Cultural bias in the assessment of language: A closer look at the Boston naming test among multicultural Canadian older adults

The Boston Naming Test (BNT) is commonly used to assess word-finding in older adults but performance may be impacted by cultural and linguistic factors. This study aimed to assess cultural bias in BNT performance among older adults, explore sources of this bias and provide clinical guidelines for its use in multicultural settings. We conducted a retrospective chart review of 525 older adults referred for neuropsychological assessment at a large geriatric hospital in a multicultural Canadian city. Participants were categorized by birthplace (Canada vs. outside Canada), and relationships between BNT scores, years in Canada, sociodevelopmental context of region of birth and first-language status were examined. Individuals born outside of Canada had significantly lower BNT scores than Canadian-born participants. These differences were not fully explained by English as a first language status or age at immigration though a significant correlation was observed between BNT scores and years in Canada. Sociodevelopmental context, measured by the Historical Index of Human Development (HIHD), partially mediated the relationship between region of birth and BNT performance. The BNT is influenced by cultural and linguistic factors, which may lead to inaccurate cognitive assessment in diverse populations. Clinicians should interpret BNT scores with caution in multicultural contexts and consider sociocultural factors to improve diagnostic accuracy and cultural sensitivity.