Preserving togetherness or ensuring safety? The dilemma of where to live and receive dementia care

BACKGROUND: As ageing populations become increasingly culturally diverse, the need for responsive dementia care grows. However, there remains limited knowledge about how older immigrants experience ageing in general and, specifically, dementia within a foreign cultural and societal context. This affects both the person with dementia and their caregivers. The aim of this study was to explore how older immigrants with dementia (and their families) wish to live their lives and receive care and support throughout the progression of the disease. METHODS: A qualitative case study design was used. Older immigrants with dementia and their family members were interviewed about 1) their views on engaging with formal dementia care and 2) their thoughts regarding admission to residential care. Two contrasting cases formed the basis of the analysis. RESULTS: The overarching theme, Residential Care as the End Point of Support Strategies, captured shared experiences across both cases despite differing circumstances. The first case concerned a couple living together, where the husband had dementia; this was represented in the theme Preserving Togetherness in the Face of Decline. The second case involved a couple in which the husband had dementia with behavioural and psychological symptoms; this was reflected in the theme Safety Over Togetherness. Across both cases, the transition from home to residential care was described as an existential threshold shaped by institutional routines, uncertainty about staff competence, cultural and linguistic mismatches, and resistance to relocation. CONCLUSION: The described barriers contributed to fears of losing personal identity, daily habits, and (culturally) meaningful ways of being. The findings highlight the need for stakeholders and policymakers to address these vulnerabilities when developing healthcare and social services for immigrants living with dementia.