Abstract
Migrant Elders in Westernized countries encounter distinctive challenges, accentuating the importance of person-centered care. Older Arab migrants are influenced by family dynamics, religious beliefs, and racism; therefore, face many barriers to meaningful engagement in long-term care. This scoping review aims to synthesize global research on culturally appropriate care practices for migrant Arab Elders in long-term settings. Conducted and reported following Joanna Briggs Institute (JBI) scoping review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) guidelines, structured database searches were used to identify publications associated with migrant Arab Elders in long-term care. From 105 possible identified publications, 13 included publications explored culturally appropriate care practices for Elders from culturally and linguistically diverse backgrounds, revealing critical gap in understanding meaningful engagement and distinct ethnic needs for Arab migrants. There is an urgent need for targeted research to address unique needs of migrant Arab Elders. The importance of meaningful engagement to implement culturally appropriate care can only be adhered to with updated evidence.
Plain Language Summary
Older migrants living in long-term care in Western countries face unique challenges, including feeling lonely, not being able to talk to others, and having nothing to do because care services do not understand their cultural needs. For older Arab migrants, issues could be even more complicated due to strong family connections, religious beliefs, and experiences of racism. Therefore, person-centered care approaches supported by occupational therapy perspective could improve care practices. This review investigated how long-term care can better meet the needs of older Arab migrants by providing respectful and engaging care. Researchers reviewed existing studies to find practices that support their well-being and meaningfully engaging in everyday activities and connecting with others. Using a structured method, researchers examined 4 major databases for studies focused on culturally appropriate care, person-centered approaches, and meaningful engagement for older migrants, particularly Arab elders, in long-term care. Researchers only found 13 studies about care for culturally diverse residents that could also be applicable for Arab elders, but none specifically for older Arab migrants. This shows a big gap in research. Findings stress the need for more focused research to understand the specific needs of older Arab migrants. Meaningful engagement is crucial for providing culturally appropriate care, but without updated and targeted evidence, aged care providers face difficulties to implement effective solutions. Addressing this gap would improve the quality of care and ensure that older Arab migrants globally feel valued, respected, and connected in long-term care.
Introduction
Migration and Aging Trends
Global migration is rising, affecting 3.6% of the world’s population. In 2020, there were an estimated 281 million international migrants, constituting 12.2% of Elders aged 65 years and above (International Organization for Migration [IOM], 2021). Among the top 20 origins of international migrants, three were from the Arab world: the Syrian Arab Republic, the State of Palestine, and Egypt. Within the top 20 African migrant countries, Egypt led the rank followed by Morocco, Sudan, Somalia, and Algeria (IOM, 2021). Concurrently, in the Arab region, demographic of Elders [preferred term to refer to older adults as to bestow a position of respect, as advocated by Eden Alternative International (Thomas, 1996)], aged 65 years and above, is projected to increase from 5% to 11% of the global population by 2050 (United Nations Economic and Social Commission for Western Asia, 2022). This highlights the significance of understanding migrant Arab Elders and identifying strategies to enhance their engagement and quality of life.
Moving to Westernized countries can pose challenges for individuals with limited exposure to Western culture and languages, which are often dominated by individualistic and independent ideologies (Hammell, 2015). Challenges extend beyond linguistic proficiency, encompassing the need to comprehend and navigate cultural norms and social expectations (Mhlanga & Mhlanga, 2021). For migrant Elders, these challenges increase risks of isolation and impact mental and physical well-being (Cela & Barbiano di Belgiojoso, 2023; Mhlanga & Mhlanga, 2021).
Culturally Appropriate Care Concepts
Person-centered care (PCC) is an individualized approach to understand a person holistically and comprehensively (Zhao et al., 2016), with the goal of promoting meaningful life (Håkansson Eklund et al., 2019). Owing to its association with quality of life and quality of care (Edvardsson et al., 2017; Terada et al., 2013), PCC is a gold standard for care in long-term care settings, referred to as residential aged care homes (RACHs) from here onwards (Pakkonen et al., 2023). As PCC emphasizes respect and empowerment for Elders, valuing their dignity, identity, and preferences, the application of Kitwood’s concepts of PCC using Brooker’s VIPS framework can be implemented in RACHs through four key elements: (a)
Cultural competence (CC) extends on PCC principles, to ensure that individuals from culturally and linguistically diverse (CALD) backgrounds are equally empowered by acknowledging and respecting their values, preferences, and needs. Embracing and implementing CC’s three domains of cultural awareness and sensitivity, cultural knowledge, and cultural skill, would support the recommendation of appropriate adjustments to provide culturally appropriate care (Lin et al., 2017).
Meaningful Engagement at Occupational and Social Levels
The World Health Organization framework for meaningful engagement proposes respectfully and fairly including individuals in a range of activities, termed as occupations (American Occupational Therapy Association [AOTA], 2020), within an enabling environment, valuing their experience, and applying it to enhance health outcomes (World Health Organization [WHO], 2023). Engaging in personally meaningful occupations promotes perceptions of competence, capability, value, and quality of life (Hammell, 2004). From an occupational therapy perspective, Pierce (2001) explains that the appeal of engaging in occupations is associated with the subjective experiences of productivity, pleasure, and restoration. In addition, engagement in occupation offers opportunities for interdependence and contributing to others (Hammell, 2009). Higher self-esteem, lower levels of depression, and fewer health issues are shown to be associated with engaging in occupations that support others (Hammell, 2014, 2015). Moreover, social participation, social connectedness, sense of belonging, and the ability to support others are integral to an individual’s well-being and quality of life (Hammell, 2014, 2015). Because occupational engagement significantly influences personal well-being, and because well-being is integral to human rights, every person inherently has the right to engage in meaningful occupations (Hammell, 2017). This not only enhances their personal well-being but also contributes positively to the well-being of their communities (Hammell, 2017; Hammell & Iwama, 2012). Developing a sense of belonging within RACHs is crucial, as these are not the communities into which residents were born (Du Toit et al., 2019; Poland & Birt, 2016). Migrant Elders living in RACHs face significant barriers to meaningful engagement, including task-oriented approaches to care and absence of common language (McGrath et al., 2022).
Health care Needs of Older Arab Migrants
Al Abed et al. (2013) conducted a systematic review on health care needs of older Arab migrants. The review presented several factors influencing Arabs in the context of health, including role of family to care and health (Awad, 2010), role of religion to health beliefs and practices (Awad, 2010; Ypinazar & Margolis, 2006), as well as respect and authority for parents and older people (Salari, 2002). Institutionalization of older people (Salari, 2002), receiving care from a nonfamily member (Boggatz et al., 2010), exposing personal or family matters to outsiders (Youssef & Deane, 2006), and open discussions on critical health issues (Rissel, 1997; Saleh et al., 2012; Sneesby et al., 2011), are all considered to be inappropriate and could generate feelings of shame and stigma. Globally, it is a known fact that Arab migrants are subjected to racism and prejudice (Moradi & Hasan, 2004; Nydell, 2006), which impacts their health and psychological well-being significantly (Irfaeya et al., 2008; Moradi & Hasan, 2004).
An extensive body of literature has examined needs of migrants from CALD backgrounds in a broad context (Chowdhury et al., 2021; McGrath et al., 2022; Montayre et al., 2018; Orb, 2002). Nonetheless, it is imperative to recognize that migrants are not a homogeneous group (Al Abed et al., 2013; Du Toit et al., 2023). Considering distinct needs, values, and beliefs of each ethnic group, as well as unique perspectives of individuals within these groups, it is essential to explore them individually for a more nuanced understanding. This scoping review aims to identify and present available culturally appropriate care practices for migrant Arab Elders living in RACHs globally.
Research Design and Method
Following the methodology described by Arksey and O’Malley (2005), this review was conducted and reported according to Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2024) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) (Tricco et al., 2018). Review protocol has been registered with Open Science Framework (OSF) database.
Identifying Research Question
The question that directed this scoping review was “What are the available culturally appropriate care practices for migrant Arab Elders living in RACHs globally?.”
Following JBI recommendations, reviewers adopted the Population, Concept, and Context framework to inform the search strategy in support of the review question (Pollock et al., 2023):
Participants
The included populations were Arab Elders, aged 65 years and above who migrated from their countries. These countries include Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, State of Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen (League of Arab States, n.d.).
Concepts
The focus was on PCC, meaningful engagement, and CC.
Context
The setting for included research addressed RACHs that provided support and accommodation for older people including personal, social, and clinical care (The Royal Commission into Aged Care Quality and Safety, 2021). Therefore, people living in the family home, receiving home care or attending day centers were excluded.
Types of Sources
Qualitative, quantitative, and mixed-methodology studies published in peer-reviewed journals and opinion pieces from the year 2000 onward were included to comprehensively capture available research in line with developments in PCC approaches. Opinion pieces were included to provide expert contextual insights and offer theoretical perspectives not captured in empirical studies, supporting holistic exploration of the research question.
Search Strategy
Four databases (MEDLINE, CINAHL, Embase, and Scopus) were searched between August 2023 and September 2024 to identify publications that met the inclusion criteria. In addition, supplementary hand searches of reference lists, Google Scholar and PubMed were completed. Limits included literature published from the year 2000 onward. The search strategy was developed in consultation with an academic librarian, to address the core elements of the Review Framework as recommended by JBI (Peters et al., 2024). A detailed account of the search terms used for each concept and an example of the search strategy can be found in Supplementary Tables 1 and 2.
Study Selection
All identified citations were imported to Endnote 20 (Clarivate, 2013) and duplicates were removed. Remaining studies were imported into Covidence (Veritas Health Innovation, 2023), where citations were systematically scrutinized, with an accurate record of the process followed. The screening process consisted of two stages, title and abstract screening followed by full-text screening. Initially, both reviewers independently screened titles and abstracts of all imported publications against predefined inclusion criteria. Publications deemed potentially relevant proceeded to the second stage. Full-text screening of the remaining publications was completed independently by both reviewers. Discrepancies and uncertainties regarding inclusion at each stage were resolved through discussion. The terms “Arabs” and “Muslims” were often used interchangeably although they refer to distinct concepts. Arabs are primarily defined by their linguistic and cultural heritage, whereas Muslims are defined by their religious beliefs. Given that, around 93% of Arabs are Muslims and 20% of the total Muslim population is in the Arab region (Hackett et al., 2015), reviewers broadened the scope to include publications on migrant Muslim Elders. Following the screening process, 13 publications were included in the scoping review. Figure 1 illustrates study/publication selection flow diagram according to PRISMA-ScR (Moher et al., 2009; Tricco et al., 2018).
PRISMA Flowchart of the Scoping Review Process (Moher et al., 2009).
It is important to note the positionality of both reviewers involved in this process as they are both from CALD backgrounds, one being of Arab descent. This cultural diversity in perspectives supported identifying, scrutinizing, and synthesizing publications, particularly given the focus on migrant Arab Elders. It enhanced the depth of analysis as lived experience encouraged recognizing the complexities of intergenerational care, familial respect, and community significance for Arab Elders, moving beyond surface-level descriptions. Throughout the review process, reviewers engaged in ongoing discussions and reflection to maintain awareness of potential biases, including selection bias, and ensure a balanced interpretation of the literature.
Data Charting
An extraction spreadsheet was developed in Microsoft Excel to extract data from included publications. The extraction tool was designed based on the research objective and included key elements such as study characteristics, participant demographics, outcomes of interest, and key findings of each study. These elements were summarized to provide context for understanding data related to culturally appropriate care in the publications. The extraction tool was revised and modified as necessary during the process (Pollock et al., 2023) to ensure insights from opinion pieces were also captured. Data were extracted by one reviewer, whereas the other cross-checked the extracted data for accuracy and consistency, ensuring reliability of extracted information. Details of the information extracted can be found in Supplementary Table 3.
Data Analysis
Following the data charting process, a basic descriptive analysis was conducted to organize and present the extracted data. This approach aligns with scoping review methodology, which emphasizes mapping the breadth and scope of available evidence (Pollock et al., 2023). The analysis aimed to map existing research on culturally appropriate care, identify key concepts, and highlight gaps in the literature (Peters et al., 2024). It comprised three primary components: organizing data, descriptive statistics, and narrative description.
Organizing Data
Extracted data were organized into tables, providing clear overview of key information such as study characteristics, participant demographics, as well as main findings and insights related to culturally appropriate care. This tabular format facilitated easy comparison across publications, allowing for identification of patterns and variations within the literature.
Descriptive Statistics
Descriptive statistics, including frequency counts and percentages, were utilized to summarize study characteristics, such as temporal and geographical distribution, and methodological approaches. This quantitative summary offered a concise snapshot of the current state of research relevant to the review question (see Table 1).
Statistics of Reviewed Studies.
Narrative Description
Tabulated data were complemented by narrative description that contextualized findings and elaborated on their relevance to the review question. This narrative not only described characteristics of the included publications, but also explored concepts related to culturally appropriate care practices, drawing connections between these concepts and the broader research landscape (See Supplementary Table 4).
Results
Of the 105 papers retrieved from both databases and supplementary searches, 44 duplicates were removed, leaving 61 publications for screening. After excluding 33 irrelevant publications based on title and abstract, reviewers proceeded to screen full texts of the remaining 28 publications. Following a thorough review, 15 publications were excluded, resulting in 13 publications that met the eligibility criteria for this review. Figure 1 provides an overview of the selection process.
Characteristics of Included Publications
Publications included in the scoping review exhibited diverse characteristics across multiple dimensions, as detailed below:
Types
Types of publications had significant variations, as reflected in Table 1. The majority were qualitative studies (n = 6), followed by opinion pieces and quantitative studies (n = 3 each). Only one study (n = 1) employed a mixed methodology.
Geographical and Temporal Distribution
Publications varied in geographical distribution; most were conducted in Australia (n = 5), followed by the United States (n = 3), then the Netherlands (n = 2), whereas single publications originated from Sweden, Canada, and other Western countries (n = 1 each). Publications spanned from 2005 to 2024, exhibiting notable variations in research conducted across the years. Years with highest number of publications were 2014, 2017, 2022, and 2024, each accounting for two publications (n = 2 each). This temporal distribution underscores the uneven attention to this topic across different years, reflecting evolving research interests and priorities over time.
Participants
Despite having clear predefined participant characteristics, none of the publications specifically focused on migrant Arab Elders living in RACHs. Included studies either clearly addressed some of the participant characteristics; contained data—quantitative or qualitative—indicating that one or more of the participants were Arab; or, although not directly covering the participant characteristics, were still considered for review because findings could be generalized for the Arab population. Reviewers also broadened the scope of review to include publications on migrant Muslim Elders, particularly because the research question was not directly addressed in the literature. For example, Khan and Ahmad (2014) addressed migrant Muslim Elders in general, whereas Hasnain and Rana (2010) incorporated Arabs in their examples, providing relevant insights to the review.
Context
Only five publications directly addressed RACHs—the context specified for this review. Three of these referred to the setting as “facilities,” one used the term “skilled nursing facilities,” whereas another referred to it as “long-term care home.” In addition, all three opinion pieces explored RACHs in their discussions. One publication included professional caregivers from residential care teams, whereas another did not specify the setting, instead reporting it as “health care organisations.” Two publications focused on the intention to use “long term care services” and “shared accommodation for the 65+ year age group.”
Concepts Related to Culturally Appropriate Care
The review addressed concepts of PCC, CC and meaningful engagement. The analysis revealed varying degrees of attention to these concepts in the literature. CC emerged as the most frequently addressed concept (n = 6), suggesting its importance in providing culturally appropriate care. PCC followed (n = 4), while meaningful engagement was notably underrepresented, only being explored once in conjunction with PCC (n = 1). In addition, two publications (n = 2) explored the intersection of PCC and CC, reinforcing their interconnectedness.
Cultural Competence
As the most prevalent concept addressed, publications primarily focused on culturally appropriate care and CC. These included two opinion pieces, two quantitative studies conducted in Australia and the United States, and two qualitative studies from the Netherlands and the United States.
The opinion piece by Al Abed et al. (2014) proposed that older Arab migrants in Australia are at a higher risk of social isolation, prejudice, and health care disparities due to racism and stereotyping, which could have traumatic repercussions in RACHs where residents and staff do not share a common language or cultural practices. Authors emphasized providing culturally appropriate care is pivotal for improving health outcomes of older Arab migrants. They recommended increasing health care providers’ awareness of cultural attributes, migration experiences, and health perceptions of older Arab migrants, ultimately fostering more effective communication in care.
Hasnain and Rana (2010) examined caregiving needs of aging Muslim immigrants with disabilities in the United States and identified several systemic limitations in the care for Muslim seniors. These included conflicts with traditional family care approaches, use of technical medical and disability terminology describing Western diagnoses that may be meaningless, and services biased toward the predominantly White population. Pertinent to RACHs, limitations included stigma associated with disability and long-term facility-based care within Muslim communities, as well as insensitivity to culturally specific needs such as dietary requirements, hygiene practices, activities, and attitudes toward death. Moreover, aging Muslim migrants with disabilities have limited access to culturally and linguistically appropriate services, experience language barriers that lead to mistrust, and are isolated due to financial and insurance-related constraints. To address these limitations, authors provided recommendations, including conducting comprehensive and culturally sensitive community assessments of Muslim seniors across various subpopulations—especially in the South Asian, Arab world, and Middle Eastern populations. These culturally appropriate recommendations would promote cultural brokering, restructuring of formal support networks, training of service providers on Muslim practices and preferences, and improving disability and elder care service systems. Recommendations also included additional funding options to cater to cultural and religious values, building community- and faith-based connections, increasing Muslim representation in formal public sectors of aged care, and incorporating Muslim culture into mainstream aged care services.
The quantitative studies addressed various aspects of CC in aged care. The Australian study by Runci et al. (2005) focused on language-relevant services. Authors investigated language needs of older individuals from CALD backgrounds and how these needs were catered for in RACHs. Language-relevant services included use of interpreters, language boards, language-relevant activity programs, and other services such as the use of family members to interpret. The study emphasized implementing strategies to better meet the needs of diverse CALD residents in mainstream RACHs. Providing language-specific services meet the needs of residents and reduce isolation, one option to do that is by grouping residents who speak the same language together. Also, access to culturally relevant resources, such as music, books, and meals, can create a more familiar and enriching environment for residents, and collaborating with families and community groups can support the acquisition of these language-appropriate resources. Finally, to further enhance communication, policies can encourage recruitment of staff who speak specific languages and provide funding for staff education in basic language skills or the use of alternative communication strategies like language boards. In contrast, Diederich et al. (2022) focused on intention to use long-term care services and assessed whether cultural factors in the importance of family shape foreign-born immigrants’ decisions. The study found immigrants who had lived in the United States for a longer time were less inclined to exclusively use family care, whereas immigrants from cultures with stronger family ties were significantly more inclined to choose long-term care options that involved the family. Family care was identified as an important complement to formal care, highlighting the significance of cultural traits regarding families in long-term care decision-making for foreign-born immigrants. Findings suggest cultural beliefs influence responses to long-term care interventions, as mismatches between preferences and care arrangements can impact their satisfaction and well-being.
Duran-Kiraç et al. (2023) adopted a different approach in their qualitative study, offering insights from informal caregivers and nurses about access to culturally appropriate health care for ethnic minority Elders living with dementia. Both groups experienced dilemmas in building and maintaining relationships, acknowledging limited cultural knowledge and skills, stereotypical thinking, lack of collaboration with and within families, and language barriers. These dilemmas were perceived as impeding the ability to advocate or provide culturally relevant care. Nurses perceived not sharing a cultural background with ethnic minority Elders living with dementia to be a dilemma. However, this study revealed a shared cultural and linguistic background is not always necessary to receive appropriate care. Findings highlighted the need for improved nursing skills, better understanding of family dynamics, and increased support for informal caregivers to enhance CC for ethnic minority Elders living with dementia. Similarly, Gray and Kim (2024) explored nurses and certified nursing assistants’ challenges when providing palliative care in RACHs. Cultural care needs of residents included religious, spiritual, and dietary preferences. End-of-life and religious preferences of residents and their families created challenges for nurses when aspiring to provide culturally relevant care, highlighting a similar need for enhanced CC among health care providers.
Person-Centered Care
PCC was described in two qualitative studies, a quantitative study, and a mixed-methodology study. Bosma and Smits (2022) provided insights into the experiences of professional caregivers caring for migrants with dementia and behavioral changes. This study confirmed the importance of providing care that is respectful to migrants’ personal and cultural backgrounds, habits, and language. Findings showed that negative experiences in communication and collaboration lead to negative emotions and decreased motivation to provide care, whereas positive experiences motivate the development of PCC for migrants. Therefore, to provide high-quality care for migrants living with dementia, it is essential to support caregivers by providing professional education that addresses both communication and collaboration skills. Similarly, Strandroos and Antelius (2017) addressed multidimensional character of communication and interaction between care staff and residents from CALD backgrounds in a RACH. The study emphasized while a shared spoken language is a key source to facilitate communication, as it provides a sense of security and increase well-being, it is neither the sole source nor a guarantee of creating common ground. Other forms of communication, such as body language, tone of voice, embodiment, artifacts, and physical environment are equally important. Authors proposed that there is a risk of oversimplifying complex situations by focusing on only one form and aspect of communication, as effective interaction is an evolving process that develops, changes, and is created over time, rather than being static. They argued that the ability to communicate is not something an individual possesses or lacks; instead, it is situationally and collaboratively constructed through elements of time and familiarity. These elements are considered essential resources for maintaining continuity in interpersonal relationships that are central to PCC.
O’Dwyer et al. (2024) explored the diversity of aged care residents in Australia who prefer to speak languages other than English and the implications for their care. Authors found that even among the top 20 preferred languages, one in five residents is the only speaker of their language in their RACH, including Arabic, suggesting they may be vulnerable to cultural, linguistic, and social isolation. O’Dwyer et al. (2024) found that even when residents from CALD background were supported by people who spoke their language, they could be prone to isolation, confirming Strandroos and Antelius (2017) findings that a common language does not overcome cultural differences nor is it a guarantee for common ground.
The mixed methodology study by Nettleton and Sufan (2017) explored Arabic-Australian communities’ attitudes toward an innovative model for people aged 65 and above, to facilitate independent behavior within a shared living environment. Authors proposed that this shared form of accommodation can contribute to a more agile, mobile, and social future, thereby facilitating, reinforcing, and prolonging physical and mental well-being. As an innovative model, the adoption of this shared accommodation is likely to be influenced by various individual and institutional factors; however, it validates the potential within Australian-Arabic communities to broaden living options for people aged 65 and above.
Meaningful Engagement
The single qualitative study conducted by Juul et al. (2019) in Australia on meaningful engagement emphasized the role of technology among CALD residents. Findings demonstrate technology can offer a resource-efficient solution to address social and physical inactivity in RACHs. Modern technology, such as touch screen technology, has been shown to increase meaningful physical and social engagement, effectively surpassing language and cultural barriers. However, residents’ engagement is influenced by interdependent factors, including environmental, organizational, caregiver, resident, and management- and government-related factors. While this study provides valuable insights to CALD residents from non-English speaking backgrounds, its findings are relevant for promoting meaningful engagement among Arab Elders in RACHs.
Person-Centered Care and CC
Two publications explored the intersection of PCC and CC. The opinion piece by Khan and Ahmad (2014) advocated for expanding culturally and religiously appropriate care options for Muslim Elders residing in Western countries. Authors emphasized the importance of integrating Islamic faith considerations into care planning and delivery to ensure that practising Muslims receive PCC. They highlighted the critical need to address language and cultural barriers as they significantly contribute to the isolation of older individuals from smaller communities. To overcome these challenges, authors recommended training aged care staff to be sensitive to the needs of Muslims and stressed the importance of thorough planning. This includes addressing specific needs, such as Islamic washing practices, ablution facilities, prayer spaces, and dietary requirements. In addition, they suggested that Muslims must contribute to CC in aged care by advocating for their needs and recommended leveraging the expertise of faith-based and charitable organizations in planning these services.
The Canadian study by Tayab and Narushima (2015) explored perceptions of CC among personal support workers in a RACHs. Findings indicated that personal support workers practiced CC through sensitivity and respect for the unique needs and preferences of each resident. Achieving CC is an ongoing daily practice that evolves to meet the changing needs of residents as their conditions progress. This study proposed that becoming culturally competent is related to the work environment, and when the environment supports flexible and collaborative work, ethnoculturally diverse personal support workers can become cultural brokers to enhance culturally competent care.
Discussion and Implications
This scoping review sought to identify, scrutinize and synthesize literature on culturally appropriate care practices for migrant Arab Elders living in RACHs globally. To answer the research question, some publications identified practices used with CALD residents including language-specific services such as using interpreters and language boards (Runci et al., 2005), communicative resources such as body language, tone of voice, embodiment, artifacts, physical environment, time and familiarity (Strandroos & Antelius, 2017), and use of touch screen technology (Juul et al., 2019). These practices reflect different direct and indirect approaches to culturally appropriate care. However, included publications still examined the needs of CALD residents in a broader context, not recognizing distinct needs, values, and beliefs of each ethnic group.
Publications called for action to implement principles of PCC and CC. These include educating and training nurses, health care providers, and professional caregivers working closely with residents to provide a higher quality of care that is culturally appropriate. Culturally appropriate care specifically related to increasing knowledge of ethnic groups by conducting comprehensive and culturally sensitive assessments across subpopulations, such as the Arab world and Middle Eastern populations (Al Abed et al., 2014; Bosma & Smits, 2022; Duran-Kiraç et al., 2023; Gray & Kim, 2024; Hasnain & Rana, 2010; Juul et al., 2019; Khan & Ahmad, 2014; O’Dwyer et al., 2024; Runci et al., 2005; Tayab & Narushima, 2015).
Meaningful engagement can be considered a practical application of principles of PCC and CC, especially for migrant Elders living in RACHs. However, as only one study explored meaningful engagement in relation to PCC, this theoretical gold standard of care appears underutilized for individualized engagement approaches that embrace each individual’s unique history, identity, and personal resources (Brooker & Latham, 2016). The scarcity of included research studies on meaningful engagement in RACHs indicates a need for more focus on translating PCC principles into practice, particularly for migrant Elders from specific ethnic groups, such as migrant Arab Elders.
A common recommendation was the contribution of Elders themselves by advocating for their needs and values and collaborating with their families and community to better support service planning, designing, and implementation (Diederich et al., 2022; Duran-Kiraç et al., 2023; Hasnain & Rana, 2010; Khan & Ahmad, 2014; O’Dwyer et al., 2024; Runci et al., 2005). This recommendation closely aligns with the process of co-design, which is “bringing in the experience of users and their communities to the design of services” (Robert et al., 2021, p. 327). The WHO (2023) definition of meaningful engagement as respectfully and fairly including individuals in a range of activities, within an enabling environment, valuing their experience, and applying it to enhance health outcomes; strongly corresponds with the co-design approach. Du Toit et al. (2019) highlights that obtaining information to appreciate resident’s circumstances and subjective experiences is the first step to promote meaningful engagement. As reviewers with lived experience as migrants and occupational therapists—one with an Arabic background—we argue that these concepts should be interconnected when implementing culturally appropriate care practices for migrant Elders in RACHs. Occupational therapists, through a co-design approach, can collaborate with residents and their families to identify personally and culturally valued occupations, adapt the environment to be familiar, and address barriers to participation, thereby offering a practical framework to meaningful engagement (Du Toit & Buchanan, 2018; du Toit et al., 2019, 2020; Patel et al., 2022; Portillo et al., 2023).
A critical element in living in RACHs is developing a sense of belonging within this new community (Matarese et al., 2022), which is closely linked to making an informed decision and exercising autonomy for this living arrangement. Having the option to favor living there as a proactive choice would positively influence well-being and quality of life, as it respects residents’ dignity and personal values, and supports the principles of healthy aging (World Health Organization, 2017). Mismatches between preferences for care arrangements can impact residents’ satisfaction and well-being. Therefore, a crucial step preceding culturally appropriate care within long-term care settings would be considering cultural beliefs on the intention to use long-term care settings as a preferred option. The studies by Diederich et al. (2022) and Nettleton and Sufan (2017) investigated the intention to use long-term care settings and how cultural differences in family ties shape immigrants’ decisions. Their findings confirm the need to not only consider distinct needs, values, and beliefs of each ethnic group, but also the unique perspectives of individuals within these groups.
This scoping review had several implications for RACHs, particularly concerning the care of migrant Arab Elders. The lack of targeted studies on migrant Arab Elders’ needs in RACHs indicates a significant gap in the literature. This implies a necessity for more focused research to understand unique cultural and linguistic needs of this group. Future studies should aim to provide a more comprehensive picture of these needs, moving beyond generalized approaches to CALD residents, and exploring the deep-seated values, beliefs, and practices that shape the experiences and expectations of migrant Arab Elders. Furthermore, limited exploration of meaningful engagement for Arab Elders suggests significant potential for improving quality of care through co-design approaches, by involving Elders and their families in care service planning and implementation. This application of culturally appropriate care practice would demonstrate how principles of PCC and CC can be specifically applied to enhance the quality of life for this population. Addressing these gaps could significantly enhance the understanding of how to provide culturally appropriate care for migrant Arab Elders in RACHs, potentially leading to improved care practices and better outcome for this population.
Limitations and Strengths
Limitations largely relate to the scope of search. First, this scoping review focused exclusively on peer-reviewed studies and opinion pieces. Not incorporating gray literature potentially excluded unpublished research relevant to the topic. Second, because none of the studies specifically focused on migrant Arab Elders living in RACHs, included studies were extended to contain data where one or more of participants were Arab.
Despite limitations, a key strength of this scoping review was its adherence to rigorous methodological processes, being conducted and reported in accordance with JBI methodological standards and PRISMA-ScR framework and checklist (See Supplementary Table 5). Another strength lies in the reviewers’ positionality, which enabled a critical examination of the included publications that may inform culturally appropriate care.
Conclusion
This scoping review reveals significant gaps in research addressing specific needs of migrant Arab Elders in RACHs. While general culturally appropriate care practices for CALD residents have been identified, targeted interventions for this population remain underexplored. The concept of meaningful engagement also requires further investigation in this context. The review highlights the need for culturally appropriate care that considers both shared cultural traits and individual preferences. Co-design approaches, involving Elders and their families, holds promise for enhancing quality of care. Future research should focus on developing a nuanced understanding of how cultural background shapes care experience and explore meaningful engagement to create culturally appropriate care practices. Occupational therapists are equipped to address these gaps and enable PCC that respects the dignity and unique needs of migrant Arab Elders. We need to consider how we mobilize ourselves to create evidence informed practice that ultimately improves the quality of life for migrant Arab Elders living in RACHs.
Supplemental Material
sj-docx-1-otj-10.1177_15394492251360231 – Supplemental material for Scoping Review: Culturally Appropriate Care for Arab Elders in Long-Term Care Settings
Supplemental material, sj-docx-1-otj-10.1177_15394492251360231 for Scoping Review: Culturally Appropriate Care for Arab Elders in Long-Term Care Settings by Najat Abdulhadi H. Alhaizan and Sanetta Henrietta Johanna du Toit in OTJR: Occupational Therapy Journal of Research
Footnotes
Acknowledgements
The authors extend sincere gratitude to Ms Elaine Tam, an academic librarian at The University of Sydney, for her invaluable assistance in the database search process, which significantly enriched the quality of this review.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
This scoping review involves analysis of existing literature and does not include primary research with human participants. Therefore, ethical approval and informed consent were not required.
Data Availability Statement
All studies included in this scoping review are fully referenced in the reference list and can be accessed through their respective citations. The full search strategy, including an example of database search for MEDLINE, is detailed in Supplementary Table 1 (Search Terms) and Supplementary Table 2.
Supplemental Material
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References
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