Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations

Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations Noeman Ahmad Mirza, Wendy Hulko This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7490541/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Culturally safe dementia care (CSDC) remains inconsistently defined, which makes it difficult for health professionals and researchers to operationalize in practice. To clarify CSDC, we conducted a concept analysis using Rodgers’ evolutionary method. Eighteen records from diverse cultural groups and care settings were included. Prominent surrogate terms were cultural sensitivity, cultural competency, and cultural appropriateness, while common related terms were person-centred care, compassionate care, and holistic care. Antecedents included provider awareness through self-reflection and commitment to continuous learning, as well as structural, organizational support. Core attributes of CSDC focused on provider qualities such as demonstrating respect, building trust, using culturally responsive communication, and applying holistic and strengths-based approaches; other attributes pointed to organizational responsibilities like creating affirming care environments, providing information, and honouring cultural preferences. Consequences consisted of reduced social isolation and fear of discrimination, and improved trust, care experiences, and quality of life. This analysis emphasizes that CSDC requires ongoing reflection, meaningful engagement, and system-wide accountability. Importantly, CSDC must be co-created with families and communities and should be rooted in their knowledge systems, histories, and priorities. To support application, we share a conceptual model and four model cases to illustrate CSDC in both urban and rural healthcare settings. The model offers a practical pathway that can guide care providers and organizations in implementing culturally safe approaches. Clearer operational frameworks and community-led strategies are needed to move from intention to sustained, culturally grounded practice. culturally safe dementia care cultural safety dementia older adults concept analysis Figures Figure 1 Figure 2 Introduction More than 55 million people around the globe live with dementia; and this number is expected to more than triple by 2050 (Alzheimer’s Disease International [ADI], 2025). However, this rise could be slowed with substantial reduction in modifiable risk factors (Livingstone et al., 2020). Along with this projected rise, many countries of the Global North are also becoming increasingly ethnically and racially diverse. For example, in 2021, 23% of the Canadian population was foreign born and 26.5% identified as visible minorities; South Asians, Chinese, and Black made up 60.5% of the latter group (Statistics Canada, 2023). Importantly, the older adult demographic also showed increasing ethno-cultural diversity, largely due to immigration(Carrière, et al., 2016). This demographic shift is coupled with recent data indicating that 30% of Canadians report facing discrimination or unfair treatment, particularly in employment settings, yet also when seeking healthcare; and racialized people face elevated levels (Statistics Canada, 2024). Due to the increase in dementia among Indigenous people and the associated lack of cultural safety in healthcare, the Alzheimer Society of Canada (2024) recommends that health care and research sectors adopt cultural safety and humility. Even the World Health Organization’s (WHO, 2017) global action plan on dementia stresses the importance of culturally sensitive/responsive/appropriate interventions in relation to health and awareness campaigns, dementia risk reduction, and health and social care for persons living with dementia and their care partners. Since then, global reports have paid attention to culture in relation to diagnosis, cultural sensitivity in dementia risk reduction, and cultural safety (for Indigenous people in Canada) (Alzheimer’s Disease International [ADI], 2024; 2022; ADI et al., 2024; Gauthier et al., 2021). The most recent global report (ADI, 2025) noted the threat posed to ADI’s guiding values of diversity and inclusion and paid scant attention to culture. As the population ages and diversifies, interest in how culture affects dementia care continues to grow considerably while more responsibility is being placed on educators, practitioners, and policy makers to prepare clinicians who are culturally responsive and safe ([Anonymized for review]). There is an expanding body of health literature that references culturally safe dementia care (CSDC), yet inconsistently defines and operationalizes this concept. There is uncertainty about the defining attributes of CSDC, its boundaries, and how the definition may be extended to better reflect diverse cultural realities. Therefore, there is a need to establish greater conceptual clarity of CSDC so it can be consistently defined and integrated into professional education, clinical practice, and healthcare systems. In this paper, we report on a concept analysis of CSDC with the aim to advance understanding, inform practice, and identify future directions for research. Background Experts and scholars conceptualize CSDC in different ways. For example, Shrestha (2024) views CSDC as a set of approaches that empower cultural identity, sensitivity, and well-being for individuals living with dementia. Among Indigenous peoples of Northern Ontario, CSDC is seen as a collaborative partnership between Indigenous Elders, knowledge holders, and healthcare providers to develop care plans that integrate traditional and biomedical practices (Shrestha & Shrestha, 2023 ). Other scholars researching trauma-informed and community-centred approaches describe CSDC as an approach that recognizes culture, the collective nature of family and community decision-making, and the need for upholding respect for Elders (LoGiudice et al., 2023 ). Goldberg et al. ( 2025 ) link cultural safety to justice and equity for Aboriginal and Torres Strait Islander peoples, which includes ensuring race and racism are discussed and individual care is connected to community. Despite similarities in how scholars define CSDC, there is conceptual ambiguity which creates challenges for practice, education, and policy. Several reviews indicate that culturally and linguistically diverse (CLD) older adults with dementia have unique needs. For example, Cabote et al. ( 2023 ) report that care facilities often fail to meet the CSDC needs of CLD older adults. These needs include access to traditional food, culturally relevant activities, and language support. Martin et al. ( 2019 ) also discuss how dementia care services overlook CLD older adults’ sense of identity, belonging, and emotional safety. Similarly, McGrath et al. ( 2022 ) show that care facilities lack culturally meaningful and familiar activities, which could reduce care recipients’ quality of life and cause them to feel disengaged and lonely. Despite these reviews, there continues to be limited awareness about CSDC approaches that address the unique needs of CLD older adults. Gaviola et al.’s ( 2024 ) review on CLD older adults with dementia also identifies the lack of traditional foods, cultural activities, and language-congruent interactions as barriers faced by care recipients. The authors explain that these barriers could weaken care recipients’ sense of identity and belonging, which are important for well-being in later life. They also highlight that healthcare facilities are unable to meet such cultural needs due to systemic constraints like minimal staff training, time pressures, and task-based care models; and call for healthcare systems to refocus care practices from task-oriented to culturally appropriate, person-centred approaches that build staff capacity, adapt organizational policy, and ensure family involvement in culturally appropriate care planning (Gaviola et al., 2024 ). While the term CSDC is increasingly used in literature, its conceptual foundations remain underdeveloped. There have been several concept analyses that address cultural concepts in healthcare more broadly. For instance, Marzilli ( 2014 ) examined ‘culture’ as a standalone concept, while other scholars examined ‘cultural competence’ in numerous analyses for over two decades (Abualhaija, 2021; Cai, 2016 ; Dudas, 2012 ; Henderson et al., 2018 ; Jeong et al., 2016 ; Sharifi et al., 2019 ; Suh, 2004 ). However, these works primarily focus on general healthcare delivery without attention to specific populations or conditions, such as older adults or persons living with dementia. The literature also consists of concept analyses on ‘cultural sensitivity’ (Foronda, 2008 ; Aghajari et al., 2019 ) and ‘cultural safety’ (Bozorgzad et al., 2016 ; Garneau & Pepin, 2012 ; Yeung, 2016 ). Of these, Yeung ( 2016 ) took a more comprehensive approach in that they defined traditional and contemporary views of culture and clarified terms such as cultural knowledge, awareness, sensitivity, competence, safety, humility, and proficiency. However, none of these conceptual papers focus on the aging population. Foronda et al. ( 2016 ) and Isaacson ( 2014 ) explored and defined ‘cultural humility’ but did not relate the concept to dementia or any specific health condition. Foronda et al., ( 2016 ) outlined how clinicians could lead a path of cultural humility – by being egoless, open, self-aware, and reflective self-critics who can recognize power imbalances and demonstrate respect for diversity. The 36-item Cultural Responsiveness Assessment Measure is a self-reflection tool developed for Australian mental health practitioners that measures cultural safety by four items that include seeking guidance from Indigenous clients, taking time with clients, changing the workplace environment, and asking Indigenous clients about their culture (Smith et al., 2024 ). Despite a growing interest in culturally responsive approaches to care, none of the existing conceptual papers systematically examined the application of cultural safety within dementia care. To our knowledge, a concept analysis of CSDC has not yet been published in health literature. Although several scholars recently attempted to discuss CSDC and what it might entail ([Anonymized for review]; LoGiudice et al., 2023 ; Shrestha & Shrestha, 2023 ; Shrestha et al., 2024 ), there is no clear definition of CSDC for healthcare providers and organizations. It is still unclear as to how this concept is understood, taught, and demonstrated by healthcare providers and organizations. The lack of conceptual clarity could prevent care providers from properly articulating CSDC and researchers from evaluating it. Care providers may experience tensions between Western approaches to individualized dementia care and cultural generalizations, the limited representation of racialized older adults in dementia care models, and the structural and systemic barriers that constrain CSDC. Hence, there is a critical need to clarify CSDC so care providers and organization can provide dementia care that is safe, equitable, and of the highest quality. This concept analysis uses Rodgers’ ( 1989 ) method to define CSDC. This evolutionary method takes into consideration that some concepts like CSDC are dynamic and evolve in response to historical, cultural, and socio-political influences. Conceptual Framework According to Rodgers ( 1989 ), a thorough concept analysis requires the examination of surrogate terms, related terms or concepts, antecedents, consequences, and defining attributes in order to distinguish the focal concept from similar or overlapping ideas. Surrogate terms are those that carry the same meaning as the concept under consideration, whereas related terms or concepts are similar but differ in certain key characteristics. Rodgers ( 1989 ) defines antecedents as events or phenomena that must occur prior to the manifestation of the concept. In contrast, consequences refer to the events or outcomes that follow the occurrence of the concept. Defining attributes are described as the core characteristics or features that consistently appear when the concept is enacted or expressed. Once these evolutionary dimensions are clarified, Rodgers ( 1989 ) recommends constructing a model case that exemplifies the concept and illustrates its defining attributes in practice. Methods Data Sources A search was conducted using the Discover! search engine, which indexes 63 interdisciplinary databases. We used a range of search terms grouped under three categories: dementia, cultural safety, and care (see Table 1 ). After combining the results, the search yielded 425 records from various databases including MEDLINE, CINAHL, Complementary Index, APA PsychInfo, Academic Search Complete, Supplemental Index, Biomedical Reference Collection, Directory of Open Access Journals, ScienceDirect, ERIC, ProjectMUSE, SwePub, and JSTOR. Table 1 Search Strategy Searches Categories Keywords Results S1 Dementia dementia (in abstract) 393,067 S2 Cultural Safety “cultur* safe*” OR “cultur* competen*” OR “cultur* sensitiv*” OR “cultur* aware*” OR “cultur* humility” OR “cultur* appropriat*” OR “cultur* relevan*” (in abstract) 111,517 S3 Care care OR caring (in abstract) 5,863,856 S4 S1 + S2 + S3 425 We limited the search results to English-language and peer-reviewed journal articles published within the last ten years (2010–2021). This narrowed the results to 332 records. After removing duplicates electronically (using the search engine’s de-duplication feature) and manually, we identified a total of 102 records. The abstracts of these 102 records were screened using predefined inclusion and exclusion criteria to determine which would undergo full-text review. We included research studies that focused on: Persons living with dementia; Cultural sensitivity, humility, safety, competence, and/or awareness; Formal care; and The context of providing culturally safe dementia care. During abstract screening, 88 records were excluded: 65 that did not meet the inclusion criteria; 11 knowledge syntheses (including literature reviews [n = 4], systematic reviews [n = 5], and scoping reviews [n = 2]); 7 were mixed formats, including abstracts (n = 2), editorials (n = 2), commentaries (n = 2), and a letter to the editor (n = 1); 5 were other documents such as a report (n = 1), product information (n = 1), poster (n = 1), or book reviews (n = 2). For some records, the abstract did not provide enough detail to determine inclusion. In these cases, we read the full text to make a final decision. We then reviewed the full text of the remaining articles to assess eligibility. The initial 2021 search process yielded a total of 14 articles (Fig. 1 ). A second search was conducted in March 2023, which resulted in 190 articles. After removing duplicates, 66 articles remained. We applied the same inclusion and exclusion criteria and excluded 62 articles – some of which were posters (n = 8) or did not meet the criteria (n = 54). This second search yielded 4 additional articles. From both searches combined, we identified a final total of 18 articles, which we included in our analysis. Data Extraction To establish consistency and ensure that the team extracted data using a common approach, we each independently reviewed and extracted data from a few of the 18 selected articles, following Rodgers’ ( 1989 ) evolutionary concept analysis method. This initial exercise allowed us to compare interpretations, reach consensus, and develop a shared understanding of the extraction process. After this step, each team member – including the authors and two research assistants – extracted data from several additional articles. We met to discuss findings and resolve any differences. This iterative process was repeated once more until we had extracted data from all 18 articles. The data extraction phase helped deepen our understanding of the various components of CSDC. We organized the extracted data according to the conceptual categories outlined by Rodgers ( 1989 ): surrogate terms, related terms, antecedents, consequences, and defining attributes of CSDC (see Table 2 ). Table 2 Data Extraction # Article Surrogate Terms Related Terms Antecedents Attributes Consequences 1 Clark et al. ( 2018 ) • Cultural competency • Cultural expectations • Cultural sensitivity • Cultural values • Cultural needs • Strengths-based approach • Patient-centered • Appreciation for complexities of cultural groups. • Demonstrate a strengths-based approach. • Understand family dynamics. • Understanding economic barriers and distrust of health system. • Build rapport. • Build trust and collaborative relationships. • Respect and support cultural values. • Provide one point of contact. • Aware of resources to refer or access. • Help ease transitions through medical providers. • Relieve ambivalence. • Offer education on aging and dementia. • Improving access to healthcare • High-quality, patient-centered care. 2 du Toit & Buchanan ( 2018 ) • Cultural humility • Person-centered care • Cultural diversity • Compassionate care • Cultural and linguistic diverse • Learn about individual needs. • Tailor care to include embracing difference. • Education in person-centered care. • Demonstrate person-centered care. • Quality interactions with clients. • Promote active engagement with other residents, family, and staff. • Build relationships and opportunities to connect with residents, resident’s family, and staff. • Understand and respond to needs. • Embrace difference. • Compassionate care. • Increased patients feeling of belonging. • More positive outcomes with residents. • Better able to tailor care for the person and support person-centered care. 3 Forbes et al. ( 2013 ) • Cultural sensitivity • Culturally relevant • Culturally appropriate • Client-centered approach • Respectful, caring relationships. • Consistent care and sustainable community programs. • Incorporate beliefs, values and language. • Involving care partners and family in care. • Trusting relationships. 4 Fredriksen-Goldsen et al. ( 2018 ) • Cultural competency • Culturally relevant • Inclusivity • Awareness of context of LGBT older adults’ lives and relationships. • Assess own attitudes and beliefs. • Address personal biases • Create a welcoming and affirming environment. • Recognize diversity, strength, and resiliency. • Be inclusive and responsive to LGBT older adults with dementia. 5 Goeman et al. ( 2016 ) • Culturally sensitive • Culturally relevant • Culturally and linguistically diverse • Knowledge and understanding of barriers in receiving care. • Self-reflection. • Organizational support. • Advocacy skills. • Provide information and interventions that are culturally relevant. • Listening skills. • Knowledge of dementia. • Interpersonal skills. • Build trusting relationships. • Assessment abilities. • Understanding and acceptance of different cultures. • Tailor support around person, care provider, and family. 6 Hämäläinen et al. ( 2021 ) • Culturally sensitive • Culture-centered • Context aware • Culturally safe • Culturally specific • Culturally empathetic • Person-centered care • Person-oriented attitude • Intercultural healthcare • Cultural diversity • Uses the person-centered approach. • Aware of cultural differences and the embodied history of peoples. • Culturally sensitive knowledge. • Have knowledge of the possible assimilation history of the specific Indigenous group. • Healthcare workers lack of knowledge of Sami cultural markers. • Hushing occasionally yoiking elderly. • Persecution of and assimilation pressure of Sami people. • Incorporate yoik into both therapeutic and daily care provision. • Connect the persons living with dementia to their past. • Treat yoik as a means of communication. • Ensure the situation is acceptable for yoiking. • Meet people with an open, curious, and person-oriented attitude. • Support fundamental human needs of self-expression, communication, social inclusion, and the feeling of being alive. • Evoked life and functioned as a means of reminiscence and recognition. • Functioned as enlivening but also calming. • Facilitated everyday well-being. • Enhanced confidence of person with dementia. • Recognition, memories, joy and contentment. • Connected Sami with their ancient history, nature, family members, and ancestors. 7 Hanssen ( 2013 ) • Cultural understanding • Culturally appropriate • Intercultural care • Openness to foreign cultural expressions. • Inability to engage in spiritual practices. • Realization that different cultural backgrounds may have different needs. • Learn about thoughts and expectations of particular patients. • Language barrier, leading to miscommunication. • Patience. • Stuck to rigid schedule. • Create caring and meaningful environment. • Create reciprocal understanding between patients and health care personnel. • Understand cultural influence on behaviour apart from dementia. • Understand importance of cultural food. • Awareness of sleep and routine of patients. • Improvement of reciprocal understanding. • Helps promote feeling of safety. • Promotes feeling of belonging. • Creates trusting relationships. • Create a safe environment. 8 Hanssen & Kuven ( 2016 ) • Culture-sensitive • Culturally relevant • Cultural identity • Culture [as] identity and heritage N/A Traditional food (Sami, Norwegian & Black South African) – linked to particular regions, sensory qualities, celebrations/seasons. • Increases sense of identity, belonging, joy, and quality of life. 9 Haydon et al. (2022) • Culturally appropriate • Culturally relevant • Culturally safe • Culturally inviting • Social Emotional Wellbeing Model • Bronfenbrenner’s Bioecological Model of Human Development • Biomedical model • Strength-based • Social determinants of health (SDoH) • Cultural stereotypes • Cultural significance of place • Inclusive approach to care • Taking into consideration the SDoH • Cultural stereotypes distorting interpretation of symptoms. • Limited access to health services. • Maldistribution of specialty services. • Lack of local dementia knowledge. • Competing priorities in the provision of healthcare. • Acknowledgement of social, political and economic factors that affects health and access to healthcare. • Focus on dignity, privacy and safety. • Provide access to care on one’s own Country and within one’s own Community. • Increasing family and carer support. • Recognizing the importance of community cohesion and strength. • Nurture the social and emotional well-being. • Support based rather than treatment-based services • View dementia as a shared experience (individuals family, kin community). • Considering cultural significance of Place (persons connection with ancestral land or country). • Promoted agency and involvement in decision making (patient, family, and local community). • Tackled dementia in a more cohesive and strength-based way. • Reduced likelihood of discrimination. • Created a more inclusive approach to care. • Increased local dementia knowledge. • Improved access (cultural and geographical). • Increased community cohesion. 10 [Anonymized for review] • Culturally competent • Culturally sensitive • Culturally appropriate • Culturally safe • Culturally relevant • Kawa Whakaruruhau • Person-centered care • Indigenous determinants of Health Model • Post-Colonialism • Settler colonialism • Trauma-informed care • Historical/cultural trauma • Cultural practices/activities • Cultural differences • Cultural needs • Biomedical perspective • Connection to the land • Education to change nurses knowledge skills and values (online or in-person). • Culturally appropriate information. • Culturally safe assessment tools. • Awareness of settler colonialism and cultural trauma. • Teaching stories (through storytelling sessions) to teach about CSDC • Understanding culture. • Respecting beliefs. • Openness to family initiating cultural practices • Conflict between organizational policies and rules and Indigenous ways of being. • An organization that creates conditions that facilitate culturally safe and trauma-informed care. • Nurses do not receive specialized training but are expected to provide culturally safe care. • Preventing dysfunction. • Predominance of biomedical perspective. • Assessment of care home culture and structural barriers within them which prevent carers ability to provide CSDC. • Incorporating connection to the land in PCC. • Understanding the impact of colonialism and cultural trauma on people with dementia. • Objects, food, stories that make client feel safe • Advocating/accommodating large families and frequent visits to allow for storytelling • Practicing cultural activities • Integrating spiritual, familial, and cultural foundations. • Should always take place within the context of families, communities, and nations. • Should be oriented towards the collective rather than the individual • Care must match the individual, historical trauma, understanding culture, staying connected with family and community, and relationship with the healthcare team • Open up the conversation at the start, nurturing traditional practices, the importance of advocacy, history impacts the present. • Responds to individual needs and preferences, including those based on spiritual, families, and cultural foundations • Creates an environment where family can bring traditional items or initiate cultural practices without concern or fear • Recognizes the importance of residents not losing their beliefs • Advocates to accommodate for large families so they can support their loved ones. • Advocates when policy is not aligned with residents' cultural needs. • Ask questions respectfully. • Demonstrates awareness that history impacts the present and can create anxiety when transitioning into the facility • Integrates and nurtures traditional practices, slowness, silence, and listening. • Views the family and community connection as a strength • Respectfully integrates cultural knowledge of a specific nation. • Settler colonialism and cultural trauma factored into assessment, information sharing and care processes. • Bridge cultural differences; improving their knowledge, skills and values with respect to providing culturally safe dementia care. • Resident feeling happy and comfortable in how they are cared for. • Residents' traditions are upheld. • Incorporation of Indigenous perspectives of dementia including shifting away from medical jargon and reasoning beyond “plaques and tangles”. • Consideration of the impact of history including IRS, and caring for Elders in the context of their families, communities and nations, rather than autonomous individuals. • Facilities/staff has increased knowledge of Indigenous culture • Residents have no fear of engaging in cultural practices. • Removal of barriers to enacting culturally safe care. 11 Inoue et al. ( 2021 ) • Cultural responsivity • Cultural congruence • Culturally sensitive • Cultural understanding • Person-centered care • Compassionate care • Cultural differences • Cultural or language norms • Availability of companion volunteers of the same culture. • Staff aware of their limited abilities with residents (communication and time) • Facility staff lacking experience or familiarity with the cultural or language norms of older immigrants • Acceptance of cultural differences • Take time with the residents. • Communicate in native language including understanding nuances and cliche differences. • Demonstrate respect and a caring touch. • Provide gentle and compassionate care. • Provide culturally sensitive environment and make resident feel at home. • Recognize emotional and spiritual significance of actions (e.g. closing eyes and being peaceful with client) • Companions identify changes in patients and report them to staff. • Staff received guidance and cultural understanding from companions. • Providing cultural food. • Increased well-being. • Improved quality of life. • Allowed patient to communicate their needs and experiences. • Improved physical and emotional health. • Reduced social isolation. • Reduced loneliness. • Facilitated access to services. • More time and attention to person with dementia. • More detailed reports about patients' needs and symptoms. 12 Kim & Woods ( 2012 ) • Culturally competent N/A • Cultural and language barriers compounding miscommunication. • Respectful attitude towards older adults. • Understand importance of body position and proximity. • Improved dementia care through competence and social interactions. 13 Kim et al. ( 2014 ) • Culturally appropriate N/A • Being respectful towards older adults. • Display dementia and cultural appropriate communication, such as initiate greeting, use eye contact, simple phrasing. • Use a gentle pace of care. • Decrease behavioural symptoms. 14 Lewis et al. (2020) • Culturally responsive • Cultural humility • Cultural differences • Holistic care • Respectful of values and beliefs. • Seek better understanding of patient’s cultural beliefs and values. • View Alzheimer’s Disease and related dementias (ADRD) holistically. • Awareness of traditional healing. • Awareness of the importance of family and community. • Understanding that other cultures look at ADRD differently than traditional Western teachings. • Appreciate relationships are central. • Treat the person, not the disease. • Provide holistic care & treatment. • Demonstrate cultural humility & respect. • Greater patient quality of care. • Improved trust. • Increased adherence to health care services & treatments. 15 McAtackney et al. ( 2021 ) • Culturally appropriate • Two-Eyed seeing • Relationality • Willing to learn about context of the person and their family’s lives. • Education, networking, and support surrounding dementia as a chronic disease. • Understanding context of life/family (Relationality) • Honour house group structure • Learn a few Gitxsan words & role of Elder in community • Use caring body language • Acknowledge connection to land • Understanding of loss/grief within First Nations families & how dementia exacerbates this. • Respectful and positive relationships. 16 Sagbakken et al. ( 2020 ) • Cultural competence • Cultural awareness • Cultural sensitivity • Culturally acceptable • Culturally congruent • Culturally adjusted • Adjusted care • Linguistic and cultural diversity • Linguistic relativity • Holistic care • Biographical approach • Openness to different philosophies of life. • Open/neutral stance. • Recognize diversity within & between groups. • Serve culturally adjusted food & allow families to prepare it. • Linguistic and cultural diversity of workforce. • Understand diversity of each individual’s illness & views on it. • Understanding family context (larger rooms). • Continuity in relations, culture, and language. • Different religious activities • ‘Familiar & homely’ songs, music, literature, TV • Allocate more time & resources, including interpreters. • Holistic care (individual & socio-cultural needs). • Value linguistic relativity (way of speaking, use of certain words, religious and cultural references). • Respect attitudes to life-prolonging treatment. • Biographical approach to needs assessment & care planning. • Equitable, adjusted/adapted & dignified health care services provided to patients. • Trust between providers and patients. • Sense of identity maintained/confirmed. • People feel ‘at home’. 17 Syphers et al. ( 2019 ) • Cultural competency • Cultural humility • Cultural differences • Bicultural Approaches • Cross-cultural interactions • Early intervention. • Understanding of differences surrounding AD and dementia. • Familiarity with medicine wheel & oral traditions. • Appreciate dementia understood differently (not as problematic) & not reason for accessing healthcare. • Create relationships with AI families, tribes and communities. • Use bicultural approach (care plans). • Appreciate quality of life more important than diagnosis & prognosis. • Cultural humility. • Enhancement of cross-cultural interactions among health care providers and patients. 18 Vissenberg et al. ( 2018 ) • Cultural sensitivity • Culturally competent • N/A • N/A • Access to free professional translators. • Patient able to practice own language, culture and tradition. • Respect right not to know/that it is a taboo. • N/A Results The included articles are on studies done in various countries, including the United States (38.9%), Norway (22.2%), Canada (16.67%), Australia (11.1%), South Africa (5.56%), and the Netherlands (5.56%). Some studies looked at specific ethno-racial groups such as African-American, Korean-American, and Japanese, while others included those from ‘culturally and linguistically diverse backgrounds’ and immigrants, with the latter including Turkish, Surinamese, Moroccan, and Black South African people. Half of the studies were about research with Indigenous people, including Gitxsan, Secwepemc, Alaskan Native, and Sami. One article was on 2SLGBTQI + older adults with dementia. In terms of settings, eight studies (44.4%) took place in long term care, two (11.1%) in home and community care, one (5.6%) in acute care, and the remaining seven (38.9%) in a variety of settings. Surrogate Terms There were 51 surrogate terms in total that began with either cultural , culture , or culturally and these words were most often paired with notions of sensitivity (n = 9) or competency/competence (n = 8), followed by appropriateness (n = 6), relevance (n = 6), humility (n = 3), safety (n = 3), congruence (n = 2), and responsiveness/responsivity (n = 2), and understanding (n = 2). Kawa Whakaruruhau , the Maori phrase for cultural safety, was used once, as were the following terms related to culture: centeredness, specific, empathetic, inviting, expectations, awareness, acceptance, adjusted, and context-aware. Related Terms There were 53 related terms that pertained to the recipient of care or to the care provision or referenced specific models or the socio-political context. The terms referencing aspects of culture that were about care recipients were cultural differences (n = 4), culturally and linguistically diverse (n = 3), cultural diversity (n = 2), cultural needs (n = 2), cultural values , cultural or language norms, cultural practices/activities, cultural stereotypes , linguistic relativity, cultural identity , cultural significance of place , and culture [as] identity and heritage . The terms referencing care provision included: person-centred care (n = 4), strengths-based (n = 2), compassionate care (n = 2), holistic care (2) , inclusivity/inclusive approach (n = 2), person-oriented attitude, client-centred approach , patient-centred, biographical approach, trauma-informed care , adjusted care, relationality , and connection to the land; and terms denoting the merging of two cultures as in two-eyed seeing and bi-cultural approaches or multiple cultures as in inter-cultural (health)care (n = 2) and cross-cultural interactions . Several specific models were mentioned including biomedical model/perspective (n = 2), social emotional wellbeing model, Bronfenbrenner’s bioecological model of human development, Indigenous determinants of health model and social determinants of health. For the socio-political context, postcolonialism, settler colonialism and historical/cultural trauma were discussed. Antecedents We identified a total of 34 antecedents and conceptually organized them either to (a) care providers and their values and beliefs (i.e., the self), (b) barriers and triggers that point to cultural differences between care providers and care recipients, (c) care providers’ efforts to grow or shift their knowledge, skills, behaviours, and attitudes (i.e., growing the self), and (d) structural facilitators that promote care providers’ growth. Most antecedents fell into categories (a) and (c) with there being far less antecedents related to barriers and triggers and structural facilitators. This could be because the self appears to be interwoven with barriers and triggers, where the barriers trigger the self. The Self The self is about people as reflective and self-directed beings. In this stage healthcare providers should reflect on their own attitudes and beliefs and how cultural stereotypes and their own biases might distort symptom interpretation and lead to incongruent or inappropriate care decisions. Care recipients must learn to take a neutral stance and be open to varying cultural expressions and philosophies of life that are different from their own. They should try to become familiar with the complexities of the cultural group they are working with by being patient and displaying a genuine desire to learn about clients and their families. The self, in a way, represents a care provider’s readiness for CSDC. There are, however, some barriers to CSDC that care providers and organizations need to overcome. Barriers and Triggers To create mutual understanding and build relationships with care recipients, care providers need to overcome certain barriers that hinder the delivery of CSDC. In our analysis, we identified a few barriers. One major barrier is the cultural difference between care providers and care recipients. Another is the language barrier some care recipients face. Together these challenges can lead to assumptions, misunderstandings, miscommunication, and conflicting expectations about how dementia should be understood and managed. When care providers rely solely on the ‘biomedical perspective,’ it can make cultural and language barriers more difficult to overcome. Rigid organizational schedules and routines can further limit opportunities for spiritual or cultural engagement. If care providers do not overcome these barriers, they can become distant from care recipients, which could trigger feelings of culturally unsafe care by care recipients and their families. However, the same barriers if viewed from a different perspective, could be seen as triggers that feed ‘the self’ – e.g., taking a neutral stance and being open, patient, and ready to grow oneself. Growing the Self To become a CSDC practitioner, healthcare providers need to seek out learning opportunities to understand Alzheimer’s Disease and other dementias, diverse cultural worldviews, and the historical and ongoing impacts of settler colonialism and cultural trauma. This educational preparation can enable them to develop respectful attitudes toward the cultural beliefs and values of persons living with dementia. Educational tools and methods could include teaching stories and storytelling sessions on CSDC. These could help providers internalize the values and relational dynamics involved in CSDC. It is important for providers to recognize diversity within and between groups. For example, they can become more aware about 2SLGBTQI + older adults’ lives and relationships within a cultural group. It is also imperative for care providers to develop an understanding about economic barriers and distrust in the healthcare system that some care recipients experience when accessing care. During the initial assessment phase, care providers should recognize care recipients’ expectations, traditions, and cultural, family, and relational needs. Insight from this assessment should be incorporated into the collaborative care plan so that cultural needs can be addressed in a timely manner. Structural Facilitators There are several ways in which organizations can support health care providers’ readiness for CSDC. This includes providing education on person-centred care and by offering networking opportunities focused on dementia as a chronic disease. Educational preparation should include content on settler colonialism, cultural trauma, and assimilation histories. This historical awareness can enhance care providers’ understanding about the systemic and intergenerational factors that continue to shape care experiences. In addition to staff training, healthcare organizations also need to develop CSDC policies that ensure care programs are sustainable and consistent in their CSDC processes. Attributes We identified 64 attributes of a culturally safe approach towards older adults with dementia which we merged and grouped under five different categories. Four of these categories indicate the attributes the care provider should possess and demonstrate in their interactions with persons with dementia, their families and communities, while the other elucidates ways the organization can support or implement culturally safe dementia care. Care Provider Attributes Demonstrate respect through holistic and reciprocal approaches. Respect was identified by many scholars as a core principle for providing CSDC. This includes respect for cultural values, attitudes towards life-prolonging treatment, the right not to know or that it may be a taboo to disclose a dementia diagnosis among European immigrants, for example. Respect must be shown through active support and extends to appreciating non-Western views on dementia that differ from the bio-medical perspective that dementia is problematic and requires medical intervention. Culturally-informed views frame dementia holistically, where quality of life is seen as more important than diagnosis and prognosis. Further, along with appreciating the diversity of views of dementia, health care providers should pay particular attention to the uniqueness of each individual’s illness. The overall goal of this is to create a reciprocal understanding between care recipients and health care personnel. Build trusting, relational partnerships with person, family and community. Our analysis shows that there is a need for quality interactions between care providers and care recipients. To do this, care providers must establish rapport and build respectful, trusting, caring, and collaborative relationships. However, these relationships should not be limited to the care recipient only; rather, they should also be developed with the care recipient’s family, tribe, and community. To establish relationships, healthcare providers should create opportunities to connect with the client, the client’s family, and visiting community members. They should also involve the care partner and family in planning and performing care. To do this, care providers might need to accommodate large gatherings and ceremonies. Doing so may offer insight into the client’s life context and the importance of family and community, both of which are foundational to supporting relationality in care. Use inclusive and culturally responsive communication. When providing CSDC, care providers should incorporate the client’s beliefs, values, and language into care processes. This can be done through dementia and culturally appropriate communication, such as initiating a greeting and using eye contact and simple phrasing. It can also include valuing linguistic relativity and ways of speaking, and use of certain words and religious and cultural references. Providers should adapt their basic interpersonal skills, including advocacy, listening, and assessment, to the various cultural groups with which they work. CSDC also requires understanding cultural influences on behaviour apart from dementia. For example, a Sami care recipient may yoik (an ancient singing tradition), which could be mistaken for repetitive verbal utterances made by persons with dementia. Therefore, it is crucial for care providers to support clients in practicing their language, culture, and traditions as these practices may improve memory and recognition. To do this, care providers need free access to professional translators and interpreters. They also need access to gathering spaces so they can accommodate family visits and meaningful, memory-sharing practices like storytelling. Finally, providers should use biographical and bicultural approaches to assess needs and develop care plans that ensure the client’s background and culture is known and integrated. Apply holistic and strengths-based care approaches. CSDC includes the application of care models that highlight diversity, strength, and resiliency as in the strengths-based approach , as well as holistic care which considers individual and socio-cultural needs and addresses not only biological determinants of health, but also social determinants. Healthcare providers should demonstrate elements of person-centred care , including the core directive to treat the person, not the disease. Their approach should reflect compassion and understanding. They should be attentive to a care recipient’s body position and proximity and should respond with a gentle pace and caring body language. Care providers should also make room for meaningful connection between care recipients, their families, staff, and other clients. When working with Indigenous clients, care providers should take time to learn about and respect ‘Indigenous ways of being.’ They could do this by embracing cultural differences, incorporating traditional healing practices, acknowledging care recipients’ connections to land (for sustenance), and supporting visits from Elders and community leaders. Care providers should also take the initiative to understand how experiences of loss and grief are shaped within First Nations families and how dementia can intensify these experiences. For example, when working with the Gitxsan people who have a house group structure, learning a few words of the Gitxsan language and the role of the Elder in the community, are significant preparatory measures for the provider to take. Organizational Attributes Nurture cultural safety at system level. Organizational attributes indicate what both healthcare providers and administrators can do to ensure cultural safety extends beyond individual interactions. This includes creating environments that are caring, meaningful, welcoming, and affirming, and providing information and interventions that are culturally relevant. Such interventions may include religious activities; ‘familiar and homely’ songs, music, literature, and TV; honouring sleep and routine of clients; and, serving culturally adjusted food and allowing families to prepare it. For many communities – such as Sami, Norwegian, and Black South African people – traditional foods are deeply tied to particular regions, sensory qualities, celebrations, and seasons. Organizations should also create an environment where family can bring traditional items or initiate cultural practices without concern or fear. They should also ensure there is one consistent point of contact for families and communities. As part of their quality improvement efforts, organizations should also invest in a workforce that is culturally and linguistically diverse and accurately reflects the clientele the organization serves. Consequences Our analysis identified several consequences of CSDC, which we organized into three categories: healthcare system, care provider, and care recipient. Healthcare System By providing CSDC, healthcare organizations can transform care settings into safe environments that value competence and social interaction. These environments could support reciprocal understanding between care providers and care recipients and may also decrease behavioural symptoms. These could lead to improved access to healthcare services and high-quality, patient-centred care. By prioritizing CSDC, healthcare organizations could also provide equitable, adjusted/adapted, and dignified healthcare services to clients. Such efforts could lead to more positive outcomes and increased adherence to healthcare services and treatments. By embracing diversity and prioritizing culturally safe experiences for clients, organizations could enhance cross-cultural interactions between care providers and care recipients. This may lead to smoother care transitions within the healthcare system. By being a leader in CSDC, organizations could reduce discrimination and create inclusive environments where care recipients feel respected, seen, and valued. As CSDC leaders, organizations will be able to uphold care recipients’ traditions while minimizing their fear of engaging in cultural practices. Not only will such organizational efforts remove barriers to providing culturally safe care, their full support of CSDC will improve both cultural and geographical access. Healthcare organizations that continue to invest in CSDC will contribute to increased local dementia knowledge and capacity, which could help staff and communities better support culturally diverse populations. Care Provider The impact of CSDC on care providers can include them being more equipped with resources that can be accessed and to which care recipients can be referred. If providers are more knowledgeable about dementia as a chronic disease and culturally safe practices, they will be able to offer education on aging and dementia to others seeking to improve their knowledge and skills. Care providers that deliver CSDC may become more understanding and accepting of cultures that differ from their own. They will also be better able to provide person-centred care and tailor care to the needs of care recipients and their families. This approach could help care providers feel more confident and capable of delivering culturally responsive care. As care providers become more comfortable embracing cultural differences and building trust with care recipients, any hesitations or uncertainties they have could lessen. Learning about and practicing CSDC could deepen care providers’ understanding of Indigenous ways of caring and shift perspectives beyond the medicalization of dementia. By involving families and communities in decisions, care providers could make care processes more shared and supportive. This could make it easier to plan care that is collaborative and holistic. Care Recipient Feelings of belonging should be increased or promoted amongst care recipients who receive culturally safe dementia care, leading to feeling ‘at home’. CSDC evokes memories, supports recognition, and connects people with their history, nature, and ancestors. With CSDC, relationships also become more respectful, positive, and trusting, with increased overall trust between providers and patients. Care recipients will experience feelings of safety, including a safe environment to express their cultural identities. 2SLGBTQI + older adults with dementia will have a sense of being included and that care providers are responsive to their unique needs. CSDC will help care recipients maintain or confirm their sense of identity, sense of belonging, joy, and quality of life. In an environment that values CSDC and upholds care recipients’ traditions, clients (and their families) may feel happy, comfortable, and respected in how they are cared for. Hence, CSDC could lead to continuity in care recipients’ relations, culture, and language. Additional outcomes could include reduced social isolation, improved physical and emotional health, enhanced everyday well-being, and better communication of care needs and preferences. By supporting reminiscence and emotional connection to family, land, and cultural history, CSDC could also enhance cognitive engagement and spiritual well-being. Improved provider-patient communication may lead to more detailed and accurate reporting of needs and symptoms, which would allow for more responsive and individualized care. Ultimately, CSDC will contribute to greater inclusion, reduced fear of discrimination, and a strengthened sense of agency among care recipients. Model Case To illustrate the application of CSDC, four hypothetical model cases are presented: two depicting a care provider working with clients with dementia (one urban and one rural) and the other two representing healthcare organizations committed to CSDC (one urban and one rural). These cases demonstrate how key attributes of CSDC can be meaningfully integrated into dementia care at both the interpersonal and systemic levels. Urban Model Cases Nurse Marcus working with an African American client. Marcus, a Licensed Practical Nurse at a long-term care home, provides care for Linda, an 82-year-old African American woman living with moderate dementia. From their first interaction, Marcus approaches Linda with warmth, and addresses her as “Miss Linda” based on her preferences. He initiates conversations by referencing familiar aspects of Linda’s life such as the church, her family, and music. This helps create an atmosphere of mutual respect and cultural recognition. Marcus understands the importance of Linda’s spirituality and ensures she has access to her church’s livestreamed services and gospel music. This brings her comfort and improves her memory recall. Marcus works with Linda’s niece to create a memory book filled with family photos, recipes, and sayings. The book helps Linda reconnect with her identity and remember parts of her life that matter most. It includes stories from her younger years as a civil rights activist and her family’s history of standing up to racial injustice. Marcus understands that Linda’s experience of systemic racism and cultural trauma may shape how she feels and behaves around white authority figures. That is why, instead of focusing only on biomedical ideas of dementia, Marcus takes a broader approach that centres Linda’s emotional well-being and overall quality of life. He builds relationships with Linda’s extended family and invites them to participate in communal meals and storytelling afternoons. He advocates for traditional foods such as Gumbo or Shrimp and Grits to be included in the care home menu and coordinates with staff to protect Linda’s daily prayer routine. Marcus demonstrates an understanding of the historical significance of food, family, and church for the survival of African American people. Therefore, he treats these aspects of Linda’s care not as preferences, but as essential to her dignity and identity (i.e., her cultural safety). Marcus also documents Linda’s cultural values and biographical details, including her civil rights activism, in her care plan. He does this to ensure Linda receives consistent and culturally responsive care. Marcus adapts his communication style by using a calm tone, simple phrasing, and provides plenty of time for Linda to respond. While doing so, he remains attentive to nonverbal cues. Marcus embodies CSDC by deeply valuing relational care and by respecting not only Linda’s personal story but also the historical and cultural factors that continue to shape her experiences. Riverside Health Centre serving inner-city clientele. Riverside Health is an inner-city hospital located in Southwestern Ontario that serves a diverse population of older adults living with dementia. Many clients face challenges such as poverty, housing insecurity, and barriers related to sexual and gender identity. Riverside is committed to CSDC not just at the clinical level, but also at the organization level. There is a specialized dementia-friendly unit that includes private spaces for rest and prayer, a courtyard for cultural ceremonies and small gatherings, and meals adjusted to reflect care recipients’ cultural backgrounds. Staff complete mandatory training in trauma-informed, anti-oppressive, and 2SLGBTQI+-affirming care, which is co-developed with local community organizations. At the point of care, staff are supported through reflective practice sessions and monitored through clinical audits to ensure CSDC principles are enacted and recorded in care plans. A care charter, outlining the hospital’s commitments to dignity, cultural recognition, and safety, is posted in all public areas. Care recipients are encouraged to maintain spiritual and cultural practices, such as smudging, prayer, music circles, and family-prepared food. Visiting policies are flexible and care recipients have access to familiar objects and media. Families and friends are invited to care planning meetings and interdisciplinary rounds to foster inclusion in the circle of care. Recognizing the complexity of their patients’ lives, Riverside established a cultural liaison team that works with family members, shelter staff, and Elders to ensure relational continuity. These system-wide practices show Riverside’s commitment to moving beyond cultural awareness and toward sustained, relationally grounded CSDC. Rural Model Cases Nurse Susánná working with an Indigenous client. Susánná is a Registered Nurse working in a long-term care home in a Sámi community in northern Scandinavia. One of the Elders in her care, Bikká, is living with dementia. Each day, Susánná begins her shift by greeting Bikká in Sámi and gently checking on her comfort. She knows that in Sámi culture, talking about an illness can be a taboo or expressed indirectly through story and ritual. With this in mind, Susánná adjusts her communication by focusing on the present moment and using words that promote peace and dignity. Susánná builds close relationships with Bikká’s extended family and works with them to support traditional practices. She respects their preferences and incorporates culturally significant music and food into the care routine. Susánná also helps organize small gatherings that include Elders and musicians and makes sure that these events are calm and familiar for Bikká. When Bikká begins to yoik (an ancient Sámi vocal tradition) Susánná listens with care and recognizes it as a meaningful expression, not a symptom of confusion. Through this relational and culturally grounded approach, Susánná supports Bikká’s sense of identity, belonging, and safety. She exemplifies the values of CSDC by treating cultural practices not as extras, but as essential parts of care. Northern Lights Health Centre serving rural and remote clientele. Northern Lights Health Centre is a regional facility in Northwestern British Columbia that serves a variety of Coastal First Nations, including Nisga’a, Tahltan, and Haida. Cultural safety is a part of its everyday operations and long-term vision. When families arrive, they receive a culturally tailored orientation that includes materials in their language. Families are also connected to a cultural liaison who acts as their consistent point of contact. The Centre offers space for traditional ceremonies and seasonal gatherings. It also stocks music, literature, and media in multiple Indigenous languages. Meals reflect seasonal and traditional foods, such as Moose, Sea Lions, and Pemmican in winter, or Oolichan and Berries in summer. There is also an option for families to bring and prepare meals onsite. Staff receive training in Indigenous cultural safety and trauma-informed care, and they adapt daily activities to align with traditional routines, including sleep and bathing practices. The Centre is mindful of the trauma caused by residential schools might affect Indigenous Elders living with dementia. Therefore, the Centre ensures that care environments and routines do not trigger re-traumatization. Each client is matched with a care coordinator who works closely with families and community leaders. Cultural coordinators are part of the interdisciplinary care teams. They ensure that assessments and care interventions promote cultural safety. Through these practices, Northern Lights Health Centre cultivates a system-wide commitment to CSDC rather than only focusing on one-time or casual training or awareness efforts. These four model cases show how care providers and organizations can role model CSDC. As illustrated in the cases, CSDC can create safer and dignified care experiences for persons living with dementia. The cases we present can also serve as practical tools for training, reflection, and discussion among care teams and administrators. They can also be useful for educators who are seeking ways to strengthen CSDC in educational and clinical environments. Discussion Our analysis highlights the predominance of the interpersonal realm in the literature on CSDC, with a particular emphasis on what care providers must do to “know and grow” themselves. This includes engaging in self-reflection, building relational trust, and developing awareness of one’s own cultural positioning and biases. When discussing cultural humility, Foronda et al. ( 2016 ) also promote ongoing reflexivity among care providers and a sound awareness of power dynamics. Despite these efforts, consequences of culturally unsafe care are more often borne by care recipients than the health care system. This asymmetry emphasizes the need to shift the responsibility from individuals to institutions so CSDC can be more broadly embedded across systems and institutions. Our findings show that existing papers on CSDC pay limited attention to the collective histories of specific cultural groups and the impact of cultural trauma. Rather, the literature approaches cultural safety through an individualized lens and does not acknowledge how histories of colonization, migration, or systemic racism shape present-day experiences of dementia care. This narrow focus could make CSDC appear to be less political and less powerful as a force for change. It could also hide the larger sociopolitical and historical realities that shape how dementia care is experienced and delivered. This gap resonates with the work of several scholars. For example, Goldberg et al. ( 2025 ) argue that cultural safety must explicitly address race, racism, and structural justice. Similarly, [Anonymized for review] stress the need to recognize structural violence in dementia care and transfer power to those living with dementia; while LoGiudice et al. ( 2023 ) highlight the importance of community decision-making and respect for Elders within CSDC. Our analysis repositions CSDC as a concept that is shaped by relationships, history, and systems of power. Family and community members of Indigenous and immigrant communities play an important role in CSDC (Cabote et al., 2023 ; Gaviola et al., 2024 ; [Anonymized for review]; LoGiudice et al., 2023 ; McGrath et al., 2022 ). However, only a few articles explicitly discussed their importance. This could be due to the influence of biomedical and person-centred models, which focus on the individual and often treat culture as something extra instead of something essential. These models overlook the importance of cultural practices like storytelling, ceremonies, and kinship roles. These practices are not just supportive additions; they help care recipients hold onto their sense of identity and belonging. Healthcare providers and organizations need to recognize these practices as a vital, not optional, part of care. This way, CSDC will be understood as both culturally rooted and identity-affirming. While many studies call for sensitivity to cultural differences, they often do not name the dominant Western, settler-colonial, or biomedical standards that define what counts as different. These standards are treated as default and could reinforce othering by making ‘other cultures’ seem unusualand presenting dominant values as the neutral norm. This subtle but common framing risks reinforcing the same cultural hierarchies that CSDC aims to challenge. By making these hidden assumptions visible, our analysis shows that cultural safety is not just about learning other cultures; rather, it is about questioning the systems and ideas that have long shaped how care is delivered. In their review of dementia education programs, [Anonymized for review] point out that there is little focus on cultural concepts relevant to persons living with dementia. Our analysis also found a lack of literature on the role of postsecondary programs (e.g., nursing or social work), professional associations, and accreditation bodies in supporting or promoting CSDC. These institutions are rarely held accountable for their inattention to CSDC despite having substantial influence over curricula, certification, and professional standards. Hence, there is a need for them to take more responsibility by building CSDC into policy, curriculum, and accreditation standards. Doing so would present CSDC as a concept with educational, professional, institutional, and systemic dimensions, rather than merely a set of individualized interpersonal practices. Our analysis sets the foundation for a working definition of CSDC. We understand CSDC as an approach that integrates cultural knowledge, respects family and community roles, addresses power asymmetries, and holds institutions accountable to support dementia care that is relational, historically informed, and equitable. A fuller definition is provided below: CSDC is a respectful and ethical approach to care that supports cultural identities, values, and relationships of persons living with dementia. It recognizes that culture shapes how people make sense of dementia, how they live with it, and the kind of care they feel is right for them. CSDC requires health care providers to engage in ongoing critical self-reflection and actively address power imbalances, historical injustices, and systemic barriers that affect care experiences. CSDC providers build trust with clients and families by using communication that respects cultural differences and by drawing on approaches that are holistic and strengths based. For CSDC to be effective, organizations need to provide culturally affirming supports such as traditional foods, spiritual care, ceremonies, opportunities for using cultural languages, and a built environment that feels like home. These aspects should inform how policies are written, how staff are trained and hired, and how care is evaluated. CSDC also involves working with communities to co-design culturally safe care models. Ultimately, CSDC enables care recipients to maintain dignity, express cultural identity, and experience belonging throughout the dementia journey. Along with this definition, we present an evolutionary model of CSDC (Fig. 2 ) that shows how it can be established based on the antecedents, attributes, and consequences we identified in our analysis. This model explains how care providers can start the journey to becoming culturally safe practitioners, the barriers they may encounter, the supports organizations can offer, and the positive effects this change can have on the healthcare system, care providers, and care recipients. Implications Our analysis has important implications for healthcare providers and organizations. While awareness of cultural differences enhances care providers’ cultural sensitivity, our findings show that this is insufficient for CSDC. Rather, care providers need to strive for cultural humility by recognizing power imbalances in care situations and taking action to address them. Care providers should also engage in reflection as it is a mandatory starting point of the CSDC pathway and not an optional component. Reflection on cultural assumptions and biases can help care providers prepare for developing trusting relationships with care recipients, their families, kin networks, and community knowledge holders. Approaching care in this way will encourage a more collective and holistic approach to care planning and delivery rather than a narrow, unidirectional one. Care organizations need to support experiential learning and mentorship opportunities instead of relying solely on awareness modules on CSDC. To gain hands-on experiences, staff could participate in cultural ceremonies or events, role-play scenarios that showcase barriers, attend guest talks on experiences of culturally unsafe care, and engage in reflective exercises (e.g., journaling, circle discussions). To mentor staff, organizations could pair them with Indigenous Elders or cultural safety leads, let them shadow experienced staff who can role model CSDC, and invite them to attend reflective practice sessions with culturally relevant topics like ‘unconscious bias.’ To ensure the adoption of the CSDC pathway at the system level, organizations need to regularly serve cultural foods, allow community ceremonies, support spiritual and language needs, prioritize interpreter services, and hire staff that are culturally and linguistically diverse (Martin et al., 2019 ; McGrath et al., 2022 ). These efforts will likely improve quality of care for care recipients. Organizations should also direct some efforts toward promoting what Gaviola et al ( 2024 ) refer to as “a sense of home.” They can do this by considering design elements that support psychological and physiological well-being (Bates, 2018 ). According to Bates ( 2018 ), such elements might include aesthetics like culturally familiar symbols, artwork, and colours; architectural updates that blend nature, green spaces, and natural material into physical spaces; and functional features like spaces for meditation or reflection. If clinical settings appear more culturally familiar, organizations would be able to create an environment that feels like home for care recipients, their families, and communities. Our analysis highlights several priorities for future research. The main priority is to advance research on the intersection between aging, culture, dementia, and complexity. Hence, research studies should examine the influence of community, family, and cultural values on care recipients’ experiences. They should also explore the impact of colonization, migration, and racism on care relationships. To understand CSDC from a non-Western perspective, there is a need for increased focus on culturally homogeneous settings. Findings from this work will add to the growing body of literature on dementia in culturally and linguistically diverse populations and will also equip healthcare providers and organizations with the information and tools they need to successfully implement CSDC. There is also a need to examine sustainability of CSDC as it relates to the tightening of healthcare funding. In these circumstances, researchers could link CSDC with other cultural safety initiatives to open opportunities for funding and support. In addition to clinical research, research should also address education and policy. The role of post-secondary programs, professional regulators, and accreditation bodies in supporting CSDC is unclear and future research should address this priority. To ensure research aligns with the priorities of those most affected by culturally unsafe care, researchers should utilize participatory, community-engaged, and decolonizing research approaches. This will ensure that voices and knowledge systems of culturally and linguistically diverse groups continue to guide CSDC pathways. Strengths and Limitations This analysis offers several important strengths. It is the first known concept analysis to define CSDC using an evolutionary method. Not only does it fill a gap in the literature, it also draws on a diverse sample of peer-reviewed articles from different geographic areas, populations, and care settings. It provides clear conceptual clarity by identifying distinct antecedents, attributes, and consequences of CSDC for both care providers and health care organizations. The conceptual model (i.e., pathway to CSDC) provides a practical and visual framework for guiding personal transformation and organizational change toward CSDC. Our analysis incorporates inclusive and intersectional perspectives, including insights on Indigenous, 2SLGBTQI+, and immigrant communities. It integrates literature from different fields such as gerontology, nursing, music, and public health. In our concept analysis, we only included peer-reviewed published articles and did not consider grey literature or books and book chapters, which could have potentially excluded practice-based innovations and grassroots approaches that are less likely to be formally published. Our omission of “culturally responsive” and “culturally congruent” as primary search terms could have limited our search results as these concepts may align with CSDC. Additionally, our decision to include only English-language articles may have limited our results. This may be why we had more studies on Indigenous peoples in settler-colonial contexts and fewer on the experiences of immigrants, refugees, or Black and Latinx communities. While much of the literature focused on cultural aspects of care, gender analysis was largely absent from the studies included. This gap limits our understanding of how gender identities and dynamics influence the experiences of CSDC. While most studies that we included described individual-level practices, only a few addressed policy and structural enablers. This limited our ability to fully assess systemic pathways for implementing CSDC. Since the studies in our analysis were from Western and English-speaking countries, the geopolitical context of CSDC outside of settler-colonial nations remained underexplored. There is an assumption that CSDC always involves cross-cultural interaction between care providers and care recipients, which was difficult to challenge in our analysis due to the lack of studies on dementia care within culturally or linguistically homogenous communities. This is the type of care that occurs when clients belong to the dominant culture or majority group (e.g., ethnic Japanese older adults receiving care in Japan, or Māori Elders being cared for in Māori communities in Aotearoa/New Zealand). This could limit the applicability and even the relevance of CSDC in such contexts. Although Rodgers’ ( 1989 ) evolutionary concept analysis method recommends reporting attributes before antecedents and consequences, this sequence can obscure the temporal and logical flow of concept development. In this analysis, we intentionally chose to present antecedents first, followed by attributes, and then consequences, to reflect the actual unfolding of CSDC in practice. This approach is consistent with our conceptual model of CSDC and aligns with other concept analyses ([Anonymized for review]) that found this order to be more intuitive and useful for application. While Rodgers ( 1989 ) does not explicitly require the development of a conceptual model, we created one to better represent the structure and interrelationships among the elements of CSDC identified in the analysis. To further support practical application, we developed four model cases – two individual level (urban and rural) and two organizational-level (urban and rural) – to illustrate CSDC in a range of healthcare contexts. However, these model cases may be more applicable to Western or English-speaking contexts. Although Rodgers ( 1989 ) does not request consultation with field experts as part of the concept analysis methodology, we consulted two experts in the field of culturally safe care, as well as drew on our ongoing research with equity-deserving populations to ensure that our conceptual model (i.e., pathway to CSDC) resonates with the needs and realities of BIPOC and 2SLGBTQI + individuals. Conclusion This concept analysis aimed to define CSDC by identifying defining attributes, antecedents, consequences, surrogate and related terms. In the analysis, we establish CSDC as a distinct concept that is rooted in relational practice, ongoing self-reflection, and the recognition of power dynamics within care relationships. We show that CSDC extends beyond the actions of care providers; it also includes systemic and organizational responsibilities. The consequences of culturally safe care such as strengthened identity, increased trust, and improved care experiences reinforce the value of clearly defining the concept. In doing so, this analysis offers a foundation upon which future education, policy, and research initiatives can more confidently build, and ensures that CSDC is not only invoked in name but also understood in practice. While the analysis acknowledges the importance of decolonizing and equity-oriented approaches, it grounds its contribution in a comprehensive and practical framework for understanding and enacting culturally safe care for persons living with dementia, their families, and communities. Declarations Funding Declaration: This research was funded by [Anonymized for Review] University’s Internal Research Fund. Data Availability Declaration: All data generated or analyzed during this study are included in Table 2 of the article. No additional datasets were generated or stored in a public repository. Competing Interest Declaration: The authors declare that they have no competing interests. Author Contribution All authors equally extracted and analyzed the data and wrote and reviewed the manuscript. They also collaboratively created the data extraction table. N.M. prepared Figures 1 & 2 and Table 1, which was based on mutual ideas and discussions. 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Dementia Alliance International. https://dementiaallianceinternational.org/blog/culturally-safe-dementia-care-a-global-health-policy-agenda Shrestha, H. L., & Shrestha, L. (2023). Exploring culturally-safe dementia care policy in First Nation community of the James and Hudson Bay region in Northern Ontario, Canada. Alzheimer's & Dementia, 19 (S20), e074912. https://doi.org/10.1002/alz.074912 Shrestha, H. L., Shrestha, L., McArthur, M., Rowe, R. K., Maar, M., & Walker, J. D. (2024). Traditional healing and medicine in dementia care for Indigenous populations in North America, Australia, and New Zealand: Exploring culturally-safe dementia care policy from a global perspective. Alzheimer's & Dementia,16 (4), e12620. https://doi.org/10.1002/dad2.12620 Smith, P., Rice, K., Schutte, N., & Usher, K. (2024). Development and validation of the Cultural Responsiveness Assessment Measure (CRAM): A self-reflection tool for mental health practitioners when working with First Nations people. International Journal of Social Psychiatry, 70 (1): 190–200. https://doi.org/10.1177/00207640231204211 Statistics Canada. (2024, May 16). Half of racialized people have experienced discrimination or unfair treatment in the past five years. The Daily . https://www150.statcan.gc.ca/n1/daily-quotidien/240516/dq240516b-eng.htm Statistics Canada. (2023, November 15). (Table). Census Profile. 2021 Census of Population. Statistics Canada Catalogue no. 98-316-X2021001. Ottawa. https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?LANG=E&GENDERlist=1,2,3&STATISTIClist=1,4&DGUIDlist=2021A000011124&HEADERlist=31,30&SearchText=Canada Statistics Canada. (2022, January 25). Study: Women working in paid care occupations. https://www150.statcan.gc.ca/n1/en/daily-quotidien/220125/dq220125a-eng.pdf?st=X0ggVwKL Suh E. E. (2004). The model of cultural competence through an evolutionary concept analysis. Journal of Transcultural Nursing, 15 (2), 93–102. https://doi.org/10.1177/1043659603262488 Syphers, D. G. P., Schumaker, C. J., & Hudak, R. P. (2019). Experiences of formal caregivers providing dementia care to American Indians. Journal of Sustainable Social Change, 11 (1), 38-48. https://doi.org/10.5590/JOSC.2019.11.1.04 Vissenberg, R., Uysal, O., Goudsmit, M., van Campen, J., & Buurman-van Es, B. (2018). Barriers in providing primary care for immigrant patients with dementia: GPs' perspectives. BJGP open, 2 (4), https://doi.org/10.3399/bjgpopen18X101610 World Health Organization [WHO]. (2017). Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. Yeung, S. (2016). Conceptualizing cultural safety: Definitions and applications of safety in health care for Indigenous mothers in Canada. Journal for Social Thought, 1 (1), 1-13. https://ojs.lib.uwo.ca/index.php/jst/article/view/498/285 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":187592,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy Selection Process\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7490541/v1/ac4d157a2547753ca1b95bf8.png"},{"id":93392466,"identity":"3f28b1d3-13b2-487c-8fae-531cf1035fa5","added_by":"auto","created_at":"2025-10-13 10:54:48","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":916245,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePathway to Culturally Safe Dementia Care\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7490541/v1/5d7b20fb7d969439bf4a28ea.jpeg"},{"id":93394265,"identity":"28f3e4aa-2334-4683-afb2-c938dac723f6","added_by":"auto","created_at":"2025-10-13 11:18:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2434708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7490541/v1/3da81120-c3a6-45d5-a4f6-fce147b9733b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMore than 55 million people around the globe live with dementia; and this number is expected to more than triple by 2050 (Alzheimer’s Disease International [ADI], 2025). However, this rise could be slowed with substantial reduction in modifiable risk factors (Livingstone et al., 2020). Along with this projected rise, many countries of the Global North are also becoming increasingly ethnically and racially diverse. For example, in 2021, 23% of the Canadian population was foreign born and 26.5% identified as visible minorities; South Asians, Chinese, and Black made up 60.5% of the latter group (Statistics Canada, 2023). Importantly, the older adult demographic also showed increasing ethno-cultural diversity, largely due to immigration(Carrière, et al., 2016). This demographic shift is coupled with recent data indicating that 30% of Canadians report facing discrimination or unfair treatment, particularly in employment settings, yet also when seeking healthcare; and racialized people face elevated levels (Statistics Canada, 2024).\u003c/p\u003e\n\u003cp\u003eDue to the increase in dementia among Indigenous people and the associated lack of cultural safety in healthcare, the Alzheimer Society of Canada (2024) recommends that health care and research sectors adopt cultural safety and humility. Even the World Health Organization’s (WHO, 2017) global action plan on dementia stresses the importance of culturally sensitive/responsive/appropriate interventions in relation to health and awareness campaigns, dementia risk reduction, and health and social care for persons living with dementia and their care partners. Since then, global reports have paid attention to culture in relation to diagnosis, cultural sensitivity in dementia risk reduction, and cultural safety (for Indigenous people in Canada) (Alzheimer’s Disease International [ADI], 2024; 2022; ADI et al., 2024; Gauthier et al., 2021). The most recent global report (ADI, 2025) noted the threat posed to ADI’s guiding values of diversity and inclusion and paid scant attention to culture.\u003c/p\u003e\n\u003cp\u003eAs the population ages and diversifies, interest in how culture affects dementia care continues to grow considerably while more responsibility is being placed on educators, practitioners, and policy makers to prepare clinicians who are culturally responsive and safe ([Anonymized for review]). There is an expanding body of health literature that references culturally safe dementia care (CSDC), yet inconsistently defines and operationalizes this concept. There is uncertainty about the defining attributes of CSDC, its boundaries, and how the definition may be extended to better reflect diverse cultural realities. Therefore, there is a need to establish greater conceptual clarity of CSDC so it can be consistently defined and integrated into professional education, clinical practice, and healthcare systems. In this paper, we report on a concept analysis of CSDC with the aim to advance understanding, inform practice, and identify future directions for research.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eExperts and scholars conceptualize CSDC in different ways. For example, Shrestha (2024) views CSDC as a set of approaches that empower cultural identity, sensitivity, and well-being for individuals living with dementia. Among Indigenous peoples of Northern Ontario, CSDC is seen as a collaborative partnership between Indigenous Elders, knowledge holders, and healthcare providers to develop care plans that integrate traditional and biomedical practices (Shrestha \u0026amp; Shrestha, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Other scholars researching trauma-informed and community-centred approaches describe CSDC as an approach that recognizes culture, the collective nature of family and community decision-making, and the need for upholding respect for Elders (LoGiudice et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Goldberg et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) link cultural safety to justice and equity for Aboriginal and Torres Strait Islander peoples, which includes ensuring race and racism are discussed and individual care is connected to community. Despite similarities in how scholars define CSDC, there is conceptual ambiguity which creates challenges for practice, education, and policy.\u003c/p\u003e\u003cp\u003eSeveral reviews indicate that culturally and linguistically diverse (CLD) older adults with dementia have unique needs. For example, Cabote et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) report that care facilities often fail to meet the CSDC needs of CLD older adults. These needs include access to traditional food, culturally relevant activities, and language support. Martin et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) also discuss how dementia care services overlook CLD older adults’ sense of identity, belonging, and emotional safety. Similarly, McGrath et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) show that care facilities lack culturally meaningful and familiar activities, which could reduce care recipients’ quality of life and cause them to feel disengaged and lonely. Despite these reviews, there continues to be limited awareness about CSDC approaches that address the unique needs of CLD older adults.\u003c/p\u003e\u003cp\u003eGaviola et al.’s (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) review on CLD older adults with dementia also identifies the lack of traditional foods, cultural activities, and language-congruent interactions as barriers faced by care recipients. The authors explain that these barriers could weaken care recipients’ sense of identity and belonging, which are important for well-being in later life. They also highlight that healthcare facilities are unable to meet such cultural needs due to systemic constraints like minimal staff training, time pressures, and task-based care models; and call for healthcare systems to refocus care practices from task-oriented to culturally appropriate, person-centred approaches that build staff capacity, adapt organizational policy, and ensure family involvement in culturally appropriate care planning (Gaviola et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile the term CSDC is increasingly used in literature, its conceptual foundations remain underdeveloped. There have been several concept analyses that address cultural concepts in healthcare more broadly. For instance, Marzilli (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) examined ‘culture’ as a standalone concept, while other scholars examined ‘cultural competence’ in numerous analyses for over two decades (Abualhaija, 2021; Cai, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Dudas, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Henderson et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Jeong et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sharifi et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Suh, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). However, these works primarily focus on general healthcare delivery without attention to specific populations or conditions, such as older adults or persons living with dementia. The literature also consists of concept analyses on ‘cultural sensitivity’ (Foronda, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Aghajari et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and ‘cultural safety’ (Bozorgzad et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Garneau \u0026amp; Pepin, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Yeung, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Of these, Yeung (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) took a more comprehensive approach in that they defined traditional and contemporary views of culture and clarified terms such as cultural knowledge, awareness, sensitivity, competence, safety, humility, and proficiency. However, none of these conceptual papers focus on the aging population.\u003c/p\u003e\u003cp\u003eForonda et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and Isaacson (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) explored and defined ‘cultural humility’ but did not relate the concept to dementia or any specific health condition. Foronda et al., (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) outlined how clinicians could lead a path of cultural humility – by being egoless, open, self-aware, and reflective self-critics who can recognize power imbalances and demonstrate respect for diversity. The 36-item Cultural Responsiveness Assessment Measure is a self-reflection tool developed for Australian mental health practitioners that measures cultural safety by four items that include seeking guidance from Indigenous clients, taking time with clients, changing the workplace environment, and asking Indigenous clients about their culture (Smith et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Despite a growing interest in culturally responsive approaches to care, none of the existing conceptual papers systematically examined the application of cultural safety within dementia care. To our knowledge, a concept analysis of CSDC has not yet been published in health literature.\u003c/p\u003e\u003cp\u003eAlthough several scholars recently attempted to discuss CSDC and what it might entail ([Anonymized for review]; LoGiudice et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shrestha \u0026amp; Shrestha, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shrestha et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), there is no clear definition of CSDC for healthcare providers and organizations. It is still unclear as to how this concept is understood, taught, and demonstrated by healthcare providers and organizations. The lack of conceptual clarity could prevent care providers from properly articulating CSDC and researchers from evaluating it. Care providers may experience tensions between Western approaches to individualized dementia care and cultural generalizations, the limited representation of racialized older adults in dementia care models, and the structural and systemic barriers that constrain CSDC. Hence, there is a critical need to clarify CSDC so care providers and organization can provide dementia care that is safe, equitable, and of the highest quality. This concept analysis uses Rodgers’ (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) method to define CSDC. This evolutionary method takes into consideration that some concepts like CSDC are dynamic and evolve in response to historical, cultural, and socio-political influences.\u003c/p\u003e\n\u003ch3\u003eConceptual Framework\u003c/h3\u003e\n\u003cp\u003eAccording to Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), a thorough concept analysis requires the examination of surrogate terms, related terms or concepts, antecedents, consequences, and defining attributes in order to distinguish the focal concept from similar or overlapping ideas. Surrogate terms are those that carry the same meaning as the concept under consideration, whereas related terms or concepts are similar but differ in certain key characteristics. Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) defines antecedents as events or phenomena that must occur prior to the manifestation of the concept. In contrast, consequences refer to the events or outcomes that follow the occurrence of the concept. Defining attributes are described as the core characteristics or features that consistently appear when the concept is enacted or expressed. Once these evolutionary dimensions are clarified, Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) recommends constructing a model case that exemplifies the concept and illustrates its defining attributes in practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eData Sources\u003c/h2\u003e\u003cp\u003eA search was conducted using the \u003cem\u003eDiscover!\u003c/em\u003e search engine, which indexes 63 interdisciplinary databases. We used a range of search terms grouped under three categories: dementia, cultural safety, and care (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). After combining the results, the search yielded 425 records from various databases including MEDLINE, CINAHL, Complementary Index, APA PsychInfo, Academic Search Complete, Supplemental Index, Biomedical Reference Collection, Directory of Open Access Journals, ScienceDirect, ERIC, ProjectMUSE, SwePub, and JSTOR.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSearch Strategy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSearches\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKeywords\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003edementia (in abstract)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e393,067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCultural Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e“cultur* safe*” OR “cultur* competen*” OR “cultur* sensitiv*” OR “cultur* aware*” OR “cultur* humility” OR “cultur* appropriat*” OR “cultur* relevan*” (in abstract)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e111,517\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecare OR caring (in abstract)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5,863,856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eS1 + S2 + S3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWe limited the search results to English-language and peer-reviewed journal articles published within the last ten years (2010–2021). This narrowed the results to 332 records. After removing duplicates electronically (using the search engine’s de-duplication feature) and manually, we identified a total of 102 records. The abstracts of these 102 records were screened using predefined inclusion and exclusion criteria to determine which would undergo full-text review.\u003c/p\u003e\u003cp\u003eWe included research studies that focused on:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePersons living with dementia;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCultural sensitivity, humility, safety, competence, and/or awareness;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFormal care; and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe context of providing culturally safe dementia care.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eDuring abstract screening, 88 records were excluded:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e65 that did not meet the inclusion criteria;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e11 knowledge syntheses (including literature reviews [n = 4], systematic reviews [n = 5], and scoping reviews [n = 2]);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e7 were mixed formats, including abstracts (n = 2), editorials (n = 2), commentaries (n = 2), and a letter to the editor (n = 1);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e5 were other documents such as a report (n = 1), product information (n = 1), poster (n = 1), or book reviews (n = 2).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eFor some records, the abstract did not provide enough detail to determine inclusion. In these cases, we read the full text to make a final decision. We then reviewed the full text of the remaining articles to assess eligibility. The initial 2021 search process yielded a total of 14 articles (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A second search was conducted in March 2023, which resulted in 190 articles. After removing duplicates, 66 articles remained. We applied the same inclusion and exclusion criteria and excluded 62 articles – some of which were posters (n = 8) or did not meet the criteria (n = 54). This second search yielded 4 additional articles. From both searches combined, we identified a final total of 18 articles, which we included in our analysis.\u003c/p\u003e\u003ch3\u003eData Extraction\u003c/h3\u003e\u003cp\u003eTo establish consistency and ensure that the team extracted data using a common approach, we each independently reviewed and extracted data from a few of the 18 selected articles, following Rodgers’ (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) evolutionary concept analysis method. This initial exercise allowed us to compare interpretations, reach consensus, and develop a shared understanding of the extraction process. After this step, each team member – including the authors and two research assistants – extracted data from several additional articles. We met to discuss findings and resolve any differences. This iterative process was repeated once more until we had extracted data from all 18 articles.\u003c/p\u003e\u003cp\u003eThe data extraction phase helped deepen our understanding of the various components of CSDC. We organized the extracted data according to the conceptual categories outlined by Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e): surrogate terms, related terms, antecedents, consequences, and defining attributes of CSDC (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eData Extraction\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e#\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArticle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurrogate Terms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRelated Terms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAntecedents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAttributes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConsequences\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClark et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural competency\u003c/p\u003e\u003cp\u003e• Cultural expectations\u003c/p\u003e\u003cp\u003e• Cultural sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Cultural values\u003c/p\u003e\u003cp\u003e• Cultural needs\u003c/p\u003e\u003cp\u003e• Strengths-based approach\u003c/p\u003e\u003cp\u003e• Patient-centered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Appreciation for complexities of cultural groups.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Demonstrate a strengths-based approach.\u003c/p\u003e\u003cp\u003e• Understand family dynamics.\u003c/p\u003e\u003cp\u003e• Understanding economic barriers and distrust of health system.\u003c/p\u003e\u003cp\u003e• Build rapport.\u003c/p\u003e\u003cp\u003e• Build trust and collaborative relationships.\u003c/p\u003e\u003cp\u003e• Respect and support cultural values.\u003c/p\u003e\u003cp\u003e• Provide one point of contact.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Aware of resources to refer or access.\u003c/p\u003e\u003cp\u003e• Help ease transitions through medical providers.\u003c/p\u003e\u003cp\u003e• Relieve ambivalence.\u003c/p\u003e\u003cp\u003e• Offer education on aging and dementia.\u003c/p\u003e\u003cp\u003e• Improving access to healthcare\u003c/p\u003e\u003cp\u003e• High-quality, patient-centered care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003edu Toit \u0026amp; Buchanan (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural humility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Person-centered care\u003c/p\u003e\u003cp\u003e• Cultural diversity\u003c/p\u003e\u003cp\u003e• Compassionate care\u003c/p\u003e\u003cp\u003e• Cultural and linguistic diverse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Learn about individual needs.\u003c/p\u003e\u003cp\u003e• Tailor care to include embracing difference.\u003c/p\u003e\u003cp\u003e• Education in person-centered care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Demonstrate person-centered care.\u003c/p\u003e\u003cp\u003e• Quality interactions with clients.\u003c/p\u003e\u003cp\u003e• Promote active engagement with other residents, family, and staff.\u003c/p\u003e\u003cp\u003e• Build relationships and opportunities to connect with residents, resident’s family, and staff.\u003c/p\u003e\u003cp\u003e• Understand and respond to needs.\u003c/p\u003e\u003cp\u003e• Embrace difference.\u003c/p\u003e\u003cp\u003e• Compassionate care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Increased patients feeling of belonging.\u003c/p\u003e\u003cp\u003e• More positive outcomes with residents.\u003c/p\u003e\u003cp\u003e• Better able to tailor care for the person and support person-centered care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForbes et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural sensitivity\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Client-centered approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Respectful, caring relationships.\u003c/p\u003e\u003cp\u003e• Consistent care and sustainable community programs.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Incorporate beliefs, values and language.\u003c/p\u003e\u003cp\u003e• Involving care partners and family in care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Trusting relationships.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFredriksen-Goldsen et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural competency\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Inclusivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Awareness of context of LGBT older adults’ lives and relationships.\u003c/p\u003e\u003cp\u003e• Assess own attitudes and beliefs.\u003c/p\u003e\u003cp\u003e• Address personal biases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Create a welcoming and affirming environment.\u003c/p\u003e\u003cp\u003e• Recognize diversity, strength, and resiliency.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Be inclusive and responsive to LGBT older adults with dementia.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGoeman et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally sensitive\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Culturally and linguistically diverse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Knowledge and understanding of barriers in receiving care.\u003c/p\u003e\u003cp\u003e• Self-reflection.\u003c/p\u003e\u003cp\u003e• Organizational support.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Advocacy skills.\u003c/p\u003e\u003cp\u003e• Provide information and interventions that are culturally relevant.\u003c/p\u003e\u003cp\u003e• Listening skills.\u003c/p\u003e\u003cp\u003e• Knowledge of dementia.\u003c/p\u003e\u003cp\u003e• Interpersonal skills.\u003c/p\u003e\u003cp\u003e• Build trusting relationships.\u003c/p\u003e\u003cp\u003e• Assessment abilities.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Understanding and acceptance of different cultures.\u003c/p\u003e\u003cp\u003e• Tailor support around person, care provider, and family.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHämäläinen et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally sensitive\u003c/p\u003e\u003cp\u003e• Culture-centered\u003c/p\u003e\u003cp\u003e• Context aware\u003c/p\u003e\u003cp\u003e• Culturally safe\u003c/p\u003e\u003cp\u003e• Culturally specific\u003c/p\u003e\u003cp\u003e• Culturally empathetic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Person-centered care\u003c/p\u003e\u003cp\u003e• Person-oriented attitude\u003c/p\u003e\u003cp\u003e• Intercultural healthcare\u003c/p\u003e\u003cp\u003e• Cultural diversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Uses the person-centered approach.\u003c/p\u003e\u003cp\u003e• Aware of cultural differences and the embodied history of peoples.\u003c/p\u003e\u003cp\u003e• Culturally sensitive knowledge.\u003c/p\u003e\u003cp\u003e• Have knowledge of the possible assimilation history of the specific Indigenous group.\u003c/p\u003e\u003cp\u003e• Healthcare workers lack of knowledge of Sami cultural markers.\u003c/p\u003e\u003cp\u003e• Hushing occasionally yoiking elderly.\u003c/p\u003e\u003cp\u003e• Persecution of and assimilation pressure of Sami people.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Incorporate yoik into both therapeutic and daily care provision.\u003c/p\u003e\u003cp\u003e• Connect the persons living with dementia to their past.\u003c/p\u003e\u003cp\u003e• Treat yoik as a means of communication.\u003c/p\u003e\u003cp\u003e• Ensure the situation is acceptable for yoiking.\u003c/p\u003e\u003cp\u003e• Meet people with an open, curious, and person-oriented attitude.\u003c/p\u003e\u003cp\u003e• Support fundamental human needs of self-expression, communication, social inclusion, and the feeling of being alive.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Evoked life and functioned as a means of reminiscence and recognition.\u003c/p\u003e\u003cp\u003e• Functioned as enlivening but also calming.\u003c/p\u003e\u003cp\u003e• Facilitated everyday well-being.\u003c/p\u003e\u003cp\u003e• Enhanced confidence of person with dementia.\u003c/p\u003e\u003cp\u003e• Recognition, memories, joy and contentment.\u003c/p\u003e\u003cp\u003e• Connected Sami with their ancient history, nature, family members, and ancestors.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHanssen (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural understanding\u003c/p\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Intercultural care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Openness to foreign cultural expressions.\u003c/p\u003e\u003cp\u003e• Inability to engage in spiritual practices.\u003c/p\u003e\u003cp\u003e• Realization that different cultural backgrounds may have different needs.\u003c/p\u003e\u003cp\u003e• Learn about thoughts and expectations of particular patients.\u003c/p\u003e\u003cp\u003e• Language barrier, leading to miscommunication.\u003c/p\u003e\u003cp\u003e• Patience.\u003c/p\u003e\u003cp\u003e• Stuck to rigid schedule.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Create caring and meaningful environment.\u003c/p\u003e\u003cp\u003e• Create reciprocal understanding between patients and health care personnel.\u003c/p\u003e\u003cp\u003e• Understand cultural influence on behaviour apart from dementia.\u003c/p\u003e\u003cp\u003e• Understand importance of cultural food.\u003c/p\u003e\u003cp\u003e• Awareness of sleep and routine of patients.\u003c/p\u003e\u003cp\u003e• Improvement of reciprocal understanding.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Helps promote feeling of safety.\u003c/p\u003e\u003cp\u003e• Promotes feeling of belonging.\u003c/p\u003e\u003cp\u003e• Creates trusting relationships.\u003c/p\u003e\u003cp\u003e• Create a safe environment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHanssen \u0026amp; Kuven (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culture-sensitive\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Cultural identity\u003c/p\u003e\u003cp\u003e• Culture [as] identity and heritage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTraditional food (Sami, Norwegian \u0026amp; Black South African) – linked to particular regions, sensory qualities, celebrations/seasons.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Increases sense of identity, belonging, joy, and quality of life.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHaydon et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003cp\u003e• Culturally safe\u003c/p\u003e\u003cp\u003e• Culturally inviting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Social Emotional Wellbeing Model\u003c/p\u003e\u003cp\u003e• Bronfenbrenner’s Bioecological Model of Human Development\u003c/p\u003e\u003cp\u003e• Biomedical model\u003c/p\u003e\u003cp\u003e• Strength-based\u003c/p\u003e\u003cp\u003e• Social determinants of health (SDoH)\u003c/p\u003e\u003cp\u003e• Cultural stereotypes\u003c/p\u003e\u003cp\u003e• Cultural significance of place\u003c/p\u003e\u003cp\u003e• Inclusive approach to care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Taking into consideration the SDoH\u003c/p\u003e\u003cp\u003e• Cultural stereotypes distorting interpretation of symptoms.\u003c/p\u003e\u003cp\u003e• Limited access to health services.\u003c/p\u003e\u003cp\u003e• Maldistribution of specialty services.\u003c/p\u003e\u003cp\u003e• Lack of local dementia knowledge.\u003c/p\u003e\u003cp\u003e• Competing priorities in the provision of healthcare.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Acknowledgement of social, political and economic factors that affects health and access to healthcare.\u003c/p\u003e\u003cp\u003e• Focus on dignity, privacy and safety.\u003c/p\u003e\u003cp\u003e• Provide access to care on one’s own Country and within one’s own Community.\u003c/p\u003e\u003cp\u003e• Increasing family and carer support.\u003c/p\u003e\u003cp\u003e• Recognizing the importance of community cohesion and strength.\u003c/p\u003e\u003cp\u003e• Nurture the social and emotional well-being.\u003c/p\u003e\u003cp\u003e• Support based rather than treatment-based services\u003c/p\u003e\u003cp\u003e• View dementia as a shared experience (individuals family, kin community).\u003c/p\u003e\u003cp\u003e• Considering cultural significance of Place (persons connection with ancestral land or country).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Promoted agency and involvement in decision making (patient, family, and local community).\u003c/p\u003e\u003cp\u003e• Tackled dementia in a more cohesive and strength-based way.\u003c/p\u003e\u003cp\u003e• Reduced likelihood of discrimination.\u003c/p\u003e\u003cp\u003e• Created a more inclusive approach to care.\u003c/p\u003e\u003cp\u003e• Increased local dementia knowledge.\u003c/p\u003e\u003cp\u003e• Improved access (cultural and geographical).\u003c/p\u003e\u003cp\u003e• Increased community cohesion.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[Anonymized for review]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally competent\u003c/p\u003e\u003cp\u003e• Culturally sensitive\u003c/p\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003cp\u003e• Culturally safe\u003c/p\u003e\u003cp\u003e• Culturally relevant\u003c/p\u003e\u003cp\u003e• Kawa Whakaruruhau\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Person-centered care\u003c/p\u003e\u003cp\u003e• Indigenous determinants of Health Model\u003c/p\u003e\u003cp\u003e• Post-Colonialism\u003c/p\u003e\u003cp\u003e• Settler colonialism\u003c/p\u003e\u003cp\u003e• Trauma-informed care\u003c/p\u003e\u003cp\u003e• Historical/cultural trauma\u003c/p\u003e\u003cp\u003e• Cultural practices/activities\u003c/p\u003e\u003cp\u003e• Cultural differences\u003c/p\u003e\u003cp\u003e• Cultural needs\u003c/p\u003e\u003cp\u003e• Biomedical perspective\u003c/p\u003e\u003cp\u003e• Connection to the land\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Education to change nurses knowledge skills and values (online or in-person).\u003c/p\u003e\u003cp\u003e• Culturally appropriate information.\u003c/p\u003e\u003cp\u003e• Culturally safe assessment tools.\u003c/p\u003e\u003cp\u003e• Awareness of settler colonialism and cultural trauma.\u003c/p\u003e\u003cp\u003e• Teaching stories (through storytelling sessions) to teach about CSDC\u003c/p\u003e\u003cp\u003e• Understanding culture.\u003c/p\u003e\u003cp\u003e• Respecting beliefs.\u003c/p\u003e\u003cp\u003e• Openness to family initiating cultural practices\u003c/p\u003e\u003cp\u003e• Conflict between organizational policies and rules and Indigenous ways of being.\u003c/p\u003e\u003cp\u003e• An organization that creates conditions that facilitate culturally safe and trauma-informed care.\u003c/p\u003e\u003cp\u003e• Nurses do not receive specialized training but are expected to provide culturally safe care.\u003c/p\u003e\u003cp\u003e• Preventing dysfunction.\u003c/p\u003e\u003cp\u003e• Predominance of biomedical perspective.\u003c/p\u003e\u003cp\u003e• Assessment of care home culture and structural barriers within them which prevent carers ability to provide CSDC.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Incorporating connection to the land in PCC.\u003c/p\u003e\u003cp\u003e• Understanding the impact of colonialism and cultural trauma on people with dementia.\u003c/p\u003e\u003cp\u003e• Objects, food, stories that make client feel safe\u003c/p\u003e\u003cp\u003e• Advocating/accommodating large families and frequent visits to allow for storytelling\u003c/p\u003e\u003cp\u003e• Practicing cultural activities\u003c/p\u003e\u003cp\u003e• Integrating spiritual, familial, and cultural foundations.\u003c/p\u003e\u003cp\u003e• Should always take place within the context of families, communities, and nations.\u003c/p\u003e\u003cp\u003e• Should be oriented towards the collective rather than the individual\u003c/p\u003e\u003cp\u003e• Care must match the individual, historical trauma, understanding culture, staying connected with family and community, and relationship with the healthcare team\u003c/p\u003e\u003cp\u003e• Open up the conversation at the start, nurturing traditional practices, the importance of advocacy, history impacts the present.\u003c/p\u003e\u003cp\u003e• Responds to individual needs and preferences, including those based on spiritual, families, and cultural foundations\u003c/p\u003e\u003cp\u003e• Creates an environment where family can bring traditional items or initiate cultural practices without concern or fear\u003c/p\u003e\u003cp\u003e• Recognizes the importance of residents not losing their beliefs\u003c/p\u003e\u003cp\u003e• Advocates to accommodate for large families so they can support their loved ones.\u003c/p\u003e\u003cp\u003e• Advocates when policy is not aligned with residents' cultural needs.\u003c/p\u003e\u003cp\u003e• Ask questions respectfully.\u003c/p\u003e\u003cp\u003e• Demonstrates awareness that history impacts the present and can create anxiety when transitioning into the facility\u003c/p\u003e\u003cp\u003e• Integrates and nurtures traditional practices, slowness, silence, and listening.\u003c/p\u003e\u003cp\u003e• Views the family and community connection as a strength\u003c/p\u003e\u003cp\u003e• Respectfully integrates cultural knowledge of a specific nation.\u003c/p\u003e\u003cp\u003e• Settler colonialism and cultural trauma factored into assessment, information sharing and care processes.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Bridge cultural differences; improving their knowledge, skills and values with respect to providing culturally safe dementia care.\u003c/p\u003e\u003cp\u003e• Resident feeling happy and comfortable in how they are cared for.\u003c/p\u003e\u003cp\u003e• Residents' traditions are upheld.\u003c/p\u003e\u003cp\u003e• Incorporation of Indigenous perspectives of dementia including shifting away from medical jargon and reasoning beyond “plaques and tangles”.\u003c/p\u003e\u003cp\u003e• Consideration of the impact of history including IRS, and caring for Elders in the context of their families, communities and nations, rather than autonomous individuals.\u003c/p\u003e\u003cp\u003e• Facilities/staff has increased knowledge of Indigenous culture\u003c/p\u003e\u003cp\u003e• Residents have no fear of engaging in cultural practices.\u003c/p\u003e\u003cp\u003e• Removal of barriers to enacting culturally safe care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInoue et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural responsivity\u003c/p\u003e\u003cp\u003e• Cultural congruence\u003c/p\u003e\u003cp\u003e• Culturally sensitive\u003c/p\u003e\u003cp\u003e• Cultural understanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Person-centered care\u003c/p\u003e\u003cp\u003e• Compassionate care\u003c/p\u003e\u003cp\u003e• Cultural differences\u003c/p\u003e\u003cp\u003e• Cultural or language norms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Availability of companion volunteers of the same culture.\u003c/p\u003e\u003cp\u003e• Staff aware of their limited abilities with residents (communication and time)\u003c/p\u003e\u003cp\u003e• Facility staff lacking experience or familiarity with the cultural or language norms of older immigrants\u003c/p\u003e\u003cp\u003e• Acceptance of cultural differences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Take time with the residents.\u003c/p\u003e\u003cp\u003e• Communicate in native language including understanding nuances and cliche differences.\u003c/p\u003e\u003cp\u003e• Demonstrate respect and a caring touch.\u003c/p\u003e\u003cp\u003e• Provide gentle and compassionate care.\u003c/p\u003e\u003cp\u003e• Provide culturally sensitive environment and make resident feel at home.\u003c/p\u003e\u003cp\u003e• Recognize emotional and spiritual significance of actions (e.g. closing eyes and being peaceful with client)\u003c/p\u003e\u003cp\u003e• Companions identify changes in patients and report them to staff.\u003c/p\u003e\u003cp\u003e• Staff received guidance and cultural understanding from companions.\u003c/p\u003e\u003cp\u003e• Providing cultural food.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Increased well-being.\u003c/p\u003e\u003cp\u003e• Improved quality of life.\u003c/p\u003e\u003cp\u003e• Allowed patient to communicate their needs and experiences.\u003c/p\u003e\u003cp\u003e• Improved physical and emotional health.\u003c/p\u003e\u003cp\u003e• Reduced social isolation.\u003c/p\u003e\u003cp\u003e• Reduced loneliness.\u003c/p\u003e\u003cp\u003e• Facilitated access to services.\u003c/p\u003e\u003cp\u003e• More time and attention to person with dementia.\u003c/p\u003e\u003cp\u003e• More detailed reports about patients' needs and symptoms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKim \u0026amp; Woods (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally competent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Cultural and language barriers compounding miscommunication.\u003c/p\u003e\u003cp\u003e• Respectful attitude towards older adults.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Understand importance of body position and proximity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Improved dementia care through competence and social interactions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKim et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Being respectful towards older adults.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Display dementia and cultural appropriate communication, such as initiate greeting, use eye contact, simple phrasing.\u003c/p\u003e\u003cp\u003e• Use a gentle pace of care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Decrease behavioural symptoms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLewis et al. (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally responsive\u003c/p\u003e\u003cp\u003e• Cultural humility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Cultural differences\u003c/p\u003e\u003cp\u003e• Holistic care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Respectful of values and beliefs.\u003c/p\u003e\u003cp\u003e• Seek better understanding of patient’s cultural beliefs and values.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• View Alzheimer’s Disease and related dementias (ADRD) holistically.\u003c/p\u003e\u003cp\u003e• Awareness of traditional healing.\u003c/p\u003e\u003cp\u003e• Awareness of the importance of family and community.\u003c/p\u003e\u003cp\u003e• Understanding that other cultures look at ADRD differently than traditional Western teachings.\u003c/p\u003e\u003cp\u003e• Appreciate relationships are central.\u003c/p\u003e\u003cp\u003e• Treat the person, not the disease.\u003c/p\u003e\u003cp\u003e• Provide holistic care \u0026amp; treatment.\u003c/p\u003e\u003cp\u003e• Demonstrate cultural humility \u0026amp; respect.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Greater patient quality of care.\u003c/p\u003e\u003cp\u003e• Improved trust.\u003c/p\u003e\u003cp\u003e• Increased adherence to health care services \u0026amp; treatments.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMcAtackney et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Culturally appropriate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Two-Eyed seeing\u003c/p\u003e\u003cp\u003e• Relationality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Willing to learn about context of the person and their family’s lives.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Education, networking, and support surrounding dementia as a chronic disease.\u003c/p\u003e\u003cp\u003e• Understanding context of life/family (Relationality)\u003c/p\u003e\u003cp\u003e• Honour house group structure\u003c/p\u003e\u003cp\u003e• Learn a few Gitxsan words \u0026amp; role of Elder in community\u003c/p\u003e\u003cp\u003e• Use caring body language\u003c/p\u003e\u003cp\u003e• Acknowledge connection to land\u003c/p\u003e\u003cp\u003e• Understanding of loss/grief within First Nations families \u0026amp; how dementia exacerbates this.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Respectful and positive relationships.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSagbakken et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural competence\u003c/p\u003e\u003cp\u003e• Cultural awareness\u003c/p\u003e\u003cp\u003e• Cultural sensitivity\u003c/p\u003e\u003cp\u003e• Culturally acceptable\u003c/p\u003e\u003cp\u003e• Culturally congruent\u003c/p\u003e\u003cp\u003e• Culturally adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Adjusted care\u003c/p\u003e\u003cp\u003e• Linguistic and cultural diversity\u003c/p\u003e\u003cp\u003e• Linguistic relativity\u003c/p\u003e\u003cp\u003e• Holistic care\u003c/p\u003e\u003cp\u003e• Biographical approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Openness to different philosophies of life.\u003c/p\u003e\u003cp\u003e• Open/neutral stance.\u003c/p\u003e\u003cp\u003e• Recognize diversity within \u0026amp; between groups.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Serve culturally adjusted food \u0026amp; allow families to prepare it.\u003c/p\u003e\u003cp\u003e• Linguistic and cultural diversity of workforce.\u003c/p\u003e\u003cp\u003e• Understand diversity of each individual’s illness \u0026amp; views on it.\u003c/p\u003e\u003cp\u003e• Understanding family context (larger rooms).\u003c/p\u003e\u003cp\u003e• Continuity in relations, culture, and language.\u003c/p\u003e\u003cp\u003e• Different religious activities\u003c/p\u003e\u003cp\u003e• ‘Familiar \u0026amp; homely’ songs, music, literature, TV\u003c/p\u003e\u003cp\u003e• Allocate more time \u0026amp; resources, including interpreters.\u003c/p\u003e\u003cp\u003e• Holistic care (individual \u0026amp; socio-cultural needs).\u003c/p\u003e\u003cp\u003e• Value linguistic relativity (way of speaking, use of certain words, religious and cultural references).\u003c/p\u003e\u003cp\u003e• Respect attitudes to life-prolonging treatment.\u003c/p\u003e\u003cp\u003e• Biographical approach to needs assessment \u0026amp; care planning.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Equitable, adjusted/adapted \u0026amp; dignified health care services provided to patients.\u003c/p\u003e\u003cp\u003e• Trust between providers and patients.\u003c/p\u003e\u003cp\u003e• Sense of identity maintained/confirmed.\u003c/p\u003e\u003cp\u003e• People feel ‘at home’.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSyphers et al. (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural competency\u003c/p\u003e\u003cp\u003e• Cultural humility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• Cultural differences\u003c/p\u003e\u003cp\u003e• Bicultural Approaches\u003c/p\u003e\u003cp\u003e• Cross-cultural interactions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• Early intervention.\u003c/p\u003e\u003cp\u003e• Understanding of differences surrounding AD and dementia.\u003c/p\u003e\u003cp\u003e• Familiarity with medicine wheel \u0026amp; oral traditions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Appreciate dementia understood differently (not as problematic) \u0026amp; not reason for accessing healthcare.\u003c/p\u003e\u003cp\u003e• Create relationships with AI families, tribes and communities.\u003c/p\u003e\u003cp\u003e• Use bicultural approach (care plans).\u003c/p\u003e\u003cp\u003e• Appreciate quality of life more important than diagnosis \u0026amp; prognosis.\u003c/p\u003e\u003cp\u003e• Cultural humility.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• Enhancement of cross-cultural interactions among health care providers and patients.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVissenberg et al. (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e• Cultural sensitivity\u003c/p\u003e\u003cp\u003e• Culturally competent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e• N/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e• N/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e• Access to free professional translators.\u003c/p\u003e\u003cp\u003e• Patient able to practice own language, culture and tradition.\u003c/p\u003e\u003cp\u003e• Respect right not to know/that it is a taboo.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e• N/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe included articles are on studies done in various countries, including the United States (38.9%), Norway (22.2%), Canada (16.67%), Australia (11.1%), South Africa (5.56%), and the Netherlands (5.56%). Some studies looked at specific ethno-racial groups such as African-American, Korean-American, and Japanese, while others included those from \u0026lsquo;culturally and linguistically diverse backgrounds\u0026rsquo; and immigrants, with the latter including Turkish, Surinamese, Moroccan, and Black South African people. Half of the studies were about research with Indigenous people, including Gitxsan, Secwepemc, Alaskan Native, and Sami. One article was on 2SLGBTQI\u0026thinsp;+\u0026thinsp;older adults with dementia. In terms of settings, eight studies (44.4%) took place in long term care, two (11.1%) in home and community care, one (5.6%) in acute care, and the remaining seven (38.9%) in a variety of settings.\u003c/p\u003e\n\u003ch3\u003eSurrogate Terms\u003c/h3\u003e\n\u003cp\u003eThere were 51 surrogate terms in total that began with either \u003cem\u003ecultural\u003c/em\u003e, \u003cem\u003eculture\u003c/em\u003e, or \u003cem\u003eculturally\u003c/em\u003e and these words were most often paired with notions of sensitivity (n\u0026thinsp;=\u0026thinsp;9) or competency/competence (n\u0026thinsp;=\u0026thinsp;8), followed by appropriateness (n\u0026thinsp;=\u0026thinsp;6), relevance (n\u0026thinsp;=\u0026thinsp;6), humility (n\u0026thinsp;=\u0026thinsp;3), safety (n\u0026thinsp;=\u0026thinsp;3), congruence (n\u0026thinsp;=\u0026thinsp;2), and responsiveness/responsivity (n\u0026thinsp;=\u0026thinsp;2), and understanding (n\u0026thinsp;=\u0026thinsp;2). \u003cem\u003eKawa Whakaruruhau\u003c/em\u003e, the Maori phrase for cultural safety, was used once, as were the following terms related to culture: centeredness, specific, empathetic, inviting, expectations, awareness, acceptance, adjusted, and context-aware.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eRelated Terms\u003c/h2\u003e\u003cp\u003eThere were 53 related terms that pertained to the recipient of care or to the care provision or referenced specific models or the socio-political context. The terms referencing aspects of culture that were about care recipients were \u003cem\u003ecultural differences\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;4), \u003cem\u003eculturally and linguistically diverse\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;3), \u003cem\u003ecultural diversity\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003ecultural needs\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003ecultural values\u003c/em\u003e, \u003cem\u003ecultural or language norms, cultural practices/activities, cultural stereotypes\u003c/em\u003e, \u003cem\u003elinguistic relativity, cultural identity\u003c/em\u003e, \u003cem\u003ecultural significance of place\u003c/em\u003e, and \u003cem\u003eculture [as] identity and heritage\u003c/em\u003e. The terms referencing care provision included: \u003cem\u003eperson-centred care\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;4), \u003cem\u003estrengths-based\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003ecompassionate care\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003eholistic care (2)\u003c/em\u003e, \u003cem\u003einclusivity/inclusive approach\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003eperson-oriented attitude, client-centred approach\u003c/em\u003e, \u003cem\u003epatient-centred, biographical approach, trauma-informed care\u003c/em\u003e, \u003cem\u003eadjusted care, relationality\u003c/em\u003e, and \u003cem\u003econnection to the land;\u003c/em\u003e and terms denoting the merging of two cultures as in \u003cem\u003etwo-eyed seeing\u003c/em\u003e and \u003cem\u003ebi-cultural approaches\u003c/em\u003e or multiple cultures as in \u003cem\u003einter-cultural (health)care\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2) and \u003cem\u003ecross-cultural interactions\u003c/em\u003e. Several specific models were mentioned including \u003cem\u003ebiomedical model/perspective\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2), \u003cem\u003esocial emotional wellbeing model, Bronfenbrenner\u0026rsquo;s bioecological model of human development, Indigenous determinants of health model\u003c/em\u003e and \u003cem\u003esocial determinants of health.\u003c/em\u003e For the socio-political context, \u003cem\u003epostcolonialism, settler colonialism\u003c/em\u003e and \u003cem\u003ehistorical/cultural trauma\u003c/em\u003e were discussed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAntecedents\u003c/h3\u003e\n\u003cp\u003eWe identified a total of 34 antecedents and conceptually organized them either to (a) care providers and their values and beliefs (i.e., the self), (b) barriers and triggers that point to cultural differences between care providers and care recipients, (c) care providers\u0026rsquo; efforts to grow or shift their knowledge, skills, behaviours, and attitudes (i.e., growing the self), and (d) structural facilitators that promote care providers\u0026rsquo; growth. Most antecedents fell into categories (a) and (c) with there being far less antecedents related to barriers and triggers and structural facilitators. This could be because the self appears to be interwoven with barriers and triggers, where the barriers trigger the self.\u003c/p\u003e\n\u003ch3\u003eThe Self\u003c/h3\u003e\n\u003cp\u003eThe self is about people as reflective and self-directed beings. In this stage healthcare providers should reflect on their own attitudes and beliefs and how cultural stereotypes and their own biases might distort symptom interpretation and lead to incongruent or inappropriate care decisions. Care recipients must learn to take a neutral stance and be open to varying cultural expressions and philosophies of life that are different from their own. They should try to become familiar with the complexities of the cultural group they are working with by being patient and displaying a genuine desire to learn about clients and their families. The self, in a way, represents a care provider\u0026rsquo;s readiness for CSDC. There are, however, some barriers to CSDC that care providers and organizations need to overcome.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBarriers and Triggers\u003c/h2\u003e\u003cp\u003eTo create mutual understanding and build relationships with care recipients, care providers need to overcome certain barriers that hinder the delivery of CSDC. In our analysis, we identified a few barriers. One major barrier is the cultural difference between care providers and care recipients. Another is the language barrier some care recipients face. Together these challenges can lead to assumptions, misunderstandings, miscommunication, and conflicting expectations about how dementia should be understood and managed. When care providers rely solely on the \u0026lsquo;biomedical perspective,\u0026rsquo; it can make cultural and language barriers more difficult to overcome. Rigid organizational schedules and routines can further limit opportunities for spiritual or cultural engagement. If care providers do not overcome these barriers, they can become distant from care recipients, which could trigger feelings of culturally unsafe care by care recipients and their families. However, the same barriers if viewed from a different perspective, could be seen as triggers that feed \u0026lsquo;the self\u0026rsquo; \u0026ndash; e.g., taking a neutral stance and being open, patient, and ready to grow oneself.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eGrowing the Self\u003c/h2\u003e\u003cp\u003eTo become a CSDC practitioner, healthcare providers need to seek out learning opportunities to understand Alzheimer\u0026rsquo;s Disease and other dementias, diverse cultural worldviews, and the historical and ongoing impacts of settler colonialism and cultural trauma. This educational preparation can enable them to develop respectful attitudes toward the cultural beliefs and values of persons living with dementia. Educational tools and methods could include teaching stories and storytelling sessions on CSDC. These could help providers internalize the values and relational dynamics involved in CSDC. It is important for providers to recognize diversity within and between groups. For example, they can become more aware about 2SLGBTQI\u0026thinsp;+\u0026thinsp;older adults\u0026rsquo; lives and relationships within a cultural group. It is also imperative for care providers to develop an understanding about economic barriers and distrust in the healthcare system that some care recipients experience when accessing care. During the initial assessment phase, care providers should recognize care recipients\u0026rsquo; expectations, traditions, and cultural, family, and relational needs. Insight from this assessment should be incorporated into the collaborative care plan so that cultural needs can be addressed in a timely manner.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStructural Facilitators\u003c/h2\u003e\u003cp\u003eThere are several ways in which organizations can support health care providers\u0026rsquo; readiness for CSDC. This includes providing education on person-centred care and by offering networking opportunities focused on dementia as a chronic disease. Educational preparation should include content on settler colonialism, cultural trauma, and assimilation histories. This historical awareness can enhance care providers\u0026rsquo; understanding about the systemic and intergenerational factors that continue to shape care experiences. In addition to staff training, healthcare organizations also need to develop CSDC policies that ensure care programs are sustainable and consistent in their CSDC processes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAttributes\u003c/h2\u003e\u003cp\u003eWe identified 64 attributes of a culturally safe approach towards older adults with dementia which we merged and grouped under five different categories. Four of these categories indicate the attributes the care provider should possess and demonstrate in their interactions with persons with dementia, their families and communities, while the other elucidates ways the organization can support or implement culturally safe dementia care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eCare Provider Attributes\u003c/h2\u003e\u003cp\u003e\u003cb\u003eDemonstrate respect through holistic and reciprocal approaches.\u003c/b\u003e Respect was identified by many scholars as a core principle for providing CSDC. This includes respect for cultural values, attitudes towards life-prolonging treatment, the right not to know or that it may be a taboo to disclose a dementia diagnosis among European immigrants, for example. Respect must be shown through active support and extends to appreciating non-Western views on dementia that differ from the bio-medical perspective that dementia is problematic and requires medical intervention. Culturally-informed views frame dementia holistically, where quality of life is seen as more important than diagnosis and prognosis. Further, along with appreciating the diversity of views of dementia, health care providers should pay particular attention to the uniqueness of each individual\u0026rsquo;s illness. The overall goal of this is to create a reciprocal understanding between care recipients and health care personnel.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBuild trusting, relational partnerships with person, family and community.\u003c/b\u003e Our analysis shows that there is a need for quality interactions between care providers and care recipients. To do this, care providers must establish rapport and build respectful, trusting, caring, and collaborative relationships. However, these relationships should not be limited to the care recipient only; rather, they should also be developed with the care recipient\u0026rsquo;s family, tribe, and community. To establish relationships, healthcare providers should create opportunities to connect with the client, the client\u0026rsquo;s family, and visiting community members. They should also involve the care partner and family in planning and performing care. To do this, care providers might need to accommodate large gatherings and ceremonies. Doing so may offer insight into the client\u0026rsquo;s life context and the importance of family and community, both of which are foundational to supporting relationality in care.\u003c/p\u003e\u003cp\u003e\u003cb\u003eUse inclusive and culturally responsive communication.\u003c/b\u003e When providing CSDC, care providers should incorporate the client\u0026rsquo;s beliefs, values, and language into care processes. This can be done through dementia and culturally appropriate communication, such as initiating a greeting and using eye contact and simple phrasing. It can also include valuing linguistic relativity and ways of speaking, and use of certain words and religious and cultural references. Providers should adapt their basic interpersonal skills, including advocacy, listening, and assessment, to the various cultural groups with which they work. CSDC also requires understanding cultural influences on behaviour apart from dementia. For example, a Sami care recipient may yoik (an ancient singing tradition), which could be mistaken for repetitive verbal utterances made by persons with dementia. Therefore, it is crucial for care providers to support clients in practicing their language, culture, and traditions as these practices may improve memory and recognition. To do this, care providers need free access to professional translators and interpreters. They also need access to gathering spaces so they can accommodate family visits and meaningful, memory-sharing practices like storytelling. Finally, providers should use biographical and bicultural approaches to assess needs and develop care plans that ensure the client\u0026rsquo;s background and culture is known and integrated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eApply holistic and strengths-based care approaches.\u003c/b\u003e CSDC includes the application of care models that highlight diversity, strength, and resiliency as in the \u003cem\u003estrengths-based approach\u003c/em\u003e, as well as \u003cem\u003eholistic care\u003c/em\u003e which considers individual and socio-cultural needs and addresses not only biological determinants of health, but also social determinants. Healthcare providers should demonstrate elements of \u003cem\u003eperson-centred care\u003c/em\u003e, including the core directive to treat the person, not the disease. Their approach should reflect compassion and understanding. They should be attentive to a care recipient\u0026rsquo;s body position and proximity and should respond with a gentle pace and caring body language. Care providers should also make room for meaningful connection between care recipients, their families, staff, and other clients.\u003c/p\u003e\u003cp\u003eWhen working with Indigenous clients, care providers should take time to learn about and respect \u0026lsquo;Indigenous ways of being.\u0026rsquo; They could do this by embracing cultural differences, incorporating traditional healing practices, acknowledging care recipients\u0026rsquo; connections to land (for sustenance), and supporting visits from Elders and community leaders. Care providers should also take the initiative to understand how experiences of loss and grief are shaped within First Nations families and how dementia can intensify these experiences. For example, when working with the Gitxsan people who have a house group structure, learning a few words of the Gitxsan language and the role of the Elder in the community, are significant preparatory measures for the provider to take.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eOrganizational Attributes\u003c/h2\u003e\u003cp\u003e\u003cb\u003eNurture cultural safety at system level.\u003c/b\u003e Organizational attributes indicate what both healthcare providers and administrators can do to ensure cultural safety extends beyond individual interactions. This includes creating environments that are caring, meaningful, welcoming, and affirming, and providing information and interventions that are culturally relevant. Such interventions may include religious activities; \u0026lsquo;familiar and homely\u0026rsquo; songs, music, literature, and TV; honouring sleep and routine of clients; and, serving culturally adjusted food and allowing families to prepare it. For many communities \u0026ndash; such as Sami, Norwegian, and Black South African people \u0026ndash; traditional foods are deeply tied to particular regions, sensory qualities, celebrations, and seasons. Organizations should also create an environment where family can bring traditional items or initiate cultural practices without concern or fear. They should also ensure there is one consistent point of contact for families and communities. As part of their quality improvement efforts, organizations should also invest in a workforce that is culturally and linguistically diverse and accurately reflects the clientele the organization serves.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eConsequences\u003c/h2\u003e\u003cp\u003eOur analysis identified several consequences of CSDC, which we organized into three categories: healthcare system, care provider, and care recipient.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eHealthcare System\u003c/h2\u003e\u003cp\u003eBy providing CSDC, healthcare organizations can transform care settings into safe environments that value competence and social interaction. These environments could support reciprocal understanding between care providers and care recipients and may also decrease behavioural symptoms. These could lead to improved access to healthcare services and high-quality, patient-centred care. By prioritizing CSDC, healthcare organizations could also provide equitable, adjusted/adapted, and dignified healthcare services to clients. Such efforts could lead to more positive outcomes and increased adherence to healthcare services and treatments.\u003c/p\u003e\u003cp\u003eBy embracing diversity and prioritizing culturally safe experiences for clients, organizations could enhance cross-cultural interactions between care providers and care recipients. This may lead to smoother care transitions within the healthcare system. By being a leader in CSDC, organizations could reduce discrimination and create inclusive environments where care recipients feel respected, seen, and valued. As CSDC leaders, organizations will be able to uphold care recipients\u0026rsquo; traditions while minimizing their fear of engaging in cultural practices. Not only will such organizational efforts remove barriers to providing culturally safe care, their full support of CSDC will improve both cultural and geographical access. Healthcare organizations that continue to invest in CSDC will contribute to increased local dementia knowledge and capacity, which could help staff and communities better support culturally diverse populations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eCare Provider\u003c/h2\u003e\u003cp\u003eThe impact of CSDC on care providers can include them being more equipped with resources that can be accessed and to which care recipients can be referred. If providers are more knowledgeable about dementia as a chronic disease and culturally safe practices, they will be able to offer education on aging and dementia to others seeking to improve their knowledge and skills. Care providers that deliver CSDC may become more understanding and accepting of cultures that differ from their own. They will also be better able to provide person-centred care and tailor care to the needs of care recipients and their families. This approach could help care providers feel more confident and capable of delivering culturally responsive care. As care providers become more comfortable embracing cultural differences and building trust with care recipients, any hesitations or uncertainties they have could lessen. Learning about and practicing CSDC could deepen care providers\u0026rsquo; understanding of Indigenous ways of caring and shift perspectives beyond the medicalization of dementia. By involving families and communities in decisions, care providers could make care processes more shared and supportive. This could make it easier to plan care that is collaborative and holistic.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eCare Recipient\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFeelings of belonging should be increased or promoted amongst care recipients who receive culturally safe dementia care, leading to feeling \u0026lsquo;at home\u0026rsquo;. CSDC evokes memories, supports recognition, and connects people with their history, nature, and ancestors. With CSDC, relationships also become more respectful, positive, and trusting, with increased overall trust between providers and patients. Care recipients will experience feelings of safety, including a safe environment to express their cultural identities. 2SLGBTQI\u0026thinsp;+\u0026thinsp;older adults with dementia will have a sense of being included and that care providers are responsive to their unique needs. CSDC will help care recipients maintain or confirm their sense of identity, sense of belonging, joy, and quality of life. In an environment that values CSDC and upholds care recipients\u0026rsquo; traditions, clients (and their families) may feel happy, comfortable, and respected in how they are cared for. Hence, CSDC could lead to continuity in care recipients\u0026rsquo; relations, culture, and language. Additional outcomes could include reduced social isolation, improved physical and emotional health, enhanced everyday well-being, and better communication of care needs and preferences. By supporting reminiscence and emotional connection to family, land, and cultural history, CSDC could also enhance cognitive engagement and spiritual well-being. Improved provider-patient communication may lead to more detailed and accurate reporting of needs and symptoms, which would allow for more responsive and individualized care. Ultimately, CSDC will contribute to greater inclusion, reduced fear of discrimination, and a strengthened sense of agency among care recipients.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eModel Case\u003c/h2\u003e\u003cp\u003eTo illustrate the application of CSDC, four hypothetical model cases are presented: two depicting a care provider working with clients with dementia (one urban and one rural) and the other two representing healthcare organizations committed to CSDC (one urban and one rural). These cases demonstrate how key attributes of CSDC can be meaningfully integrated into dementia care at both the interpersonal and systemic levels.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eUrban Model Cases\u003c/h2\u003e\u003cp\u003e\u003cb\u003eNurse Marcus working with an African American client.\u003c/b\u003e \u003cem\u003eMarcus, a Licensed Practical Nurse at a long-term care home, provides care for Linda, an 82-year-old African American woman living with moderate dementia. From their first interaction, Marcus approaches Linda with warmth, and addresses her as \u0026ldquo;Miss Linda\u0026rdquo; based on her preferences. He initiates conversations by referencing familiar aspects of Linda\u0026rsquo;s life such as the church, her family, and music. This helps create an atmosphere of mutual respect and cultural recognition. Marcus understands the importance of Linda\u0026rsquo;s spirituality and ensures she has access to her church\u0026rsquo;s livestreamed services and gospel music. This brings her comfort and improves her memory recall. Marcus works with Linda\u0026rsquo;s niece to create a memory book filled with family photos, recipes, and sayings. The book helps Linda reconnect with her identity and remember parts of her life that matter most. It includes stories from her younger years as a civil rights activist and her family\u0026rsquo;s history of standing up to racial injustice. Marcus understands that Linda\u0026rsquo;s experience of systemic racism and cultural trauma may shape how she feels and behaves around white authority figures. That is why, instead of focusing only on biomedical ideas of dementia, Marcus takes a broader approach that centres Linda\u0026rsquo;s emotional well-being and overall quality of life. He builds relationships with Linda\u0026rsquo;s extended family and invites them to participate in communal meals and storytelling afternoons. He advocates for traditional foods such as Gumbo or Shrimp and Grits to be included in the care home menu and coordinates with staff to protect Linda\u0026rsquo;s daily prayer routine. Marcus demonstrates an understanding of the historical significance of food, family, and church for the survival of African American people. Therefore, he treats these aspects of Linda\u0026rsquo;s care not as preferences, but as essential to her dignity and identity (i.e., her cultural safety). Marcus also documents Linda\u0026rsquo;s cultural values and biographical details, including her civil rights activism, in her care plan. He does this to ensure Linda receives consistent and culturally responsive care. Marcus adapts his communication style by using a calm tone, simple phrasing, and provides plenty of time for Linda to respond. While doing so, he remains attentive to nonverbal cues. Marcus embodies CSDC by deeply valuing relational care and by respecting not only Linda\u0026rsquo;s personal story but also the historical and cultural factors that continue to shape her experiences.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRiverside Health Centre serving inner-city clientele.\u003c/b\u003e \u003cem\u003eRiverside Health is an inner-city hospital located in Southwestern Ontario that serves a diverse population of older adults living with dementia. Many clients face challenges such as poverty, housing insecurity, and barriers related to sexual and gender identity. Riverside is committed to CSDC not just at the clinical level, but also at the organization level. There is a specialized dementia-friendly unit that includes private spaces for rest and prayer, a courtyard for cultural ceremonies and small gatherings, and meals adjusted to reflect care recipients\u0026rsquo; cultural backgrounds. Staff complete mandatory training in trauma-informed, anti-oppressive, and 2SLGBTQI+-affirming care, which is co-developed with local community organizations. At the point of care, staff are supported through reflective practice sessions and monitored through clinical audits to ensure CSDC principles are enacted and recorded in care plans. A care charter, outlining the hospital\u0026rsquo;s commitments to dignity, cultural recognition, and safety, is posted in all public areas. Care recipients are encouraged to maintain spiritual and cultural practices, such as smudging, prayer, music circles, and family-prepared food. Visiting policies are flexible and care recipients have access to familiar objects and media. Families and friends are invited to care planning meetings and interdisciplinary rounds to foster inclusion in the circle of care. Recognizing the complexity of their patients\u0026rsquo; lives, Riverside established a cultural liaison team that works with family members, shelter staff, and Elders to ensure relational continuity. These system-wide practices show Riverside\u0026rsquo;s commitment to moving beyond cultural awareness and toward sustained, relationally grounded CSDC.\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eRural Model Cases\u003c/h2\u003e\u003cp\u003e\u003cb\u003eNurse Sus\u0026aacute;nn\u0026aacute; working with an Indigenous client.\u003c/b\u003e \u003cem\u003eSus\u0026aacute;nn\u0026aacute; is a Registered Nurse working in a long-term care home in a S\u0026aacute;mi community in northern Scandinavia. One of the Elders in her care, Bikk\u0026aacute;, is living with dementia. Each day, Sus\u0026aacute;nn\u0026aacute; begins her shift by greeting Bikk\u0026aacute; in S\u0026aacute;mi and gently checking on her comfort. She knows that in S\u0026aacute;mi culture, talking about an illness can be a taboo or expressed indirectly through story and ritual. With this in mind, Sus\u0026aacute;nn\u0026aacute; adjusts her communication by focusing on the present moment and using words that promote peace and dignity. Sus\u0026aacute;nn\u0026aacute; builds close relationships with Bikk\u0026aacute;\u0026rsquo;s extended family and works with them to support traditional practices. She respects their preferences and incorporates culturally significant music and food into the care routine. Sus\u0026aacute;nn\u0026aacute; also helps organize small gatherings that include Elders and musicians and makes sure that these events are calm and familiar for Bikk\u0026aacute;. When Bikk\u0026aacute; begins to yoik (an ancient S\u0026aacute;mi vocal tradition) Sus\u0026aacute;nn\u0026aacute; listens with care and recognizes it as a meaningful expression, not a symptom of confusion. Through this relational and culturally grounded approach, Sus\u0026aacute;nn\u0026aacute; supports Bikk\u0026aacute;\u0026rsquo;s sense of identity, belonging, and safety. She exemplifies the values of CSDC by treating cultural practices not as extras, but as essential parts of care.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eNorthern Lights Health Centre serving rural and remote clientele.\u003c/b\u003e \u003cem\u003eNorthern Lights Health Centre is a regional facility in Northwestern British Columbia that serves a variety of Coastal First Nations, including Nisga\u0026rsquo;a, Tahltan, and Haida. Cultural safety is a part of its everyday operations and long-term vision. When families arrive, they receive a culturally tailored orientation that includes materials in their language. Families are also connected to a cultural liaison who acts as their consistent point of contact. The Centre offers space for traditional ceremonies and seasonal gatherings. It also stocks music, literature, and media in multiple Indigenous languages. Meals reflect seasonal and traditional foods, such as Moose, Sea Lions, and Pemmican in winter, or Oolichan and Berries in summer. There is also an option for families to bring and prepare meals onsite. Staff receive training in Indigenous cultural safety and trauma-informed care, and they adapt daily activities to align with traditional routines, including sleep and bathing practices. The Centre is mindful of the trauma caused by residential schools might affect Indigenous Elders living with dementia. Therefore, the Centre ensures that care environments and routines do not trigger re-traumatization. Each client is matched with a care coordinator who works closely with families and community leaders. Cultural coordinators are part of the interdisciplinary care teams. They ensure that assessments and care interventions promote cultural safety. Through these practices, Northern Lights Health Centre cultivates a system-wide commitment to CSDC rather than only focusing on one-time or casual training or awareness efforts.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThese four model cases show how care providers and organizations can role model CSDC. As illustrated in the cases, CSDC can create safer and dignified care experiences for persons living with dementia. The cases we present can also serve as practical tools for training, reflection, and discussion among care teams and administrators. They can also be useful for educators who are seeking ways to strengthen CSDC in educational and clinical environments.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur analysis highlights the predominance of the interpersonal realm in the literature on CSDC, with a particular emphasis on what care providers must do to \u0026ldquo;know and grow\u0026rdquo; themselves. This includes engaging in self-reflection, building relational trust, and developing awareness of one\u0026rsquo;s own cultural positioning and biases. When discussing cultural humility, Foronda et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) also promote ongoing reflexivity among care providers and a sound awareness of power dynamics. Despite these efforts, consequences of culturally unsafe care are more often borne by care recipients than the health care system. This asymmetry emphasizes the need to shift the responsibility from individuals to institutions so CSDC can be more broadly embedded across systems and institutions.\u003c/p\u003e\u003cp\u003eOur findings show that existing papers on CSDC pay limited attention to the collective histories of specific cultural groups and the impact of cultural trauma. Rather, the literature approaches cultural safety through an individualized lens and does not acknowledge how histories of colonization, migration, or systemic racism shape present-day experiences of dementia care. This narrow focus could make CSDC appear to be less political and less powerful as a force for change. It could also hide the larger sociopolitical and historical realities that shape how dementia care is experienced and delivered. This gap resonates with the work of several scholars. For example, Goldberg et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) argue that cultural safety must explicitly address race, racism, and structural justice. Similarly, [Anonymized for review] stress the need to recognize structural violence in dementia care and transfer power to those living with dementia; while LoGiudice et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) highlight the importance of community decision-making and respect for Elders within CSDC. Our analysis repositions CSDC as a concept that is shaped by relationships, history, and systems of power.\u003c/p\u003e\u003cp\u003eFamily and community members of Indigenous and immigrant communities play an important role in CSDC (Cabote et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Gaviola et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; [Anonymized for review]; LoGiudice et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; McGrath et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, only a few articles explicitly discussed their importance. This could be due to the influence of biomedical and person-centred models, which focus on the individual and often treat culture as something extra instead of something essential. These models overlook the importance of cultural practices like storytelling, ceremonies, and kinship roles. These practices are not just supportive additions; they help care recipients hold onto their sense of identity and belonging. Healthcare providers and organizations need to recognize these practices as a vital, not optional, part of care. This way, CSDC will be understood as both culturally rooted and identity-affirming.\u003c/p\u003e\u003cp\u003eWhile many studies call for sensitivity to cultural differences, they often do not name the dominant Western, settler-colonial, or biomedical standards that define what counts as different. These standards are treated as default and could reinforce othering by making \u0026lsquo;other cultures\u0026rsquo; seem unusualand presenting dominant values as the neutral norm. This subtle but common framing risks reinforcing the same cultural hierarchies that CSDC aims to challenge. By making these hidden assumptions visible, our analysis shows that cultural safety is not just about learning other cultures; rather, it is about questioning the systems and ideas that have long shaped how care is delivered.\u003c/p\u003e\u003cp\u003eIn their review of dementia education programs, [Anonymized for review] point out that there is little focus on cultural concepts relevant to persons living with dementia. Our analysis also found a lack of literature on the role of postsecondary programs (e.g., nursing or social work), professional associations, and accreditation bodies in supporting or promoting CSDC. These institutions are rarely held accountable for their inattention to CSDC despite having substantial influence over curricula, certification, and professional standards. Hence, there is a need for them to take more responsibility by building CSDC into policy, curriculum, and accreditation standards. Doing so would present CSDC as a concept with educational, professional, institutional, and systemic dimensions, rather than merely a set of individualized interpersonal practices.\u003c/p\u003e\u003cp\u003eOur analysis sets the foundation for a working definition of CSDC. We understand CSDC as an approach that integrates cultural knowledge, respects family and community roles, addresses power asymmetries, and holds institutions accountable to support dementia care that is relational, historically informed, and equitable. A fuller definition is provided below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eCSDC is a respectful and ethical approach to care that supports cultural identities, values, and relationships of persons living with dementia. It recognizes that culture shapes how people make sense of dementia, how they live with it, and the kind of care they feel is right for them. CSDC requires health care providers to engage in ongoing critical self-reflection and actively address power imbalances, historical injustices, and systemic barriers that affect care experiences. CSDC providers build trust with clients and families by using communication that respects cultural differences and by drawing on approaches that are holistic and strengths based. For CSDC to be effective, organizations need to provide culturally affirming supports such as traditional foods, spiritual care, ceremonies, opportunities for using cultural languages, and a built environment that feels like home. These aspects should inform how policies are written, how staff are trained and hired, and how care is evaluated. CSDC also involves working with communities to co-design culturally safe care models. Ultimately, CSDC enables care recipients to maintain dignity, express cultural identity, and experience belonging throughout the dementia journey.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlong with this definition, we present an evolutionary model of CSDC (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) that shows how it can be established based on the antecedents, attributes, and consequences we identified in our analysis. This model explains how care providers can start the journey to becoming culturally safe practitioners, the barriers they may encounter, the supports organizations can offer, and the positive effects this change can have on the healthcare system, care providers, and care recipients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cp\u003eOur analysis has important implications for healthcare providers and organizations. While awareness of cultural differences enhances care providers\u0026rsquo; cultural sensitivity, our findings show that this is insufficient for CSDC. Rather, care providers need to strive for cultural humility by recognizing power imbalances in care situations and taking action to address them. Care providers should also engage in reflection as it is a mandatory starting point of the CSDC pathway and not an optional component. Reflection on cultural assumptions and biases can help care providers prepare for developing trusting relationships with care recipients, their families, kin networks, and community knowledge holders. Approaching care in this way will encourage a more collective and holistic approach to care planning and delivery rather than a narrow, unidirectional one.\u003c/p\u003e\u003cp\u003eCare organizations need to support experiential learning and mentorship opportunities instead of relying solely on awareness modules on CSDC. To gain hands-on experiences, staff could participate in cultural ceremonies or events, role-play scenarios that showcase barriers, attend guest talks on experiences of culturally unsafe care, and engage in reflective exercises (e.g., journaling, circle discussions). To mentor staff, organizations could pair them with Indigenous Elders or cultural safety leads, let them shadow experienced staff who can role model CSDC, and invite them to attend reflective practice sessions with culturally relevant topics like \u0026lsquo;unconscious bias.\u0026rsquo;\u003c/p\u003e\u003cp\u003eTo ensure the adoption of the CSDC pathway at the system level, organizations need to regularly serve cultural foods, allow community ceremonies, support spiritual and language needs, prioritize interpreter services, and hire staff that are culturally and linguistically diverse (Martin et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; McGrath et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These efforts will likely improve quality of care for care recipients. Organizations should also direct some efforts toward promoting what Gaviola et al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) refer to as \u0026ldquo;a sense of home.\u0026rdquo; They can do this by considering design elements that support psychological and physiological well-being (Bates, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). According to Bates (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), such elements might include aesthetics like culturally familiar symbols, artwork, and colours; architectural updates that blend nature, green spaces, and natural material into physical spaces; and functional features like spaces for meditation or reflection. If clinical settings appear more culturally familiar, organizations would be able to create an environment that feels like home for care recipients, their families, and communities.\u003c/p\u003e\u003cp\u003eOur analysis highlights several priorities for future research. The main priority is to advance research on the intersection between aging, culture, dementia, and complexity. Hence, research studies should examine the influence of community, family, and cultural values on care recipients\u0026rsquo; experiences. They should also explore the impact of colonization, migration, and racism on care relationships. To understand CSDC from a non-Western perspective, there is a need for increased focus on culturally homogeneous settings. Findings from this work will add to the growing body of literature on dementia in culturally and linguistically diverse populations and will also equip healthcare providers and organizations with the information and tools they need to successfully implement CSDC.\u003c/p\u003e\u003cp\u003eThere is also a need to examine sustainability of CSDC as it relates to the tightening of healthcare funding. In these circumstances, researchers could link CSDC with other cultural safety initiatives to open opportunities for funding and support. In addition to clinical research, research should also address education and policy. The role of post-secondary programs, professional regulators, and accreditation bodies in supporting CSDC is unclear and future research should address this priority. To ensure research aligns with the priorities of those most affected by culturally unsafe care, researchers should utilize participatory, community-engaged, and decolonizing research approaches. This will ensure that voices and knowledge systems of culturally and linguistically diverse groups continue to guide CSDC pathways.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThis analysis offers several important strengths. It is the first known concept analysis to define CSDC using an evolutionary method. Not only does it fill a gap in the literature, it also draws on a diverse sample of peer-reviewed articles from different geographic areas, populations, and care settings. It provides clear conceptual clarity by identifying distinct antecedents, attributes, and consequences of CSDC for both care providers and health care organizations. The conceptual model (i.e., pathway to CSDC) provides a practical and visual framework for guiding personal transformation and organizational change toward CSDC. Our analysis incorporates inclusive and intersectional perspectives, including insights on Indigenous, 2SLGBTQI+, and immigrant communities. It integrates literature from different fields such as gerontology, nursing, music, and public health.\u003c/p\u003e\u003cp\u003eIn our concept analysis, we only included peer-reviewed published articles and did not consider grey literature or books and book chapters, which could have potentially excluded practice-based innovations and grassroots approaches that are less likely to be formally published. Our omission of \u0026ldquo;culturally responsive\u0026rdquo; and \u0026ldquo;culturally congruent\u0026rdquo; as primary search terms could have limited our search results as these concepts may align with CSDC. Additionally, our decision to include only English-language articles may have limited our results. This may be why we had more studies on Indigenous peoples in settler-colonial contexts and fewer on the experiences of immigrants, refugees, or Black and Latinx communities. While much of the literature focused on cultural aspects of care, gender analysis was largely absent from the studies included. This gap limits our understanding of how gender identities and dynamics influence the experiences of CSDC.\u003c/p\u003e\u003cp\u003eWhile most studies that we included described individual-level practices, only a few addressed policy and structural enablers. This limited our ability to fully assess systemic pathways for implementing CSDC. Since the studies in our analysis were from Western and English-speaking countries, the geopolitical context of CSDC outside of settler-colonial nations remained underexplored. There is an assumption that CSDC always involves cross-cultural interaction between care providers and care recipients, which was difficult to challenge in our analysis due to the lack of studies on dementia care within culturally or linguistically homogenous communities. This is the type of care that occurs when clients belong to the dominant culture or majority group (e.g., ethnic Japanese older adults receiving care in Japan, or Māori Elders being cared for in Māori communities in Aotearoa/New Zealand). This could limit the applicability and even the relevance of CSDC in such contexts.\u003c/p\u003e\u003cp\u003eAlthough Rodgers\u0026rsquo; (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) evolutionary concept analysis method recommends reporting attributes before antecedents and consequences, this sequence can obscure the temporal and logical flow of concept development. In this analysis, we intentionally chose to present antecedents first, followed by attributes, and then consequences, to reflect the actual unfolding of CSDC in practice. This approach is consistent with our conceptual model of CSDC and aligns with other concept analyses ([Anonymized for review]) that found this order to be more intuitive and useful for application.\u003c/p\u003e\u003cp\u003eWhile Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) does not explicitly require the development of a conceptual model, we created one to better represent the structure and interrelationships among the elements of CSDC identified in the analysis. To further support practical application, we developed four model cases \u0026ndash; two individual level (urban and rural) and two organizational-level (urban and rural) \u0026ndash; to illustrate CSDC in a range of healthcare contexts. However, these model cases may be more applicable to Western or English-speaking contexts. Although Rodgers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) does not request consultation with field experts as part of the concept analysis methodology, we consulted two experts in the field of culturally safe care, as well as drew on our ongoing research with equity-deserving populations to ensure that our conceptual model (i.e., pathway to CSDC) resonates with the needs and realities of BIPOC and 2SLGBTQI\u0026thinsp;+\u0026thinsp;individuals.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis concept analysis aimed to define CSDC by identifying defining attributes, antecedents, consequences, surrogate and related terms. In the analysis, we establish CSDC as a distinct concept that is rooted in relational practice, ongoing self-reflection, and the recognition of power dynamics within care relationships. We show that CSDC extends beyond the actions of care providers; it also includes systemic and organizational responsibilities. The consequences of culturally safe care such as strengthened identity, increased trust, and improved care experiences reinforce the value of clearly defining the concept. In doing so, this analysis offers a foundation upon which future education, policy, and research initiatives can more confidently build, and ensures that CSDC is not only invoked in name but also understood in practice. While the analysis acknowledges the importance of decolonizing and equity-oriented approaches, it grounds its contribution in a comprehensive and practical framework for understanding and enacting culturally safe care for persons living with dementia, their families, and communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by [Anonymized for Review] University’s Internal Research Fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in Table 2 of the article. No additional datasets were generated or stored in a public repository.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors equally extracted and analyzed the data and wrote and reviewed the manuscript. They also collaboratively created the data extraction table. N.M. prepared Figures 1 \u0026amp; 2 and Table 1, which was based on mutual ideas and discussions.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to acknowledge Robert Perryment and Lilly Chisholm, Student Research Assistants (2021-2023), for assisting in the search and data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbualhaiji, N. (2021). 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(2017). \u003cem\u003eGlobal action plan on the public health response to dementia 2017\u0026ndash;2025.\u003c/em\u003e Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO.\u003c/li\u003e\n\u003cli\u003eYeung, S. (2016). Conceptualizing cultural safety: Definitions and applications of safety in health care for Indigenous mothers in Canada. \u003cem\u003eJournal for Social Thought, 1\u003c/em\u003e(1), 1-13. https://ojs.lib.uwo.ca/index.php/jst/article/view/498/285\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"culturally safe dementia care, cultural safety, dementia, older adults, concept analysis","lastPublishedDoi":"10.21203/rs.3.rs-7490541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7490541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCulturally safe dementia care (CSDC) remains inconsistently defined, which makes it difficult for health professionals and researchers to operationalize in practice. To clarify CSDC, we conducted a concept analysis using Rodgers\u0026rsquo; evolutionary method. Eighteen records from diverse cultural groups and care settings were included. Prominent surrogate terms were cultural sensitivity, cultural competency, and cultural appropriateness, while common related terms were person-centred care, compassionate care, and holistic care. Antecedents included provider awareness through self-reflection and commitment to continuous learning, as well as structural, organizational support. Core attributes of CSDC focused on provider qualities such as demonstrating respect, building trust, using culturally responsive communication, and applying holistic and strengths-based approaches; other attributes pointed to organizational responsibilities like creating affirming care environments, providing information, and honouring cultural preferences. Consequences consisted of reduced social isolation and fear of discrimination, and improved trust, care experiences, and quality of life. This analysis emphasizes that CSDC requires ongoing reflection, meaningful engagement, and system-wide accountability. Importantly, CSDC must be co-created with families and communities and should be rooted in their knowledge systems, histories, and priorities. To support application, we share a conceptual model and four model cases to illustrate CSDC in both urban and rural healthcare settings. The model offers a practical pathway that can guide care providers and organizations in implementing culturally safe approaches. Clearer operational frameworks and community-led strategies are needed to move from intention to sustained, culturally grounded practice.\u003c/p\u003e","manuscriptTitle":"Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 10:54:43","doi":"10.21203/rs.3.rs-7490541/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5c318c1-0c64-4cd2-9b8d-e4c1d01027f5","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T06:25:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 10:54:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7490541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7490541","identity":"rs-7490541","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}