Cultural Awareness in Dementia Care—“Hal million oo dollar maaha baraka”

By Farhiya M. Farah

The translation of this Somali phrase is “A Million Dollars is not a Blessing”. In the Somali culture, highly prioritizing a loved one places you advantageously in all your affairs. Theoretically you can make a million dollars but it is not a blessing if you have not helped your elder in need. Regardless of your obligations, the Somali culture expects one to highly prioritize a loved one’s care—it is through the care that a person receives blessings that eases their affairs—and when it comes to the chronic disease of dementia this can be a very demanding cultural value.

Minnesota is home to the largest Somali refugee population in the United States, and on arrival they encounter drastic lifestyle changes. In addition to learning a new language, acclimatizing to new weather, and living in a new environment, the Somali community members are challenged to integrate into a new culture and the elders are the most affected. Moreover, the high prevalence of PTSD and the high depression rates in the community complicates the recognition of dementia. These high prevalence rates are the consequences of war trauma and social isolation.

The low literacy rates and the Somali community’s mental health stigma have complicated dementia diagnosis. Moreover, diet change combined with exposure to unfamiliar cold weather has significantly reduced the mobility of the Somali elders. The reported increase to cardiovascular risk factors for this elderly population prompts an urgent need for dementia awareness and screening initiatives. But how do professionals from aging agencies conduct dementia awareness in a culturally sensitive way? And how do you make a compelling prevention argument when Somali elders are functioning from a disease “pre-ordainment platform”?

While considering the burgeoning Somali elderly population and their struggles, it becomes imperative to examine their cultural knowledge of dementia to help deliver optimum dementia care to the Somali elders. My recent qualitative research with Somali elder focus groups (including Imams) presents findings that offer information on the cultural understanding of dementia in the Somali community. This inquiry offers a high level overview of the community’s cultural and religious beliefs that drives its life norms and that informs the Somali community’s health seeking behavior. It provides information that allows service and healthcare providers to contrast the Somali traditional approach to healthcare against the western perspective.

Almost all Somalis are Muslims, and the theological essence of Islam is belief in one God. Islam succinctly prescribes a Muslim’s daily practices from the moment a person wakes up. Do you know how Muslims are expected to enter the bathroom? Do you know of the mandatory requirement of water use prior to toilet paper use? Or what side to lay in bed during sleep? And the recommended compass direction to face when sleeping? How about the daily five mandatory prayers? And directions to face during prayers? Is a person allowed to walk in front of a person praying?

These daily rituals are learned at very early ages and are deeply engrained and becomes intuitive over time. These rituals become habitual after many years of practice and are typically the last life aspects to be disrupted by dementia. How can aging network professionals use these daily cues to understand dementia severity? Can elements of these rituals be used in screening tools to substantiate a diagnosis?

The attitudes, beliefs and behavior concerning dementia in the Somali community are directly tied to their religious practices. How can aging network professionals and healthcare providers enhance their outreach and service delivery to diverse ethnic and cultural communities without understanding some of these issues?

One way to aid these professionals is a pioneering consulting initiative from the Minnesota Board on Aging called “Cultural Awareness in Dementia Care”. They have begun educating members of cultural communities about dementia and matching these cultural consultants with agencies that work with elders in cultural communities. I’ve had the privilege of working with two aging agencies that serve many Somali clients. We’ve identified challenges regarding dementia screening, dementia awareness, staff training and screening tools that needed to be addressed. From these concerns we’ve created a working framework to tackle these challenges. This is the beginning of the creation of culturally relevant solutions for effective lasting change.

If you would like to learn more about this important subject, join my ASA workshop, “Cultural Awareness in Dementia Care” (book code TU139) on March 21, 2017 from 9:00 to 10:30 AM in Roosevelt 1 (East Tower, Bronze Level), Hyatt Regency Hotel, Chicago, during the 2017 ASA Aging in America Conference.

Farhiya M. Farah, has a Masters of Public Health Degree-Administration and Policy degree and is a public health consultant who owns GlobeGlow Consulting and Research, Inc. She has over ten years of experience conducting qualitative public health studies in the Somali community and other Limited English Populations. She owns a multicultural adult day care facility in the City of Minneapolis. Farah is a Cultural Consultant with the Minnesota Board on Aging’s “Cultural Awareness in Dementia Care” initiative funded in part by a federal Administration for Community Living – Alzheimer’s Disease Initiative Support Services grant. Farah can be reached at

Photo by Farah Omar, on Flickr