SAN FRANCISCO — When elderly Hmong, Chinese or Vietnamese people become demented or chronically confused, family members attribute the condition to a normal part of the aging process, something they would have to live with. Admission to a long-term care facility is unthinkable because of the shame it would bring the family.

This was the observation made by researchers who have worked with the three immigrant populations in the United States. They shared their findings at a recent symposium on ""Working with Asian American Families in the Context of Dementia."" The event was one of several dozen symposia held at the Hilton San Francisco during the three-day 60th Annual Scientific Meeting of The Gerontological Society of America.

But there also are significant differences in beliefs in the three ethnic groups about the disease that affects, in one form or another, more than 40 percent of people over the age of 85 but can occur in people over the age of 55. The most common cause of dementia is Alzheimer’s disease. Because of the cultural differences in the three groups, health education programs need to be tailored differently, researchers said.

Researcher Linda A. Gerdner of the University of Minnesota School of Nursing said that Hmong viewed dementia as a ""soul loss."" Family caregivers generally sought treatment by a shaman, or traditional healer, to satisfy the spiritual needs of the elder.

Gerdner lamented that dementia and family caregiving in the Hmong community have not been on the radar of most American researchers, despite the great contributions of the Hmong people to the United States during the Vietnam War. Most of the older Hmong people living in the United States today came as refugees in the 1970s.

Gerdner’s own research shows that Hmong elders generally lived in multigenerational homes, where grandchildren often feel anxious and fearful about communicating with demented elders. This increases the stress in the household.

To overcome this, Gerdner recently co-authored an illustrated storybook for children that she hopes will serve as a ""teaching tool"" for them and their family members. The book, titled ""Grandfather’s Story Cloth,"" is due out in March.

Weiling Liu, a researcher at the Older Adult and Family Center, Stanford University School of Medicine, and Jane Nhã Uyên Tr?n, a researcher at the Older Adult and Family Center at Stanford University School of Medicine, shared their research findings on the Chinese and Vietnamese elder communities, respectively.

Although the Chinese American community often view dementia as a form of madness, and many Vietnamese Americans speak of the disease in religious terms — that the demented are possessed by spirits or demons both communities generally believe that the disease is a retribution for past deeds.

In recent years, two in-home-based, culturally sensitive intervention programs for the Chinese community have been started in California: the Chinese Caregiver Project and the Chinese Caregiver Assistance Program. Other community-based Chinese American organizations do outreach to churches to educate the congregation about the disease, including how to recognize dementia, Liu said.

Family members of both Chinese American and Vietnamese American communities believe that because elders are to be respected, they need to be cared for no matter what the difficulty is.

""The filial piety among those interviewed was very strong,"" Tr?n noted. ""And they accept the sacrifice of time and material resources.""

Said Liu: ""There is a shame and guilt attached with not caring for family members.""