Cultural and Language Barriers

Transcription

1 Cultural and Language Barriers to Using Residential Aged Care Facilities: Important Issues for Vietnamese Elderly People in South Australia A research report submitted in partial fulfilment of the requirements for the degree Master of Gerontology Student: Tieu Van Nguyen ID: S Supervisor: Susan Gilbert Hunt, M. Hith. Sc. (OT) Course Co-ordinator Gerontology Post Graduate Awards School of Occupational Therapy University of South Australia November 1999

2 AB S TRACT Objective: This small scale exploratory qualitative research study investigated how Vietnamese elderly people in South Australia perceived the use of residential aged care facilities. Method: A focus group involving a semi-structured interview was conducted with eight Vietnamese elderly people. Results: Three primary themes emerged from the data: barriers to using residential aged care facilities, the importance of cooperation with nursing staff, and the aspirations of the Vietnamese elderly group. Conclusions: Vietnamese elderly people are under-represented in residential aged care facilities. A number of Vietnamese elderly people are in a sad plight due to cultural and language barriers to using these facilities. This study suggests the need for further research to investigate the appropriateness of current policies and practices in residential aged care, and to develop policy which brings social justice to all Australians.

3 INTRODUCTION Research relating to migrants in Australia has focused on those people who migrated while still young, little attention has been given to those people who arrived in their later years [1]. Of the more than three hundred entries on ethnic ageing noted by Rowland, only a small number focused on issues of migration in old age [2]. Moreover, research relating to Vietnamese migrants has been very limited [3]. In South Australia, research relating to migrants has focused more on ethnic aged people in general [4,5,6]. Only a few surveys of older Vietnamese migrants' general needs have been conducted. These surveys mention aspects of nursing home and hostel needs among other needs. The surveys did not focus on issues surrounding the use of residential aged care facilities among Vietnamese elderly people as a specific topic [7,8]. Thus no research has specifically focused on residential care need for Vietnamese elderly people, despite this group of people being under-represented in the residential care sector. Non-English-speaking background (NESB) people are commonly underrepresented in residential aged care facilities [2,6, 9]. In particular, the low representation of Vietnamese elderly people is more marked in residential aged care facilities in South Australia. There are 736 Vietnamese elderly people (aged 60 or more) living in South Australia. As survey of 508 Vietnamese elderly people [8] found there were 404 people with mild or 2

4 severe disability, including 49 people receiving regularly domiciliary nursing care and 51 people using respite care. However, of this group, only 5 people were found to use high residential aged care facilities (formerly nursing homes). Nobody was found to use low residential aged care facilities (formerly hostels) [8]. This research aimed to explore the cultural issues surrounding the use of residential aged care facilities among Vietnamese elderly people. It is anticipated that the findings may offer suggestions to residential aged care service providers and related agencies in relation to meeting the special needs of Vietnamese elderly people. Moreover, the results of the research can contribute to the enhancement of multicultural policy, social justice, access and equity for ethnic aged people in general, Vietnamese elderly people in particular [10]. By providing information which has not been found in the previous studies in the field, this study will, in part, fill the gap in gerontological knowledge in Australia. METHOD The inquiry was small scale and exploratory. The study aimed to identify issues regarding the specific situation of a particular group (older Vietnamese group). Thus qualitative methodology, using a focus group technique, was adopted to explore the research question [11,12,13,14,15]. The research question was: What are the cultural issues surrounding the use I 3

5 of residential aged care facilities which limit their use among Vietnamese elderly people in South Australia? Participants included eight Vietnamese elderly people (three women and five men), aged between 65 and 79 years, who were selected through purposive sampling. (All participants were 'on the same wave length' [11, p.13]). Participants were required to be potential users of residential aged care facilities, living in South Australia, and able to attend the group interview in terms of their physical and mental health. Most of the participants had acquaintances who live or had lived in a high residential aged care facility (nursing home). One participant's husband resides in a nursing home. Data was elicited from an in-depth group interview and field notes. A focus group topic guide and questioning route was developed (see appendices). There were seventeen initial questions which flowed in a logical sequence. Further and serendipitous questions were developed during the interview [13]. Semi-structured interview techniques were used. During the focus group interview the researcher played the roles of the moderator and the assistant moderator simultaneously facilitating the interview session and taking notes. Given the homogeneity of the older Vietnamese group and the simplicity of the research question, the researcher conducted a single focus group instead of a series of focus groups [15]. One 90-minute focus group interview 4

6 session was held during which the researcher observed that a point of saturation was achieved [16]. The interview was audio taped and transcribed. Data Analysis began when the researcher commenced the study. Focus group data from transcript, observational and field notes were analysed. The transcript, initially written in Vietnamese, was translated into English for the purpose of analysing and reporting. The researcher carefully transcribed the audio tapes and translated the transcript so that the essential features of the participants' responses or comments remained intact [13,15]. Participants read the transcript in Vietnamese for checking. The researcher then read the draft report in English and translated it into Vietnamese for participants to hear and to comment on the findings. Two types of units of analysis in this study are: (a) the identifiable words, sentences or key statements in the texts and (b) the focus group as a whole rather than individuals [12]. Systematic coding using content analysis and ethnographic summarisation was used [12,17]. Themes were identified [12,18,19,20,21,22]. Given the small scale of this research, analysis was conducted manually, using index cards [22,23] and the cut-and-paste technique [15,16]. Briefly, the analysis process involved: (a) coding data, discovering themes and developing propositions, (b) refining themes and propositions, and (c) reporting the findings [19]. 5

7 RESULTS Three primary themes were identified from the data: barriers to using residential aged care facilities; the importance of cooperation with nursing the aspirations of the Vietnamese elderly group. Barriers to using residential aged care facilities Participants (the focus group) discussed issues regarding a range of factors which they considered as cultural or language barriers to using residential aged care facilities. They cited situations where a number of Vietnamese elderly people were in a sad plight because of these barriers. A number of sub-themes within this theme further elucidated the group's views in relation to barriers. Food. Participants regarded food as an essential part of people 's life. The food in residential aged care facilities was seen as inappropriate for Vietnamese elderly people due to different food habits. Life-long dietary customs and preferences make it difficult for Vietnamese residents in residential care facilities to eat Australian food. In some cases, in order to cope with this problem, a family carer had to play the role of the cook for a family member in a nursing home. 6

8 He couldn't eat Australian food. So one of his children had to bring him Vi etnamese food. (Focus group participant). Recreation and leisure activities. Participants referred to the recreation and leisure options in residential care facilities not meeting the cultural needs of Vietnamese elderly people. (When visiting a resident the visitor/participant asked) she wanted to watch TV She said, "No" because she can 't understand English, I asked she wants to watch video. "What films do you want to see?" She said, "Vietnamese reformed theatre and Chinese films ". (Focus group participant). She 's very sad. I asked, "Do you like reading?" (Reading Vietnamese books only) She said, "No ", but I would listen to someone (a Vietnamese person) who reads for me" (Focus group participant). Confucian concepts. Participants emphasised the influence of Confucianism as a philosophy within Vietnamese culture. One must care for frail aged parents and disabled spouses at home and not place them in nursing homes. An example was given where a family consisted of three people: a man, 65, his mother, 94 and his wife, 67. The man was not really well; his mother suffered from dementia; his wife suffered from diabetes 7

9 and was disabled. Despite this he decided to care for his mother and his wife at home. He said (the man mentioned above) that according to Vietnamese culture, children must take care of their parents. There are three responsibilities (tam cuong) including national loyalty (trung), filial piety (hieu) and conjugal affection/relationship between husband and (nghia). He said, national loyalty now no longer exists, because we have lost our country (Vietnam). He now has only two remaining responsibilities that are filial piety (caring for his mother) and conjugal affection (caring for his wife). He said, "I must keep these remaining responsibilities" (Focus group participant). Reputation. According to participants, children might fear a bad reputation, shame and guilt if they sent their parents to nursing homes, even if circumstances compelled them to do so. Previously he had been ill. He had been hospitalised and the situation had been grave. After his discharge from hospital, his children sent him to the nursing home. After he entered the nursing home, his children lied saying that he was still in hospital, because they didn 't dare say that they had institutionalised their father in the nursing home. They thought if they said that they had sent their father to the nursing home, then they would acquire a bad reputation (as children being guilty of filial impiety). (Focus group participant). 8

10 Participants discussed a situation in which a couple had the wife's mother and father living with them. It seems that the father suffered from dementia, and the mother was elderly. The father was kept at home despite the family not being able to care for him. Because the younger couple were busy going to work, they left their father at home with nobody to care for him. Initially the couple let the father live in a room of their house. But, because the father cried too much and made it difficult for the children to study, the couple took him to live in the shed. The mother, although not well, cared for her husband in the shed. The couple kept their father at home to hide their bad behaviour towards their parents and to avoid bad reputation, but this had an adverse effect: fear of a bad reputation resulted in filial impiety. (Focus group participant). Living in the shed the father usually cried out when it was very hot. Neighbours heard his cries and discovered what was happening in the couple's family. Then they reported it to the authorities who came to inspect the shed and decided to institutionalise both parents...the wife (the couple's mother) caredfor her husband (the couple's father). She wasn't really ill but was very old and frail. Caring for her husband she stayed at home all day. It was usually very hot in the shed. So she was constantly under pressure and it was affecting her health. She seemed to suffer from mental illness. There was the 9

11 lack of hygienic condition in this shed. Under the circumstances, the authority decided to institutionalise both parents. (Focus group participant). Extended family. Participants referred to the extended family, which these Vietnamese elderly people regarded as a means of bringing more happiness to all family members. Participants said many frail elderly and disabled Vietnamese people did not want to leave their extended family and hesitated to enter a residential care facility. Although they were in their twilight years, they still thought of their children, grandchildren and relatives. Despite a limited amount of social benefits, they tried to save money to help their family. This was one of the reasons which prevented them from entering a nursing home. If they were to enter a nursing home they would have to contribute almost all their income to the facility and would have no money left to help their families financially. There are a number of(vietnamese)frail elderly people who want to enter a nursing home, but they don 't apply for admission, because they think that when living in a nursing home they must pay fees, which are nearly equal to all of their pension or social benefits. (Focus group participant). I think that Vietnamese people live different lives from those of western people. The latter receive social benefits, which never cover their needs, whereas Vietnamese people receive $1000, but only 10

12 spend $700 or $800, for example. Their savings may be either sent to Vietnam to help their relatives or given to their children or grandchildren living here, because many Vietnamese people have austere lives. (Focus group participant). Last resort. Participants considered admission to a residential aged care facility as a most serious step in the life of Vietnamese elderly people and their families. Vietnamese elderly people would enter a nursing home only when there was no alternative. I participated in a survey of Vietnamese elderly people 's needs, conducted by Mr T (from the Vietnamese Community). In the survey there was a question" Would you like to enter a nursing home?" All Vietnamese elderly people (NlOO in that survey) had the same answers such as the following: "At present I don 't want to leave my family, children and grandchildren. In the future, however, when I'm not able to care for myself I'll probably be forced to enter a nursing home. The reason is that nobody will be able to take care of me, and my children, grandchildren and close relatives will be busy at work or going to school" (Focus group participant). When circumstances compel us, we will be forced to enter a nursing home. (Focus group participant). 11

13 Language. The focus group revealed a case in which language barriers were a significant factor that disastrously affected a Vietnamese elderly woman living in a nursing home. This was because nursing staff misunderstood her situation and wishes. She copes with a lot of djfjiculties especially language barriers. This problem vexes her, then she becomes angry and irritable. She cries so much. Staff in the nursing home take her into a special room and treat her as a person who suffers from dementia... This elderly woman had a normal ltfe. Now she has become a person with dementia. (Focus group participant). Each time I (the participant/visitor from the Vietnamese community) come to see her, she shouts. It's her usual behaviour... Because staff don 't understand that she shouts asking to return home, they think her suffering from dementia. (Focus group participant). Participants alluded to a situation where a Vietnamese elderly man who could not speak English, and staff had to ask his children act as interpreter. He couldn 't speak English. So when staff in the nursing home wanted to tell him something, they had to telephone his children to come to see them and play the role of the interpreter. (Focus group participant). 12

14 UNIVERSITy OF SOUTh AUSTRAUA LIBRARY Participants said that they would enter a nursing home eventually. They would encounter the obstacles caused by language difficulties because they could not communicate with other residents. I think that language is very important. We will be unfamiliar with people around us because we can 't communicate in English. People will want to be acquainted with us but they won 't be able to because of language barriers. (Focus group participant). The importance of cooperation with nursing staff. Participants emphasised the importance of family and community cooperation with nursing staff. The following sub-themes describe this. More family cooperation. Residents felt happy when family members regularly visited and cared for them The (Vietnamese) elderly person in this nursing home was happy, because here his children cared for him perfectly. Once we visited him, he was smiling very happy. So there was care given by both the nursing home and the family. (Focus group participant). His children took turns to care for him. One of his children came to the nursing home at about a. m. and stayed here with him until 13

15 all visitors were asked to leave the nursing home. (Focus group participant). Less family cooperation. Less family cooperation with nursing staff made the elderly individual feel sad and full of self-pity. She looks around and sees other residents who have children coming to visit them, while her children don 't come to see her or care for her, but entrust her entirely to the care of staff in the nursing home. Often nobody comes to see her even once a month. So she feels sad and full of self-pity. (Focus group participant). The need for community cooperation. Community cooperation with nursing staff was important; especially when there was the lack of family cooperation. Perhaps someone interprets what she says or explains what she feels (because she can't speak English), and a nurse in the nursing home then telephones the Vietnamese Community to let this organisation know about her situation. After that the Vietnamese Community lets me (the participant who organised the community to visit residents) know that this nursing home is asking the Vietnamese Elderly Association to nominate members of the Association to come to the nursing home to visit her. We can only visit her once a fortnight or once a month. (Focus group participant). 14

16 The aspirations of the Vietnamese elderly group In order to overcome the barriers, participants wished to have gerontological policies and practices leading to innovation, improvement or modification of residential aged care facilities to meet their special needs. The group discussed three options in the following sub-themes. A specific nursing home. Participants wished to have a nursing home for Vietnamese people, similar to the one, reserved for Italian people or like the one, reserved for Ukrainian and Croatian people in Adelaide. This, however, is impossible because there are very few potential residents, and Vietnamese elderly people only enter a nursing home when circumstances compel them. (In a survey on general needs conducted by the Vietnamese Community in South Australia, there was a question asking) whether Vietnamese elderly people wanted to enter a particular nursing home for Vietnamese. Only one answered "Yes"...Most Vietnamese elderly people don 't want to enter a nursing home now. They only enter it when circumstances compel them. I think we shouldn 't build a particular nursing home for Vietnamese elderly people yet. (Focus group participant). A specific hostel. Participants referred to the Mekong Senior Citizens Hostel in Melbourne. According to the participant, who has visited it, this 35-bed hostel has a library, activity and entertainment room, communal 15

17 living room and Vietnamese medical and nursing staff. It caters adequately for residents. They wanted a similar hostel for Vietnamese elderly people in South Australia. Vietnamese elderly people in Australia, in general, and in South Australia in particular, aspire at present to have a hostel like the Mekong Senior Citizens Hostel. (Focus group participant). Participants were asked whether they rely heavily on the government or on their own community to build the hostel. Their responses were follows: The government would provide some facilities such as land, buildings and necessary equipment, and the workers would be Vietnamese volunteers. At first the government wouldn 't provide us with all facilities, there should be Vietnamese voluntary workers such as doctors, nurses and other volunteers who work at the hostel. Later on, once the government considers the new hostel is essential for the life of Vietnamese elderly people and needs to be developed, the government would provide more facilities or give more grants. (Focus group participant). Reserved area. Participants all agreed that building a nursing home or hostel for Vietnamese people is a matter for the future. At present although most Vietnamese elderly people do not want to enter a nursing home, there are times when some, if not many, must enter a generalist nursing home. 16

18 Therefore their view is that modifying or improving some aspects of existing nursing homes is imperative, for example, having a reserved area with Vietnamese staff and providing culturally appropriate services, so that they could live there relatively comfortably. We can 't ask too much at the moment. If we need to use a nursing home now, we would enter a generalist one. But we request a special area reserved for Vietnamese elderly people. (Focus group participant). DISCUSSION The themes identified in this study can be found in the existing literature which suggests that the results from this study have meaning for the Vietnamese community. Food habits are a common problem for migrants including Vietnamese elderly people [7,24,25]. In residential care settings, family involvement is regarded as a useful strategy for coping with this problem [24]. This strategy effectively solves the problem for both the resident and the care staff However, it becomes problematic for the family carer with such an indefinite commitment. Within Vietnamese culture, Confucianism, reputation and extended family play an important role in the life of Vietnamese elderly people [26]. Within this philosophy, children are considered as wealth; to be childless is perceived as a tragedy. Children must support their parents until they die, as 17

19 filial piety is obligatory [27]. Thus children may feel guilty and ashamed if they place their parent(s) in a nursing home [7,28]. Entering a nursing home is commonly viewed as a last resort for everyone, not just for Vietnamese people. The terms "ultimate negative choice" or "the hardest thing" are used to describe the act of placing a family member in a nursing home [29, p.140]. For Vietnamese people, especially when older, the nursing home has a "very negative image", [7, p.3'7]. As a community member, the researcher has visited five Vietnamese elderly people who reside in nursing homes. They are all severely disabled, very demanding and their families would find it extremely difficult if trying to keep and care for them at home. This is another indication that Vietnamese frail elderly people only enter a nursing home when circumstances compel them, and assists the policy of deinstitutionalisation in aged care which "Australia too has been rigorously pursuing" since 1985 [30, p.13]. The focus group's responses and comments are congruent with the view that, in generalist residential aged care facilities, ethnic frail elderly people are unlikely to make friends or even have an acquaintance among other residents because of language barriers. This contributes to their loneliness and isolation [311. Vietnamese elderly residents in residential care facilities cope with three significant difficulties: loss of family, loss of culture and loss of community. They may have feelings of isolation, rejection, dishonour and disrespect (see 18

20 [32] for full details). For this reason they need consolation particularly from family, because intimacy and "tender loving care" (the terms used in [24, p.7]) are only found in the family carer. Family caregiving is a lifeline of special care [7,29]. Maintaining contact and creating solidarity between families and staff is very important [29,33]. Loss of community means entering another community [32]. Therefore, community visits to residents are significant. Constructing a nursing home for Vietnamese people now is still problematic because of insufficient potential residents and finances. Apart from these reasons, a new Vietnamese nursing home built now for the first generation of elderly Vietnamese in South Australia would be less relevant for second and third generations. This year's innovations may become next year's obstacles to effective provision of care, a problem which needs to be avoided [9, p.336]. A specific hostel for Vietnamese elderly people is still a matter for the future. Among the three options the focus group discussed, their preferred option was to have a reserved area for Vietnamese elderly people in generalist facilities, because they realise that such a reserved area is imperative. This aspiration is consistent with those who promote the view of clustering or grouping people from the same NESB in residential care facilities [7,34]. 19

21 Given the small scale, non-random and exploratory nature of this research, the results are inconclusive and cannot be generalised. However, the data analysis reveals important issues regarding the use of residential aged care facilities among Vietnamese elderly people in South Australia. This implies the need for further research to investigate the need for innovative gerontological policies and practices. It may also lead to improvement or modification in some of generalist residential aged care facilities to meet the special needs of Vietnamese elderly people and to bring social justice to the diverse Australian population. The findings may also precipitate an educational program for Vietnamese elderly people and their family carers, to make them familiar with residential aged care, and for care staff to acquire knowledge about the Vietnamese culture relative to the use of residential aged care facilities. 20

22 KEY POINTS Markedly low representation of Vietnamese elderly people in residential aged care facilities in South Australia. Cultural and language barriers to using residential aged care facilities and a number of Vietnamese elderly people in a sad plight. Imperative need for gerontological policies and practices to overcome the barriers to using residential aged care facilities among Vietnamese elderly people in South Australia. REFERENCES 1. Thomas T, Balnaves M. New Land, Last Home. The Vietnamese Elderly and the Family Migration Program. Canberra: Australian Government Publishing Service, Rowland DT. Pioneers Again: Immigrants and Ageing in Australia. Canberra: Bureau of Immigration Research, Australian Government Publishing Service, Thomas T. Elderly Vietnamese Migrants in Australia: Current Issues and Research. In: Lefroy RB. ed. Proceedings of the Annual 21

23 Conference of the Australian Association of Gerontology Sydney Victoria: Australian Association of Gerontology, 1991: Mignone I. Non-English-speaking background South Australians and their needs for Domiciliary Care Services. Supporting Paper No 4. Adelaide: Domiciliary Care Services, Munn P. Carter J. The Ethnic Aged Survey Report. Adelaide: University of South Australia, Whyalla Campus, Vukovich D, Hanen M. Report on Survey of Residents from Non-English Speaking Background in Nursing Homes and Hostels in South Australia. Adelaide: Advisory Committee on Ethnic Aged Issues, Hanen M, Do DL. Ageing Away from Home: A Society of the Present and Future Life Situation of Older People in the Vietnamese Community in South Australia. Adelaide: Officer of the Commissioner for the Ageing, Pham T, Binnie D. Vietnamese Elderly People Needs Survey: Findings. Paper presented at the Vietnamese Aged Care Focus Group Meeting. Adelaide: Vietnamese Community and Multicultural Aged Care,

24 9. McCallum J. The Mosaic of Ethnicity and Health in Later Life. In: Reid J, Trompf P. eds. The Health of Immigrant Australia. A Social Perspective. Sydney: Harcourt Brace Jovanovich, 1990: Office of Multicultural Affairs. Government Response to the 1996 Report on Migrant Access and Equity by the Former House of Representatives: A Fair Go for All. Canberra: Australian Government Publishing Service, Bellenger DN, Bernhardt KL, Goldstucker JL. Qualitative Research Techniques: Focus Group interviews. In: Higginbotham JB, Cox KK. eds. Focus Group Interviews: A Reader. Chicago: The American Marketing Association, Illinois, 1979: Bender ED, Ewbank D. The Focus Group as a Tool for Health Research: Issues in Design and Analysis. Health Transition Review 1994; 16(1): Krueger RA. Focus Groups: A Practical Guide for applied Research. ed. London: Sage Publications, Phan TT, Fitzgerald MN. Culture & Mental Health Current Issues in Transcultural Mental Health: Guide for the Use of Focus Groups in Health Research. Sydney: Transcultural Mental Health Centre,

25 15. Stewart DW, Shamdasani PN. Focus Groups. Theory and Practice. London: Sage Publications, DePoy E, Gitlin LN. Introduction to Research: Multiple Strategies for Health and Human Services. Sydney: Mosby, Patton MQ. Qualitative Evaluation and Research Methods. ed. London: Sage Publications, Miles MB, Huberman AM. Early Steps in Analysis. In: Miles MB, Huberman AM. eds. Qualitative Data Analysis: An Expanded Sourcebook. ed. Thousand Oaks: Sage Publications, 1994: Minichiello V. Aroni R, Timewell E, Alexander L. In-depth Interviewing: Principles, Techniques, Analysis. ed. Melbourne: Longman, Roberts K, Taylor B. Nursing Research Processes: an Australian perspective. Melbourne: Nelson, Srauss A, Cobin J. Basis of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage Publications, Taylor SJ, Bogdan R. Introduction to Qualitative Research Methods: The research for Meanings. 2nd ed. Brisband: John Wiley & Sons,

26 23. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Aldine Publishing Company, Legge V, Westbrook M. Provisions Made for Ethnic Patients in Nursing Homes. Australian Journal on Ageing 1989; 8(4): Miller T, McHoul A. Popular culture and everyday London: Sage Publications, Pham Ky. The Vietnamese Culture: An Introduction. USA: The Pham Kim Vinh Research Institute, Rutledge PJ. The Vietnamese Experience in America. USA: Indiana University Press, Nay R. Nursing Home Entry: Meaning Making by Relatives. Australasian Journal on Ageing 1996; 15(3): Fleming AA. Family Caregiving of Older People with Demanding Illnesses in Nursing Homes: A Lifeline of Special Care. Australasian Journal onageing 1998; 17(3): Gibson D. Aged care: Old Policies, New Problems. Melbourne: Cambridge University Press,

27 31. Schappi U. The Case of Ageing Immigrants. In: Ferguson B, Browne E. eds. Health Care and Immigrants: A Guide for the Helping Professions. Sydney: MacLennan and Petty, 1991: MacLean M, Bonar R. Ethnic elderly people in long-term care facilities of the dominant culture: implications for social work practice and education. International Social Work 1986; 29(3): Pilemer K, Hegeman CR, Aibright B, Henderson C. Building Bridges Between Families and Nursing Home Staff: The Partner in Caregiving Program. The Gerontologist 1998; 38(4): Perkons R. The Care of Non-English Speaking Background Residents in Mainstream Nursing Homes and Hostels A Research Report. Adelaide: Ethnic Communities Council of S.A., Department of Health, Housing and Community Services,

28 APPENDICES Appendix 1 - HREC approval Appendix 2 Research project information sheet Appendix 3 Consent form Appendix 4 Letter to the related organisation Appendix 5 Focus group topic guide Appendix 6 Focus group questioning route Appendix 7 Journal style

29 appioval

30 UNIVERSITY OF SOUTH AUSTRALIA RESEARCH SERVICES. helping research happen... i I I The Levels Campus Mawsori Lakes Boulevard Mawson Lakes Telephone: (08) Facsimile: (08) South Australia 5095 Tieu Van Nguyen 15 Burman Avenue Gilles Plains SA June 1999 Dear Tieu Thank you for submitting the amendments relating to your protocol (P1 11/99) Cultural and language barriers to using residential aged care facilities: important issue for Vietnamese elderly people in South Australia as requested by the Human Research Ethics Committee. I am pleased to be able to tell you that the ethics approval for your project is now finalised. As you know, HREC approval is made on the basis of a number of conditions detailed as dot points in Linley Hartmann's 26 May letter to you. I hope that your research goes well. Yours sincerely Ruth Sims Executive Officer, HREC cc Susan Gilbert Hunt / P) f/ic LOJ))))JIH!ltI?

31 UNIVERSITY OF SOUTH AUSTRALIA RESEARCH SERVICES lie/ping research happen... Warrendi Road The Levels South Australia Tieu Van Nguyen 15 Burman Avenue Gilles Plains SA May 1999 Dear Tieu The Human Research Ethics Committee considered your protocol (P1 11/99) Cultural and language barriers to using residential aged care facilities: important issue for Vietnamese elderly people in South Australia at its meeting on 24 May It was agreed that the protocol be approved subject to the final point on the consent form being amended to read '1 confirm that I am over the age of 18. This statement on the consent form ensures that those signing the form are legally able to give consent to their involvement in the project. The committee raised some concerns about the appropriateness of the focus groups and suggested that you might discuss this with your supervisor Could you please submit a single copy of the corrected consent form to: Ruth Sims Ethics Officer Research Services Levels Campus phone fax You should not begin your research before receiving final approval. Please note that following the submission of the necessary amendments, Human Research Ethics approval will be finalised on the following conditions. Approval is for a period of twelve months only. Requests for extension of approval must be made annually. However, Masters by Research and PhD students will be granted extensions, if necessary, through the annual review of progress process. The Human Research Ethics Committee must approve the content and placement of advertisements for the recruitment of volunteers. The committee must be notified of and approve any changes to the original protocol (eg additional procedures, changes to inclusion or withdrawal criteria, changes in mode and content of advertising, modification of drug dosages). A project completion report must be made to the Human Research Ethics Committee within three months of the project's completion. In Australia there is a legal obligation for raw data arising from human research to be held securely. The University requires that research data be retained for a period of seven years. If your data are not stored by your school, the school must be aware of their location. The safe and ethical conduct of the study is the responsibility of the investigators. Consent forms and information sheets should have a header which includes the University of South Australia and the name of your school. In addition, the information sheets should include the name of the chair of the Human Research Ethics Committee as a person who is able to discuss the research with participants. These details should read Ms Linley Hartrnann, telephone (08) , fax (08) Finally, I remind you that student researchers normally own the data that they are responsible for collecting. Please contact me or Ruth Sims if you have any questions. Yours sincerely Linley Hartmann Chair, Human Research Ethics Committee cc Susan Gilbert Hunt Eciiictitiiig P,cifcssionals.4ppliiinc,' SL'rz'i;ig the Commwiitu

32 project information

33 UNIVERSITY OF SOUTH AUSTRALIA North Terrace South Australia DIVISION OF HEALTH SCIENCE SCHOOL OF OCCUPATIONAL THERAPY (GERONTOLOGY PROGRAM) INFORMATION SHEET Project Title: Cultural and Language Barriers to Using Residential Aged Care Facilities: issues for Vietnamese elderly people in South Australia. Important Plain English Title: Investigating how Vietnamese elderly people in South Australia perceive the use of nursing homes and hostels. Researcher: Mr Tieu Van Nguyen Burman Ave Gilles Plains 5086 South Australia ph: This research project is being undertaken by Tieu Van Nguyen as part of the requirement for the degree of Master of Gerontology (Coursework) at the University of South Australia. The research will explore the issues which surround the use of residential aged care facilities. (nursing homes and hostels) by older Vietnamese people in South Australia. Concern exists regarding the low representation of Vietnamese people in these facilities. The results from the research may offer suggestions to residential aged care service providers and related agencies in relation to meeting the special needs of Vietnamese elderly people. As mentioned in the invitation letter, you are invited to participate in this research because you will be likely to be one of the potential users of nursing homes or hostels. You may contribute your ideas surrounding the use of residential aged care services to the focus group interview session, which will last for ninety minutes maximum and will be audio taped. There will be one or a couple of group interview sessions depending on the issues discussed. If after the first session, there is nothing to discuss ftjrther, the interview will be completed. The group will include no more than eight members Vietnamese people, both male and female, aged 65 years old or more, able to attend group interviews in terms of their physical and mental health, can volunteer to be interviewed. If you decide to take part, you will attend the focus group interview session. We will discuss in details the venue where the group interviews will take place. The first focus group interview session will be held about three weeks after you have received the invitation letter and this information sheet. Educating Professionals - Applying Knowledge - Serving the Community

34 The group interview session will be worthwhile. Its goal is to reduce the problems surrounding the provision of aged care in nursing homes and hostels for Vietnamese elderly people in South Australia. The School of Occupational Therapy, University of South Australia will keep the information you give in a secure place for 7 years following the completion of the research and the audio tapes recording the interviews will be erased once transcription is completed. The transcribed material associated with the focus group discussion will be kept under password access on the researcher's personal computer. No reference is made to your name and identity. If you wish you can choose your first name other than your real name. In the stored information your real name does not appear on any records of the interview because you will be given a code. Should you still agree to participate in the research as in our conversation last week, you will be asked to give signed consent to be interviewed and to audio tape the focus group discussion. The final results from this research will be published in a form of a journal article. However, you may be reassured that at no time your identity or personal details will be revealed. You are welcome to discuss the results with the researcher. If you wish you would be given a copy of the article. Your consent is absolutely voluntary, If you agree to participate in the research, you have the right to be free to withdraw from the research at any stage without having to give any reason. Whether or not you have attended a group interview session, your wish will be respected and any information you have given will not be used. I sincerely thank you very much for taking time to think about this request. If you are interested and want to discuss with the researcher about your participation or know more about the study, you can contact me, Tieu Van Nguyen on (08) If you agree to participate in the focus group interview session, I will phone you two days prior to the session takes place to confirm your attendance. You may also contact the following people if you wish, I would arrange for a Vietnamese interpreter to help you to discuss the conduct of the research or your right as a participant in this research: Ms Susan Gilbert Hunt Gerontology Course Coordinator School of Occupational Therapy University of South Australia Telephone (08) Fax (08) Ms Linley Hartmann Chair, Human Research Ethics Committee University of South Australia Telephone (08) Fax (08)

35 UNIVERSITY OF SOUTH AUSTRALIA North Terrace Adelaide Australia Information sheet (Vietnamese language) PHANKHOAKHOAHOCS(JCKHOE TRIJONG CHUYEN KHOA ye PHEP DIEU TRI BANG LAO DONG (CHIJONG TR1NH LAO KHOA) To GIAI THICH CHI TIET TUa (theo tci chuyên môn): Trô van hoa và ngôn ngq trong s1 dung các vy chãm sac ngtjôi cao niên tai các cii tru quan trqng ct6i vol cao niên Nam 0 Nam Uc. TUa (theo thông Nghien c(iu xem cao niên Nam 0 Nam Uc nhân thclc nhtj thg nao d6i voi viêc vào cii ngu trong các viên diiong lao. ncihiên O. Van. Burman Avenue Glues Plains 5086 Nam cjc Cong trinh nghien nay sinh viên Van Tigu tign hành theo stj qui dinh ctai hçc Nam Uc nhii là mqt trong hoàn thành h9c Thac Si Lao Khoa (Master of Gerontology), khoa Xã HQc chuyên nghièn cao niên. nghiên ctiu nay sé khai thác các vgn xoay quanh ngu8i cao niên Viêt Nam 0 Nam Uc sii dung các vu chãm sac cao niên t?i các dllong lao. M6i quan tam là t?i ngtjoi Nam sii dung các vy nay 0 Bang Nam Uc.côn qua Kgt qua cüa cuôc nghien ccfu co nêu len nghj giüp cho các vien dilong lao va cac cd quan lien he CO giài phap thich nghi, dap CIng thoa dáng nhu ccia cao niên Nam. Educating Professionals - Applying Knowledge - Serving the Community

36 NhU cia cap trong thu môi, Ong/Ba cliiçic tham dij vào cuoc nghien c(lu, vi Ong/Ba CO là môt dyng tièm tang các dlch vy châm sac cao fliêfl các viên diiông lao. Ong/Ba CO dong gop xoay quanh su dung dlch vu chãm sac ngliôi cao niên trong các dtl8ng lao trong bu6i phông vgn nhom. Bu61 phông vgn sé kéo dài t6i cia 90 phüt và se duçic ghi am. SO CO hoãc vài phóng nhom tüy thea cuoc tháo Sau bu6i tháo luân tiên, khong con dè gi tháo thi thào xem nhil cia hoàn t& NhOm tháo so CO 8 ngtiôi. Ong, Ba nào ti) 65 tu6i trô len, ngu CO do stlc khôe tham dij hçp nhom, CO tinh nguyen tham gia bu6i phông vgn. Ngu Ong/Ba con git:i dinh tham dti phóng chung ta so chi tiét coa hçp. Bu6i hpp nhom tion so ducic t6 chtlc khoán ba sau khi Ong/Ba thu và giài thich chi tigt nay. phông vgn nhom so dem I?i Ich dáng Myc dich coa cuoc phông vgn nay là lam giàm nhqng vgn kho khon trong VàO CU ngy t?i các duông lao d6i vôi nguôi cao niên Nam. dai h9c Nam Uc so luu tru so cong trinh nghien 8 mot noi an toàn trong th8i gian 7 nom sau khi cuoc nghien cuu hoàn và cac bong thou am so duçic tiou hoy sau khi biên xong. Tài lieu biên lion quan ctgn cuoc thào luân nhom so cliiç3c báo trong may toon CO nhon coa ngu8l nghion ma. Khong CO danh tonh va nhân coa ngu8i duc3c phông vgn. Ong/Bà mu6n Ong/Bà CO ch9n ton gpi bang ten khác hon là ton Trong so kfu khong bao gki tim ton that coa dudc phóng vgn vi ton cia duoc ma hoa. Ong/Bà gii3 tham dij vào nghion c(lu nhu trong cau ma chung ta cia bàn tháo vào triiôc, thi Ong/Bà so ducic you ton vào t8 Ung thuân tham gia vào nghion cciu, và bu6l thoo nhom so ghi am. Kgt qua cu6i cong coa cuqc nghion ctfu so dong vào mqt t8 chi chuyon nhong cho chuyen kháo duôl dang mqt bài boo. Tuy nhion, nhon và moi chi cá nhon coa Ong/Ba so baa dam là khong bao giô Ong/Bà tháo Iuân qua nghien cong vôi nghien là dong ducic hoan nghenh. Ngu Ong/Bà mu6n Ong/Ba so duçic bigu tang mot bàn sao coa bài boo.

37 SiJ ting coa Ong/Ba là hoàn toàn tij nguyen. Néu Ong/Ba tham gia vao nghien c(iu, Ong/Ba co ttj do rut Iui khôi cuoc nghion bgt cci lüc nào và khong do. DCi tham dij hay không tham dtj bu6i phóng nhom, mu6n cüa Ong/Ba sé dtiç3c ton tr9ng. Co sii rut lui và yeu thi cà tin tcic ma Ong/Ba ctã cung sé không ctliç5c dung. Tôi xin chân thành cam On Ong/Ba vi dã bô thi gki qul báu suy nghi toi yeu Ong/Ba cam thich thu va mu6n tháo vôi ngikil nghien cciu tham dv mu6n them cuqc nghien cciu, Ong Ba co xuc vol tôi, Van Tigu, qua tho?i s6 (08) Ngu OngIBa tham dv thào nhom, tôi se gql tho?i OngIBa 2 ngày trijoc khi budi h9p dd xác su tham dii ccia OngIBà. Ngu Ong/Ba mudn Ong/Ba cüng Co thg xuc voi nhqng ngiiôi sau day, toi Se thông viôn Nam cid giup Ong/Ba trong thâo sil tign hành nghien c(iu hoãc coa Ong/Bà vol tu cách là ngilôi tham gia vào cuôc nghien cciu: Ba Susan Gilbert Hunt Hç5p Viên KhOaLãoKhoa Chuyên Khoa Phép Tn Lao Triking eai HQC Nam Uc D. T. (08) (08) Ba Linley Hartmann ChO Tich CJy Ban Dao Nghien CUu Nhân Lo?i Trt.king Sai Hoc Nam Uc D. 1. (08) Phk (08)

38 APPENIbIX 3 - Consent form

39 UNIVERSITY OF SOUTH AUSTRALIA North Terrace South Australia CONSENT FORM Project Title Cultural and Language Barriers to Using Residential Aged Care Facilities: Important issues for Vietnamese elderly people in South Australia. Researcher's name Tieu van Nguyen Supervisor 's name Susan Gilbert Hunt I have read the information sheet regarding the research. The researcher has explained the nature and the aim of the study. I understand and agree to take part I understand that I may not directly benefit from participating in the research I understand that information collected during the research will be reported and at no time my identity and personal details will be revealed. I understand that I can withdraw from the study at any time and that withdrawal will absolutely not effect me in any way. I understand that the interview during the focus group interview session in which I participate will be audio taped. I confirm that I am over the age of 18. Name of subject Signed Dated I have explained the research project to the subject and consider that he/she understands his/her involvement in this study. Researcher' signature and date Educating Professionals - Applying Knowledge - Serving the Community

40 UNIVERSITY OF SOUTH AUSTRALIA Nath ibrace Cat To LJNG ThUs N SaSMnnk TtJa di cong trlnh nghln cdii: Nam Uc. ngiibl caoninvltnamb TOn ngdbi nghlon cdii: Nguyen Van Tidu TOn ngdbl glém thi: Susan Gilbert Hunt TOl do dqc Tb GIâI Thith Chi vi vic nghion cdii. NgiIbI nghlon cdii do giài thich tlnh chdt ye mvc dich coa cuoc nghion cdii. TOI hidu và dbng 9thamgia TOI hidu rêng WI so thông tnjc tldp htlbng 101 do tham gla vs cuqc nghlon cdii nay TOI hidu thng WI co thd rut lul khôl cuqc nghlon thu bat cd luc So ye su rut liii sotuytddl thông co ánh huiâng gi d61 vôitol ddói bdtcdhlnh thdc nào TôI hldu ring cuoc phóng vdn trong budi phông vdn nhóm ma WI tham du soddøcghlom TOlxacnhnrAngtOltrOnl8tu& TOn d61 tuløng: K9tOn Ngày k9 II TOI do giâi thith cong tilnh nghlon cdii cho ddi tdøng và xem nhd OnglbO dy hldu vi sij dlnh déng cua Onglbà dy vs cuøc nghln cdii nay ChO k9 cua ngdbi nghlon cdu va ngày k9 I_I_ Educating Pn4basionale - Applying Knowledge - Serving the Connnunity

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42 UNIVERSITY OF SOUTH AUSTRALIA North Terrace South Australia LETTER TO THE RELATED ORGANISATION Date Burman Avenue Gilles Plains 5086 SA ph Dear I am writing as a courtesy to let you know that I am currently completing a Master of Gerontology at the University of South Australia. I am required to summit a minor thesis in addition to the coursework, and as such I am undertaking a small research project. The research title is as follows: Cultural and Language Barriers to Using Residential Aged Care Facilities: Important issues for Vietnamese elderly people in South Australia. The aim of my research is to explore the issues surrounding the use of residential aged care facilities in South Australia within the Vietnamese community. Information gathered through the research may offer suggestions to residential aged care service providers and related agencies in relation to meeting the special needs of Vietnamese elderly people in particular and non-english-speaking background elderly people in general. As an organisation which might be interest in the outcomes of the study, I am writing to inform you that the study is in progress. I envisage that the research project will be completed by the end of this year. So I would be happy to provide your organisation with a copy of the journal article which reports my research. Yours sincerely Tieu Van Nguyen Educating Professionals - Applying Knowledge - Serving the Community

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44 Focus Group Topic Guide for Vietnamese elderly Focus Group Introduction: Your name and one thing you enjoy doing I. Community Concerns 1. Most common problems facing families and older Vietnamese people? 2. If a frail or disabled Vietnamese elderly person remains at his or her own home, Are there difficulties? (Carer, financial problem). III. The Use of nursing homes and hostels 3. Under what circumstances this person may enters a nursing home or hostels? 4. Do you know someone who has lived or is living in a nursing home or hostel? What do you know about this person? If yon don't know about it, What do you know about the use of these facilities among Vietnamese elderly people? IV. Residential and community care 5. Do you expect to remain at your own home when you become too frail? 6. What make you decide to continue to live at home? 7. Can you live all you life without using nursing home? 8. Are there difficulties if you decide to enter a nursing home or hostel? 9. Compare the use of generalist facilities to the use of ethnic specific ethnic nursing homes and hostels? 10. What should be a facility be like to suit Vietnamese elderly people's needs? 11. Can existing nursing homes and hostels be improved? 12. At present could you do something to reduce the problems? 13. Where can you find information relating to nursing homes and hostels? (After they have answered, hand out a list of facilities and organisations} CUES: Hand out list - Seniors Information Service - Nursing homes and hostels - Office for the Ageing -Vietnamese Community in South Australia - Council on the Ageing - Multicultural Aged Care - Multicultural Communities Council - Vietnamese Elderly Association - Asian Elderly Association - Tao Phung Indochinese Elderly Association - Asian Elderly Welfare Association/Northern Area 14. What would you like more of? V. Summary and conclusions 15. Summary of questions 7, 8, 9, 10, 11, and Have we missed anything? 17. What advice do you have for us? {Adapted from Krueger (1994): Focus Group Topic Guide)

45 Focus Group Topic Guide for Vietnamese Elderly Focus Group (Vietnamese language) Bang hiiông chü tháo nhom cao niên Viêt Nam I - Nhâp dè: Cho qui danh và thu tiêu hay sinh hoot ma qul vi thich II - m6i quan tam trong cong 1. vgn ma qul vi cao nion và gia dhnh phái? 2. cao niên qua cao và qua hay khigm tuc s6ng tai gia, thi CO trô gi khong? chãm soc, nhqng kho khãn tài chánh v,v,) III - Viêc vào s6ng ô các viên duông lao: 3. Trong trueing hc5p nào nay cô vào s6ng ô duông lao? 4..QuI vi co ai dã hay clang s6ng ô các duóng lao không? Qul vi Co bigt tinh cüa nguôi nay ra sao khong? qul vi khong bigt, qul vi co vào s6ng các diiông lao d6i vol ngtjôl cao nion Nam nhu nào khong? IV - Viêc chám soc trong cong và chãm soc 8 các viên duônglao 5. QuI co nghi qul sé tyc s6ng nhà khi tu6i da qua cao và qua khong? 6. Ygu t6 nào khign qui vi tyc s6ng gia? 7. Qul CO s6ng gia su6t d8i và khong dgn duông lao không? 8 CO nhüng kho khãn nào ngu qul vi vào s6ng 8 duong lao khong? 9. CO nhqng khác nào khi so sánh cu ngy ndi các dtiong lao thông thu8ng vá CU ngy ndi các duong lao chuyen dành cho các sac toc? dilong lao phái nhu tm nào thi moi dáp (ing thoa clang nhu cua ngtj8l cao niên Nam? 11 Các viên du8ng lao CO cài nhu thg nào? t?i qul vi CO lam gi giàm kho khàn khi sii dung dich vy do các duông lao cung 13.QuI CO tim tài các duong lao 8 dâu?

46 (Sau khl nhom trá IbI cáu hôl, phán phét bang lilt Ice các vim ddöng lao và céc td thac, cd quan). PHAN PHAT bang lilt co - Dich Vy Thông un COng DOn Cao MOn - sâ Phyc Vy NguIbl Cao NIOn - H4l Phyc Vy Ngdbl Cao NIOn - H41 Cng Bbng Ba VOn Hoa - H4I Cao NiOn A ChOu Cao NIOn Bong Dddng Tao PhOng - Cac V1n DtIâng Lao - CQng Bbng NgiIbl VI,t TV Do NU Phyc Vy Ngdbl Cao NiOn Ba VOnHoa - HQl Cao NIOn V1,t Nam - HQIPhUcLØICaoNiOnAchau VOng Phia B&c 14. Bqn co cm them gi nila khong? V-Tomt&tvOkilluln 15.TomtOtcOutràlôlchocaccOuhól7,89,1O,11,v Con thliu gi khong qulvj? 17.Qulvjcbnco9klinglddglUpchUngtblkhOng? (4 dyng theo bang hddng din thu dl hqp nhôm cua Krueger (1994)

47 group

48 Focus Group Questioning Route for Vietnamese Elderly Focus Group INTRODUTORY QUESTION: Tell us your name and one thing you enjoy doing (hobby activity, etc.) 1. What are the most common problems facing families and Vietnamese elderly in the Vietnamese community in South Austrlia? 2. A number of concerns have been mentioned. Think about an older Vietnamese person with frailty and disability. When this person remains at home: A. Who can take care of them? i. Spouse? ii. Daughter? iii. Son? iv. Other? B. Are there any difficulties? (carer being busy to work, financial problem, others) C. How can Community Care Program help them? (personal care, home help, respite care etc). Are there any difficulties? 3. Under what circumstances could the older person mentioned above need to enter a nursing home or hostel? 4. Do you have friend(s), relative(s) or acquaintance(s) who have lived or are living in a nursing home or hostel? A. If any, do you know about their situation? B. If not, what do you know about the use of nursing homes and hostels among Vietnamese elderly in our State? 5. In the future if you become very frail or disabled would you decide to remain in your own home or enter a nursing home? 6. What would make you decide to continue to live at home? A.Who is your carer? B. Are there difficulties? C. If so, what are they? 7. Can you live all your life without using a nursing home? (because of Vietnamese culture, your children's filial duty, inappropriate facilities etc) 8. If you would enter a nursing home: A. Who in your family would decide this? (yourself, your children, your spouse, others) B. What would you think about staff, residents, food, activities, religion language etc. when you live in a generalist nursing home? C. What are good for you? D. What would make you feel disadvantaged or inconvenienced? E. What do your family and other Vietnamese people in our community think about living in a nursing home? 9. How do regard the use of generalist facilities just mentioned compare to the use of ethnic specific nursing homes and hostels such as that one in Italian village and in a number of ethnic communities? 10. In your opinion, what should a nursing home or hostel be like in order to meet the needs of Vietnamese elderly people?

49 11. Do you have other ideas about how existing nursing homes and hostels can be improved to suit your residential care need? 12. At present if you do the following things may these problems be reduced? A. learn more English? Is it difficult? B. find more information on nursing homes and hostels? Is it useful? 13, What are the organisations that can provide you with information relating to nursing homes and hostels? (After they have answered, hand out the list of facilities and organisations) This is a list of some of facilities and organisations that may provide you with information relating to nursing homes and hostels: Seniors Information Service Nursing homes and hostels (hundreds of facilities on this list) Office for the Ageing Vietnamese Community in South Australia Council on the Ageing Multicultural Aged Care Multicultural Communities Council Vietnamese Elderly Association Tao Phung Indochinese Elderly Association Asian Elderly Association Asian Elderly Welfare Association/Northern Area. 14. What would you like more of?. 15. Let's summarise the key points of our discussion (The moderator will give 2-minute summary of the responses to questions 7, 8, 9, 10, 11, and 12) 16. The goal of this discussion is to reduce the problems surrounding the provision of aged care in nursing homes and hostels for Vietnamese elderly people in South Australia. Have we missed anything? 17. What advice do you have for us? {Adapted from Krueger (1994): Focus Group Questioning Route}

50 Focus Group Questioning Route for Vietnamese Elderly Focus Group (Vietnamese language) Bang hiiômg câu hôi thào nhom cao niên Viêt Nam CAU HÔI NHAP: Xin cho bigt qul danh và nhqng gl ma qul thich (thi dy thu tiêu hay sinh v.v.) 1. Qul và gia dmnh gap phài vgn gl trong cong chung ta Nam Uc? 2. ChUng ta dã cap dgn nhcing m6i quan tam. Hay suy nghi mot cao nien Nam tu6l qua cao và tat. Khi nay s6ng gia: A. Al là ngtjôl chàm soc? I. ph6i ii. Con gai? iii. Con trai? iv. nào khác? B CO nhqng kho khãn nào (ngiiôi chàm soc di lam, kho khàn tài chánh, nhqng kho khãn khác)? C. Chtidng Trinh Chãm SOc Cong co giup diiç3c nhung gi? (chãm soc cá nhân, giup nhà, t?m thay chàm soc v.v.). CO gi kho khãn? 3. Trong hoàn cánh nào ngliôi cao niên vua noi trên vào cii ngy ncii diiông lao? 4. QuI co be, bà con quen dã hay dang s6ng trong cac vi co bigt tinh cüa ngtj8l ra sao không? B. khong bigt, qul vi co bigt vào s6ng ô các nhà diiông lao 8 Bang chung ta d6i vol cao niên Nam nhti nào khong? 5. Trong tiic3ng lai, ngu qui vi trô nên già qul vi se dinh tyc s6ng gia hay vào cii ngy ncii diiong lao? 6. Dièu gi khign cho qui tyc s6ng gia? A. Al se chàm soc qul vi? B. CO nhang kho khàn khong? C. co, do là kho khãn gi? 7 Qul vi co s6ng gia su6t dôi và khong s6ng trong dtiong lao khong? (do phong tyc Nam, sil higu d?o cua con cal, dtiong lao khong thich hdp v.v.) 8 Trong triiông qul vi vào sóng 8 diiong lao: A. Al trong gia dinh qul vi do? (chinh qui vi, con cal, ph6i cuà qul vi, hay al khác).

51 B. Qul nghi gl nhân viên phyc vy, ngtiôi ct.i, thuc an, sinh ton giáo, ngôn ngq, v.v. khi qul vi vao s6ng ndi diiông lao thông C. Dièu gi qul vi cho là t6t? D. gl qul vi cam trô hay bgt E. Gia dinh ccia qul Va ngikil trong cong chüng ta se nghi gi ngu qul vi vào cii ngy ndi dliông lao? 9. CO nhi)ng khác nào khi so sánh cii ngy ndi cac diiông lao thông vá cii ngu ndi các difông lao chuyen dành cho cac sac nhii vièn dtiông lao ô lang hay 8 mqt s6 cong sac tqc khác? 1O.Theo ccia qul thi diiông lao phâi nhii thg nao môl dap thôa clang nhu cüa ngijôi cao niên Nam? 11.Theo kign cüa qul thi nhqng diiông lao tai CO cái tién nhii thg nao clap Ung thoa clang nhu cüa qul vi? 12. th8i qui vi thtic sau day thi CO giam diiçic nhüng kho khàn không? A. Hpc Anh ngci? CO kho khong? B.. Tim tài lieu lien quan dgn các duông lao? Nhii CO Ich 101 không? 13.Cci:quan nào CO cung cho qul vi nhang tài lieu lien quan cac dijông lao? (Sau khi nhom trá 181 câu hôi, phân phát bang kê các dtiông lao va cac chclc, cd quan). là bang kê môt s6 cd quan và diiông lao CO cung cho qul tài lieu lien quan các diiông lao: - Djch Vy Thông Tin Cong Dan Cao Niên - Các DiJông Lao - S8 Phyc Vy Ngii8l Cao Niên - Cong Ding NgU81 Tij Do NU - HQI Phyc Vy Ngii8l Gao Niên - HQI Phyc Vy Ngii6l Cao Niên Da - Cong Da Van HOa Van HOa - HQI Cao Niên A Châu - HQI Cao Niên Nam - Cao Niên Dông Dii dng - Phüc Cao Niên A Châu Tao PhUng VUng Phia Bac 14. QuI vi co them gi ncla khong? 15. Bay giô chüng ta hay tom tat nhcing chmnh trong cuqc tháo luân. (NgU8l hiiông cuqc thào dành 2 phüt tom nhüng cãu tra 181 cho cac câu hói 7, , 11, và Myc dich ccia cuôc thao luân nay giám nhqng dè kho khãn chung quanh cung vy chàm soc ngii6l cao nion Nam Nam LJc. ChUng ta con bô sot chi khang? 17. QuI vi có s,', khign gi them giup chung tôi không? (Ap dyng theo bang hilông câu hôi h9p nhom coa Krueger (1994)

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54 Cheryl AUSTRALASIAN JOURNAL ON AGEING: the journal of Aged Care Australia, the Australian Association of Gerontology, the Australian Society for Geriatric Medicine and the Council on the Ageing (Australia) Published by the Council on the Ageing (Australia) Level 2, 3 Bowen Crescent, Melbourne Vic Telephone: (03) Facsimile: (03) cota@cota.org.au Web Site: EDITOR IN CHIEF Professor Anthony Jorm NHMRC Psychiatric Epidemiology Research Centre Australian National University EXECUTIVE EDITOR Joanna Johnson Council on the Ageing (Australia) EDITOR, BOOK REVIEWS Dr Elizabeth Ozanne Department of Social Work University of Melbourne The Journal is published four times per year. Annual subscriptions are available from COTA (Australia) at the following rates: Within Australia $A58. Australian Library Subscriptions $A65. New Zealand and the Pacific Islands $A65. Overseas $A75. Single issues are available at $15 plus postage and handling for overseas orders. Subscriptions are accepted on either a calendar year basis or can begin with current issue. For information on subscriptions or advertising in the Journal, please contact Ms Kathy Hogarty on (03) , at Council on the Ageing, Level 2, 3 Bowen Crescent, Melbourne Vic cota@coth.org.au ISSN Printed by Allanby Press Pty. Ltd. Camberwell Victoria MANAGEMENT COMMITTEE Denys Correll Council on the Ageing (Chair) Anthony Jorm Editor-in-Chief Elizabeth Ozanne Editor, Book Reviews Joanna Johnson Executive Editor Mike Rungie Aged Care Australia Robert Prowse Australian Society for Laurie Buys Australian Association of Gerontology Geriatric Medicine EDITORIAL BOARD Felicity Allen Kua Ee Heok Monash University National University of Singapore Ruth Bonita Richard Lefroy University of Auckland University of Western Australia John Campbell John McCallum University of Otago University of Western Sydney Frank Chariton Sarah Mott La Probe University Royal North Shore Hospital Iris Chi Anne Opie University of Hong Kong Victoria University of Wellington Sung-Jae Choi Richard Sainsbury Seoul National University Princess Margaret Hospital Leon Flicker Sydney Sax University of Western Australia ACT Older Australians' Advisory Council Robert Helme Terence Seedsman National Ageing Research Institute Victoria University of Technology Scott Henderson. John Snowdon Australian National University Rozelle hospital Anna Howe. Tilse' Australian Association of Gerontology University of Queensland. -. Akira Honuna Jean Woo Tokyo Metropolitan Institute of Gerontology Chinese University of Hong Kong Peggy Koopman-Boyden D;uhari Wirakartakusumah University of Waikato University of Indonesia.'

55 Contents OPINION The effects of physical health upon the outcome of admission to an acute psychogeriatrics ward 134 Houses for all ages 106 B. Draper & G. Luscombe P Archibald Understanding conflict: perception of female Crime and older people 107 caregivers 140 A. Graycar N. Rahman Is hostel care good for you? Quality of life measures in older people moving into REVIEW ARTICLES residential care 145 C. Reberger, S.E. Hall, R.A. Criddle Long-term health consequences of war-time imprisonment: a review of the Concord Hospital POW project 109 O.F Dent CASE REPORT Suicide among seniors 114 The Charles Bonnet syndrome 150 J. Klinger R.B. Lefroy RESEARCH BOOKSHELF 152 Undernourished patients with hip fracture: poor outcome is not due to excess infections 119 D. Bruce, I. Laurance, L. Ng, P Goldswain The effect of sensory impairment on the lifestyle activities of older people 124 M.S. Clark, M.J. Bond, L. Sanchez Satisfaction with medical and allied health services among aged people in Sydney 130 O.F Dent, GA Broe, H. Creasey, L.M.Waite, J.S. Cullen, D.A. Grayson Australasian Journal on Ageing, 18 (3) August

56 1. SCOPE AND MISSION The Australasian Journal on Ageing is a peer reviewed journal which publishes original work in any It area of gerontology and geriatric medicine. welcomes international submissions, particularly from authors in the Asia Pacific region. The journal publishes the following categories of articles (word limits include text and references, but not tables). Research. These are reports of original research up to 4,000 words long. Priority will he given to brief research reports of up to 1,500 words, with no more than 1 table or figure, which can be printed in 2 journal pages. Reviews. The journal publishes reviews of the literature of up to 4,000 words. Opinion. Opinion pieces are invited contributions of up to 900 words designed to stimulate discussion and debate. Professional Practice Updates. These are invited reviews of up to 4,000 words, by an expert in the field, which aim to update readers on some area of professional practice with the elderly. Innovations in Aged Care. These are invited articles of up to 4,000 words which describe and evaluate an innovation. Innovations can include new treatments, community and residential care programs, professional training courses and social policies. Case Reports. The journal accepts reports of up to 900 words. Letters. Letters to the editor may be up to 400 words. They may be edited and are subject to reply. Authors who wish to write an Opinion article or a Professional Practice Update, or describe an Innovation in Aged Care, should first write to the Editor-in.Chief with a proposal for the article. Invited articles, like other contributions to the journal, are subject to refereeing. 2. SUBMISSION Send all papers to: Professor Anthony Jorm, Editorin..Chief, Australasian Journal on Ageing, do Council on the Ageing (Australia), Level 2, 3 Bowen Crescent, Melbourne Vic Telephone (03) , Fax (03) , cota@cota.org.au Package submissions securely and include the following: - A covering letter signed by all the authors with the title of the manuscript and contact details for the corresponding author. The covering letter should state that: 1. The paper is not submitted for publication nor published elsewhere. 2. Any research involving humans or animals has been approved by an institutional ethics committee. 3. All authors have made a major contribution to the paper (for reports of original research, all authors should have made a major contribution to at least 2 of the following: planning the study, collecting the data. analysing the data, writing the paper). 4. Any potential conflicts of interest have been declared. - Four copies of the manuscript with all pages numbered. - A title page with authors' names and affiliations and (to allow blind review) a second title page without author identification. - One return, regular size self addressed envelope for acknowledgment. INSTRUCTIONS FOR AUTHORS 3. MANUSCRIPT PREPARATION Word limits. In order to publish as many contributions as possible, word limits for articles have to be strictly enforced. The title page should state the number of words in the article (including references but excluding tables). Research articles. Articles should have sections for Abstract, Introduction, Method, Results, Discussion, Acknowledgment (if applicable), Key Points and References. Abstracts should be structured into sections preferably under the headings: Objective(s), Method, Results. Conclusion(s). Key Points (which must be included) are 3-4 dot points which give the essential take-home messages of the paper. Other articles. Reviews, Professional Practice Updates, Innovations in Aged Care and Case Reports should be preceded by a short Abstract. Opinion articles do not need an Abstract. Manuscript presentation. Print the manuscript on A4 paper, double-spaced. In the final submission, after the review process is completed, authors are asked to submit an electronic copy on a 3.5 inch IBMformatted disk in Microsoft Word for Windows or some other common package that is clearly identified. References. Personal communications and unpublished manuscripts are not acceptable. Use the Vancouver system of referencing. In the text, references should be identified by numbers in square brackets (not as superscripts). In the Reference list, number the references in the order in which they appear in the text. However, once a reference is cited, all subsequent citations should refer to the original number. All journal titles must be quoted in full (no abbreviations). List all authors when there are 6 or fewer; when there are more than 6, list only the first 3 and add 'et al'. Prepare references as follows: Journals: 1. White AM, Groves MA. Interdependence and the aged stereotype. Australian Journal on Ageing 1997; 16: Books: 2. Sax S. Agein.g and public policy in Australia. Sydney: Allen and Urwin, Chapters: 3. Esterman A, Andrews GR. Southeast Asia and the Pacific: a comparison of older people in four countries. In: Kendig HL, Hashimoto A, Coppard LC. eds. Family support for the elderly: the rnternational experience. Oxford: Oxford University Press, 1992: Tables. Type tables on separate sheets, double spaced, nunibered separately with arabic numerals and given a brief title. Type footnotes immediately below each table using superscript letters. Use asterisks exclusively for probability levels of tests of significance, eg. *p<øø5 Indicate in the text where tables should be placed. Figures and illustrations. Photographs must be black and white. Figures must be professionally lettered in a sans-serif type like Helvetica or Univers or produced on a laser printer. Typewritten or dot matrix lettering is not acceptable. Original copies should not be sent until the final revisions are completed. 4. COPYRIGHT Authors of accepted manuscripts must transfer copyright to the Council on the Ageing (Australia). Authors have unlimited rights to publish their own articles in volumes they write or edit and to duplicate material for classroom use. When articles are republished, a citation to the previous publication of the Australasian Journal on Ageing and written notice to Council on the Ageing (Australia) are required.