period of mourning, followed by a ceremony for the afterlife for the soul of the deceased.

Sikhism

  • Sikhs believe in reincarnation.
  • Prayers are usually read to the dying by family, friends or pastoral workers.
  • Sikh people wear five articles of Sikhism (or faith) including; kesh (uncut hair and beard); the kanga (a semi-circular hair comb); the kara (a bangle made of steel or gold and is worn on the right wrist); the kirpan (a symbolic dagger which is worn under the clothes) and the kaccha (long underpants).
  • The five articles of faith should not be removed from a deceased person, nor should the person’s hair be cut or trimmed.
  • Family, friends or pastoral workers may read prayers to the dying.
  • Meditation may also be used.
  • After death, the eyes should be closed, limbs straightened, and the body should be washed according to Sikh tradition and covered with a clean sheet.
  • Cremation generally takes place as soon as possible.
  • Death is considered a reunion with the Creator, and as such, is not an occasion for grief.
  • Sikhs are generally discouraged from displaying grief.
  • They usually have a 10 day mourning period, where visitors are welcomed to pay their respects at their home.

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

  • Public displays of affection are highly discouraged.
  • It is considered rude to touch someone or pass objects with your shoes.
  • Gestures such as winking and whistling are frowned upon and should be avoided.
  • The ears are considered sacred as grasping the ears signifies repentance and sincerity, therefore it is highly insulting to pull or hit the ears.

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

  • Superstitious beliefs vary significantly across India and amongst individuals.
  • Lemon and chili may be strung together and hung on doorways of the home, office, shops and even vehicles to bring good luck, and to ward off the “evil eye” (a curse causing misfortune or injury).

Some superstitions thought to bring bad luck:

  • To cut nails on a Tuesday or a Saturday.
  • To wash hair on a Thursday or Saturday.
  • Cats (particularly if black in colour) crossing your path. If this should happen, it is believed that you should stop and take three steps back to avoid bad luck.
  • Broken idols and mirrors in the house.

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

Religion and food

  • For most Indian people, diet and religion are closely linked.
  • Most Indian people in Australia are Hindu. A common saying is “Food is Brahman (God).”
  • Hindus hold animals in high regard (especially cows) and believe that they have spiritual awareness. They are often vegetarian and will often avoid food that may have caused pain to animals in their manufacture.
  • Some Hindus may believe that if they consume animal flesh, it will be bad karma that will need to be balanced with good acts.
  • Hindu people often get their protein from dairy foods and legumes such as lentils, split peas and beans.
  • Dairy products (milk, butter, yoghurt etc.) are consumed as they are believed to enhance spiritual purity.

Common types of Indian food

  • There is variation in food choices in each region in India, and each area has their own style of cooking and traditional foods.
  • Indian food is traditionally very spicy.
  • Food and spices are believed to have restorative or healing powers. For example; cold foods may be eaten to bring down a fever.
  • People that are ill often prefer to eat soft food, such as vegetable curry.
  • Rice is the staple in the South, and roti (a flat bread) is a staple in the North.
  • Beetle leaves and nuts are commonly eaten after meals to aid digestion.

Dining Etiquette

  • It is polite to turn down the first offer of tea/coffee or snacks (as these will be offered again).
  • Indian people may offer a range of different foods. It is respectful to accept their hospitality and try a bit of each food.
  • People may use their hands for meals rather than utensils and it is expected that people will eat naan bread or chapatti (flat breads) with their hands.
  • Dietary restrictions are common amongst Indian people, including:
    • Hindus - do not eat beef and many are vegetarians
    • Muslims - do not eat pork or drink alcohol
    • Sikhs - do not eat beef.
  • Common non-vegetarian dishes often include lamb, chicken, or fish, as these tend to avoid the meat restrictions of religious groups.
  • The evening meal is often eaten late in, as with other Asian countries.

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

  • Western medicines and treatments are generally accepted within the Indian community, and health professionals are usually welcomed into the home.
  • Health professionals of the same sex are preferred, especially in the event of physical examination.
  • Community support, hospice and hospital services are also generally accepted amongst the Indian community.
  • Residential care may create some stress as it is traditionally viewed as a service for the very poor in India, and as such may cause stress for seniors in Australia who are being placed in residential care.
  • Generally, family and friends rotate as carers for the sick or elderly. This should be encouraged to continue in the event that an elderly Indian person is placed in residential care.

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

Hierarchy

  • Hindu and caste system influences mean that India has a complex hierarchical culture. (For further information, refer to “Cultural traits resources).
  • Indian people are conscious of their social status and of the status of those around them.
  • Each relationship has a clear hierarchy and social order.
  • Teachers are called gurus and are seen as the source of knowledge.
  • Families are patriarchal and the oldest male is the head of the family.
  • Muslim women are often represented by a male relative (usually their father, husband or brother), who will speak for them.

Avoidance of negative responses

  • Generally, Indian people avoid giving a negative response, whether it be verbal or non-verbal.
  • Indian people often give vague, affirmative answers that they believe another person wants to hear, rather than disappoint them by saying ‘no’.
  • Non-verbal cues, as well as a reluctance to commit to details, can suggest that the person may not actually mean ‘yes’ to what they agreed to.
  • It should not be considered as dishonest, but rather an attempt to please.

Personal assistance

  • Servants and drivers are quite common in India.

Sacred animals

  • The cow and elephant are both highly regarded and honoured.

Hygiene etiquette

  • In India, as with other parts of Southern Asia, people may chew beetle nut (the nut of an Areca palm, wrapped in leaved and chewed). Some red liquid is produced in the mouth from chewing beetle nut. This liquid is usually disposed of by spitting, which some Indian people do not consider rude.
  • Other behaviours which may be considered unacceptable in Western culture (and also to some Indian people), may be acceptable practices within the Asian region. For example; blowing the nose without a handkerchief or tissue.

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 Indian person is Christian (about 2.3%), they do not celebrate Easter.

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

  • Unless the Indian person is Christian (about 2.3% of the population), they do not celebrate Christmas.

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 Indians.
  • The date of New Year varies across different regions of India. Refer to “Special days, New Year resources section” for further information.
  • Distinctive New Year traditions can be seen across India.
  • The celebrations of New Year include; lots of food, rituals, music, and dance.
  • New Year often coincides with the beginning of the agricultural season.

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

Independence Day – 15 August

  • Each year the prime minister raises the Indian flag and gives a speech. Parades and celebrations are held in recognition of the freedom from British Rule.

Republic Day – 26 January

  • Commemorates the day when the Constitution of India came into force.

Days with religious influence

  • Special days are also often influenced by religious beliefs, as well as the class (caste) system.

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

  • Sport is a popular activity in India, particularly cricket. Soccer and golf are also played by many.
  • Yoga, which originated in India, is also a popular activity.
  • Other popular activities include socialising and walking.

Reminiscence  

  • Smell or taste - Using smell kits, different cultural foods. Suggestions include; Cinnamon, Cloves, Coriander seeds, Fennel seeds, Garlic, Ginger and Turmeric.
  • Sight - Cultural Photographs, Slides, Films, Painting pictures, looking at objects. (Refer to the “Cultural activities resource” 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 without being intrusive.
  • 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 is an important part of Indian culture.
  • There is musical diversity across regions of India, such as Hindustani in the north (with Arab and Persian musical influences) and Carnatic (lyrical and rhythmically intense music) in the south.
  • The sitar (a guitar like instrument) is a popular instrument of North India.
  • “Filmi” or “Hindi film songs” are a popular form of Indian music. It is used in the Hindi film industry (known as Bollywood).
  • Each region in India has a form of folk music.

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