Cross-cultural Influences on Older Adults

1. Cross-cultural Influences on Older Adults

2. Objectives • Describe cultural beliefs and values and discuss their effect on behaviors and beliefs about health care • Acknowledge the heterogeneity within groups of ethnic elders and that there are patterns of morbidity for each ethnic group • Assess client position on acculturation, education, and income and relate these to client ability and desire to access the health care system

3. Objectives • Recognize the cultural and religious beliefs, practices, and life experiences of ethnic groups and the influences of these on attitudes toward aging • Discuss the roles, attitudes, and influences of family and support systems toward caregiving within ethnic groups • Conduct culturally appropriate assessments that are respectful of individuals and families

4. Multiculturalism is here to stay…. • Multiculturalism, integration, assimilation, and acculturation can trigger insensitivities • Immigration Gateways: • Former • Continuous • Post-World War II • Emerging • Re-emerging • Pre-emerging • Immigration Patterns: Salt Lake City; Raleigh-Durham “hot jobs”; California, New York, Los Angeles, Chicago, Houston, and Miami

5. Cultural Competence • A continuum of care • Sensitive to issues related to culture, race, gender, and sexual orientation • Provided by nurses who use nursing theory and models within the cultural context of the client

6. Culture defined a way of life consisting of beliefs and values that give individuals a sense of identity, self-worth, and belonging, and rules of behavior which enable the group to survive and provide for the welfare and support of its members.

7. Other definitions Race: biological or physical groups of people Minority: describes numerical and power disadvantage Ethnic or Ethnicity: used to refer to groups identified by racial or religious differences.

8. Cultural Competence Group Discussion • Examine the influence of your own cultural background and attitudes toward people of your own and of different cultures • Examine how your orientation influences caregiving practices generally, and older people specifically

9. Ethnic Older Adults…in perspective GLOBAL OLDER ADULTS • 2000: 1 of 14 people on EARTH = 440 million or 7% of the population • 2020: Will double to over 9% • 2050: Will triple to almost 20% UNITED STATES OLDER ADULTS • 2002: 35.6 million older adults predominantly White, more women than men • Minorities: 17.24% of all older adults (6.1 million)

10. Ethnic Older Adults…in perspective • 8.1% were African-Americans • 5.5% were persons of Hispanic origin, who may be of any race • 2.7% were Asian or Pacific Islander • less than 1% were American Indian or Native Alaskan • 0.5% identified themselves as being of two or more races.

11. Acculturation and Assimilation Acculturation • Cultural modification • Adoption of behavior patterns of surrounding culture • Acquiring the capability to function within the dominant culture, while retaining one’s original culture Transition – state of equilibrium Assimilation • When the second culture becomes the dominant culture

12. Indicators of Acculturation • Usage of the English language • Length of United States residency • Expression of values • Ties to people in country of origin • Interpersonal network composition • Media behavior Source: [1] Korzenny, Felipe. (1998). Acculturation: Conceptualization and Measurement. Retrieved April14, 2004 from http://www.hamcr.com/acculturation.htm

13. Differences in ethnic older adult aging • Chronic illness onset earlier than Whites • Higher incidence of obesity and late onset diabetes • Underreported health problems • Delay in seeking health-related treatments • Excluded from drug research • Poor mental health: due to poverty, segregated and disorganized communities, poor education, unemployment, discrimination, poor healthcare

14. Differences in ethnic older adult aging • African Americans and Hispanics – receive a lower quality of healthcare across a range of disease entities • African Americans are more likely to receive less desirable services such as amputation of all or part of a limb • Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account

15. Differences in ethnic older adult aging • Disparities are found across clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc. • Disparities are associated with higher mortality among minorities who do not receive the same services as White, such as surgical treatment for small-cell lung cancer.

16. Factors in racial and ethnic disparities • Patient Level Factors • Clinical appropriateness of care • Patient attitudes and preferences • Expectations regarding healthcare • Mistrust • Treatment refusal • Care-seeking behaviors: “culture match” Source: The National Academy of Sciences, Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed on April 14, 2004 from http://www.nap.edu/openbook/030908265X/html/125.html.

17. Factors in racial and ethnic disparities • System-Level Factors • Insurance Coverage • Limited English Proficiency (LEP) • Ad hoc Interpretation • Access to Service Source: The National Academy of Sciences, Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed on April 14, 2004 from http://www.nap.edu/openbook/030908265X/html/125.html.

18. Factors in Racial and Ethnic Disparities 3. Care-Process Factors • Physician biases • Stereotyping • Uncertainty factors Source: The National Academy of Sciences, Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed on April 14, 2004 from http://www.nap.edu/openbook/030908265X/html/125.html.

19. Influence of Beliefs and Practices What are some beliefs and practices that influence the care-seeking behaviors of the minority older adult? Cultural Elements • Respect • Death and Dying • Pain • Medicine and Nutrition • Independence

20. Influence of Life Experiences The elements of life experiences that influence the minority older adult’s ability and desire to access health care: • Experience with racism and discrimination • Income and the ability to buy needs – socioeconomic status • Traditions, rituals, taboos • Trust and mistrust toward healthcare providers

21. Family Power Relationships Assessment Points • Who controls the flow of information to the patient? • Who makes decisions? • What is the role of family when personal representative is needed for end-of-life decisions? • What are the values of independence and community?

22. Home Care / Assisted Living Nursing Home Hospital Considerations: Care-giving Settings

23. All scales and instruments should be translated or given orally; use drawings Verify translation: trained translator vs. ad hoc translators; Interpretations may vary LEARNING Listen Explain Acknowledge agreement/differences Recommend course of action Negotiate what’s important Involve client Never negate beliefs and views Gather the family or decision makers whenever necessary Culturally appropriate assessments

24. Questions?