GERO GEMS Diversity in Aging: Ethnogeriatrics

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Osborne Bradley
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GERO GEMS Diversity in Aging: Ethnogeriatrics April 2007 Everyone is influenced by their individual culture, ethnicity, history, values, and

This rich tapestry of diversity is evident in history, adds brilliance to art and literature, and is apparent in the people within our

For years, aging studies in the U.S. focused mainly on Caucasian/White Americans. In recent years, the research focus has broadened.

5% 64.2% Hispanic/Latino 5.6% 16.4% African-American 8.1% 12.2% Asian/Pacific Islander 2.4% 6.

Recognizing the need to include culture and ethnicity as a research/practice branch, the American Geriatrics Society (AGS) coined the term

As defined by AGS, this component of geriatrics considers the influence of ethnicity, and culture on the health and well-being of older adults.

1 GERO GEMS Diversity in Aging: Ethnogeriatrics April 2007 Everyone is influenced by their individual culture, ethnicity, history, values, and beliefs. These variables influence every aspect of our lives, including our health and wellness practices. This rich tapestry of diversity is evident in history, adds brilliance to art and literature, and is apparent in the people within our community. The interrelationships among aspects of diversity have a major impact on how we age and on our support system. For years, aging studies in the U.S. focused mainly on Caucasian/White Americans. In recent years, the research focus has broadened. Sheer numbers may be a driving force behind this trend as the census data 1 and projections indicate significant change: U.S. population: White Americans 83.5% 64.2% Hispanic/Latino 5.6% 16.4% African-American 8.1% 12.2% Asian/Pacific Islander 2.4% 6.5% A one size fits all approach to health and health care is not an option! Recognizing the need to include culture and ethnicity as a research/practice branch, the American Geriatrics Society (AGS) coined the term ethnogeriatrics. As defined by AGS, this component of geriatrics considers the influence of ethnicity, and culture on the health and well-being of older adults. 2 There is great cultural diversity and variation between people classified as minorities, even within each group. For example, Hispanic or Latino populations may include Mexican- Americans, Puerto Ricans, Cubans or those from the Dominican Republic or South or Central America, perhaps representing 22 different countries. Due to these differences, it is incumbent on health care and social services professionals to provide culturally sensitive care.

2 Self-Assessment To determine your level of cultural sensitivity, consider how you would answer the questions below. 3 These questions are intended to increase your awareness about the role that your individual culture plays in your attitudes and beliefs. 1. What stigmas are associated with the sociocultural group that I most closely identify? 2. How has the group in which I grew up / live in, influenced the dominant values I now hold? 3. How do my perceptions differ from those who come from other cultural backgrounds? 4. What is my attitude toward people, especially older adults... who have difficulty with the English language? who have an accent or are difficult to understand? who have a cultural background different from my own? who are immigrants? 5. Do my health care practices differ from conventional Western medicine practices (i.e., herbs, folk remedies)? 6. How might my belief about alternative/complementary health care practices influence my work? Call for Cultural Competence Faculty members from the Stanford Geriatric Education Center offer strategies to help reduce cultural barriers within organizations. Embracing these strategies is an important step to providing culturally competent health care. Hire ethnically diverse staff Provide adequate interpreter services Train staff on the history and culture of clients, cultural competencies Assess literacy and provide culturally appropriate verbal and written information Understand who health decision makers are in the culture 4 We have been the benefactors of our cultural heritage and the victims of our cultural narrowness. Stanley Kripper Psychologist Health care professionals need a set of integrated attitudes, knowledge and skills that enable a health care professional or organization to care effectively for patients from diverse cultures, groups and communities. 5 Culturally Specific Perspectives Culturally diverse faculty, staff and students at the University of Cincinnati College of Nursing have shared information and perspectives to help health care and social services professionals enhance their understanding of ethnogeriatrics. Cultural considerations are presented here as a general guide for understanding the intersection of culture and aging for each diverse group. African-American Elders Older adults are held in a position of honor and respect, and should be addressed accordingly. Extended and collateral family networks often provide support. Older adults depend on people outside the immediate family to assist with physical care needs. Older adults often turn to spiritual and religious practices to manage and cope with life stressors including illness. Older adults may be reticent to trust health care institutions and providers due to the history of discrimination and racism. 2

3 Preparation of traditional foods are symbolic of one s heritage and values, are a source of comfort, and are an important part of holidays and family gatherings. 6 Although those elders of common culture, ethnicity, and age may share similar characteristics, it is vital to recognize the heterogeneity and variation within cultural groups. Donna Shambley-Ebron, Assistant Professor Cameroon Elderly Older adults are held in the highest regard and revered for their wisdom, experience, and closeness to the spiritual world. Family and friends consider caring for the elderly not as a duty, but a privilege. (This view of the elderly is primarily based on traditional African beliefs that the elderly will judge us in the next world). When an elderly person is ill or hospitalized, family prefers to provide personal care. During chronic illness, elderly relatives are taken care of by family in the home. There are no nursing homes and very limited home health services from professionals. In general, I believe that views of the elderly in Cameroon are much more positive than what my experience here in the U.S. leads me to believe. Comfort Enah, Assistant Professor Chinese Elders Confucianism has played an important role in the traditional Chinese culture. The goal of Confucianism is to achieve social harmony. A central theme of Confucianism is the relationships between younger ( juniors ) and older ( senior ) generations in their society. Juniors have obligations of respect and service to seniors, and seniors have obligations of benevolence and concern toward juniors. Seniors are respected and honored. Seniors are considered wise from their living experiences and their opinions are always taken in serious consideration by juniors. In China, unlike the West, most Chinese elders still live with their families. Traditionally, parents move to live with the oldest son when the son gets married. The parents help take care of grandchildren and the adult children have responsibilities to care for their parents when the parents themselves need care. The children hesitate to send their parents to a nursing home because it is considered against the tradition of filial piety (respect and obedience children show their parents) and the children may be criticized by the relatives or public. Yin Xu, Assistant Professor 3

4 American-Indian Elders (The Navajo) Indian cultures have a great deal of respect for the aged. Considered the teachers of the Navaho culture, older adults see that traditions are maintained. Families are very close and live on or near the grandmother s property. When a woman marries, she and her husband build their home near her mother. Decisions are always up to the mother s family, elders have a voice on all family matters as their wisdom is valued. Adults are cared for in their old age by their children. (There have been recent changes as people are moving from their family camps to towns on or off the reservations where they find work with tribal or federal governmental agencies.) Dependent elderly parents may receive care in senior day centers or nursing homes. In the clinical setting, it is common for the grandparents to be consulted before parents will give permission for medical treatment for their children. Groups such as the Tribal Council call upon the wisdom of the elders. The NANAINA (National Alaskan Native American Indian Nurses Association) encourages their members to use their elders as a resource in planning and giving care. Nancy Savage, Professor Emerita Hispanic/Latino Elders When a person only speaks Spanish that does not equate to a lack of education. Some older adults speak English as a second language. Oral skills in English often exceed reading and writing skills. Mexican Americans tend to have fewer years of formal education than Anglo Americans. Non-verbal communication, such as silence, may not mean agreement, and touch can be viewed as disrespectful. Health decisions often include the family, and extended family tends to be involved in care. Dying at home is considered desirable, and organ donation is culturally unacceptable. Germ theory leads to a belief that illness may stem from stress and evil spirits. Families from Latin countries tend to have an old custom viewpoint and would rather keep older adult at home whereas with westernized cultures, nursing home care is acceptable. Be aware of cultural needs and individualize instead of generalize. The health care model most often used in the U.S. is based in Northern European values of self-determination, time orientation, etc., that may contribute to cross cultural misunderstanding when providing care. Liz McClure, Assistant Professor Clinical Nursing Asian Indian Elders (Culture is mostly based in Hinduism) Older people are highly respected, are considered head of the household, and are the decision maker. People care for family members in sickness and in old age. Larger cities, such as Mumbai (formerly Bombay) and New Delhi have nursing homes. An estimated 10-15% of the older adult population is cared for in nursing homes since many adult children are now working outside the home. 4

5 Depending on the relationship with the family and medical providers, health care may be sought for older adults through home visits. Upon marriage, the couple typically lives with the husband s family. There is no 911 system for emergencies and families pay for health care by co-pay system (10-20% of cost). Madhavi Saxena, Junior Nursing Student Korean Elders Korea is becoming an aging society (9% in 2005) and has one of the most rapidly increasing aging populations in the world. Elders usually live with family and tend to reside with an adult son and his family. Recent societal changes such as women working outside the home, have resulted in a significant number of elders living alone or with a spouse (44%). Some elders volunteer to teach younger generations traditional cultural customs, and a few baby-sit for their grandchildren. Health insurance for elders has been covered by employee benefits through their children as dependents. There are few nursing homes for elders who do not have children or income. The government also provides free subway and bus transportation for all elders. The Korean government is planning to provide more alternative living arrangements for elders such as independent living facilities or nursing homes through a national pension plan in the future. Hae Sue Chung, Assistant Professor and Jong Kuyng Lee, Visiting Nurse Scholar Elders in Ukraine (Note: Some customs may have changes since Mrs. Kogan left the Ukraine) It is common for three generations of family to live in one household or in close proximity. The retirement age for women was 55 years and for men 60 years. Grandparents were taking care of their grandchildren and doing all kinds of housework (e.g. shopping, cooking, cleaning). As grandparents were getting older and needed more help, their children and grandchildren were take on the role of caregivers. Nursing homes for the elderly did not exist in Ukraine (as far as know). The very old, very needy and very sick, live with their children until the day they die. In addition to providing day-to-day care, children play the role of nurse-aides or nurses. The family members were giving each other support financially, physically and psychologically as needed. Nina Kogan, Library Staff, UCCON 5

Recommended Resources Evelyn s Picks Website: http://www.omhrc.gov/clas. The Dept.

6 Recommended Resources Evelyn s Picks Website: The Dept. of Health and Human Services, Office of Minority Health website includes 14 standards for Culturally and Linguistic Appropriate Services (CLAS) along with a variety of addt l resources regarding cultural competency. Website: The Stanford Geriatric Education Center provides a comprehensive training module on culturally sensitive geriatric care and is an excellent source of ethnogeriatric information. Stanford also offers an ethnogeriatric IQ quiz available at Website: Health disparities affecting minorities will continue to be apparent and may increase unless solutions are found to address both current and anticipated challenges. Visit the Office of Minority Health website for further information and resources regarding this important topic. There is compelling evidence that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations demands national attention. CDC website from the Office of Minority Health Book: Spector, R.E. (2004). Cultural Diversity in Health and Illness. 6 th Ed. Upper Saddle River, NJ: Prentice Hall. Thanks to our colleagues at the University of Cincinnati College of Nursing for sharing valued cultural information. References: 1. US Census Bureau January American Geriatrics Society Position Statement on Ethnogeriatrics (2003, 2006) 3. Miller, C. (2004). Nursing For Wellness in Older Adults. New York: Lippincott, Williams & Wilkins 4. Yeo, G. (2005). Our Ethnogeriatric imperative. Available online 5. Ibid. 6. Purnell, L.D. & Paulanka, B.J. (2005). Guide to Culturally Competent Health Care. Philadelphia: F.A. Davis GERO GEMS is a publication of the Center for Aging with Dignity (CFAWD). The CFAWD is devoted to keeping people SAFE After 60 by advocating for, advancing and developing best-practice programs on the safety and mistreatment of older adults. GERO GEMS is written by Evelyn Fitzwater and edited by Charles Puchta. Copyright 2007 University of Cincinnati. College of Nursing University of Cincinnati 3110 Vine Street, 429 Procter Hall PO Box Cincinnati, OH (513)

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CAHPS Hospice Survey Please answer the survey questions about the care the patient received from this hospice: [NAME OF HOSPICE] All of the questions in this survey will ask about the experiences with