“The conversation wouldn’t happen without us”: How interpreter involvement affects dementia service delivery for CALD clients in Australia

Dementia is a condition that changes how a person thinks, remembers, and communicates. For anyone living with this condition, the ability to speak clearly and be understood is the foundation of good medical care. Doctors need to hear symptoms to make a diagnosis, and patients need to understand their treatment plans to stay safe. But when a person with dementia speaks a language different from their doctor, a gap opens up. In countries like Australia, where many older people were born overseas and speak languages other than English, this gap is a daily reality. To bridge it, health services often rely on interpreters—people who translate what is said between the doctor and the patient. However, simply having a translator present does not guarantee that the conversation will work well. The way an interpreter is treated, the tools they use, and the time they are given can change the entire outcome of a medical visit.

A new study from Australia explores exactly how these translations shape care for older people with dementia. The researchers wanted to understand the real-world experience of using interpreters, not just as a technical step, but as a human interaction that affects who gets heard and who gets left out. They gathered stories from three groups of people: professional interpreters, health workers like doctors and nurses, and the family members who care for people with dementia. By listening to all three sides, the study reveals that successful care depends on much more than just finding someone who speaks the right language. It depends on whether the interpreter is treated as a partner in the medical team or just a tool, whether the system allows enough time for a slow and careful conversation, and whether the specific challenges of dementia are understood by everyone in the room.

The study, conducted by Mojtaba Zokaee at RMIT University, brought together data from 64 questionnaires filled out by interpreters, 17 from health practitioners, and interviews with 11 health workers and 12 caregivers. The researchers did not just count how often interpreters were used; they looked deeply at how those interactions felt and what happened because of them. They found that when interpreters are involved, they often make the difference between a consultation that works and one that fails. One interpreter described their role with a simple, powerful truth: "The conversation wouldn't happen without us." Without a professional translator, many conversations simply cannot take place because the doctor and patient cannot understand each other's words, let alone the complex feelings and memories involved in dementia care.

However, the study discovered that having an interpreter is not a magic fix. The quality of the care depends heavily on how the interpreter is positioned. In some cases, health workers treat the interpreter as a "talking machine," a device that simply passes words back and forth without adding any human context. In these situations, the interpreter is often left out of the decision-making process, and their valuable observations about the patient's confusion or cultural background are ignored. In contrast, when the interpreter is treated as a team member—someone who is briefed before the meeting and debriefed afterward—the care improves. These professionals can explain not just what the patient said, but how they said it, noting pauses or hesitation that might signal a specific type of memory loss. When the medical team respects the interpreter's expertise, the patient is more likely to be addressed directly, rather than having the conversation happen only with a family member.

A major problem identified in the study is how health services organize these appointments. Often, the system is driven by what is immediately available rather than what is best for the patient. Because booking a professional interpreter takes time and effort, families or bilingual staff members are frequently asked to translate instead. While family members are trusted and can offer emotional comfort, the study found that this substitution often changes the nature of the visit. The conversation can shift from being between the doctor and the patient to being between the doctor and the family. This can mean that sensitive information is filtered, or that the person with dementia loses their voice in their own medical care. One health worker noted that while a family member might be faster to arrange, they might also insert their own thoughts into the process, whereas a professional interpreter strives to keep the original meaning intact.

The challenges are even greater when it comes to testing a patient's memory and thinking skills. Many standard tests used to diagnose dementia were designed for English speakers and may not work well when translated. The study found that interpreters often face a difficult choice: translate a word literally, which might make no sense in the patient's culture, or explain the concept, which might change the difficulty of the test. For example, a question about a specific type of boat equipment might be impossible to answer for someone who has never seen such a boat, not because of memory loss, but because of cultural differences. If the interpreter tries to help by explaining the item, they might accidentally make the test easier, leading to an inaccurate diagnosis. The researchers found that for these assessments to be fair, interpreters need specific training in dementia care and a clear understanding of how to handle these tricky moments without altering the test's purpose.

Continuity also plays a vital role. People with dementia often feel anxious and confused, and seeing a different interpreter at every visit can make them feel unsafe or unheard. The study showed that when the same interpreter returns, it builds trust and reduces the need to explain the situation from scratch. However, the current system often makes this difficult. Interpreters are frequently unavailable, or the booking systems do not allow for the same person to be assigned to a long-term care plan. This lack of consistency forces families to step in again, or leaves the patient struggling to connect with a stranger who does not know their history.

The findings suggest that for dementia care to be truly equitable, health services need to change how they think about language support. It is not enough to just have interpreters available; they must be integrated into the care team with clear roles, given enough time to do their job, and supported with training specific to the needs of people with dementia. The study also highlights that while family members are often the first line of support, relying on them for complex medical decisions can place an unfair burden on them and risk the patient's privacy and autonomy. The research does not claim to have solved these problems or proven that one specific method works best in every case. Instead, it offers a clear picture of the current barriers and suggests that fixing the system requires attention to the details of how interpreters are booked, trained, and treated. By making these changes, health systems can ensure that every person, regardless of the language they speak, has a real chance to be heard and understood in their time of need.