Crosscultural
Influences
on Older
Adults
1
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
2
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
3
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; RaleighDurham “hot jobs”; California, New York, Los
Angeles, Chicago, Houston, and Miami
4
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
5
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.
6
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.
7
Cultural Competence
Group Discussion
1.Examine the influence of your own
cultural background and attitudes
toward people of your own and of
different cultures
2.Examine how your orientation
influences caregiving practices
generally, and older people
specifically
8
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)
9
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.
10
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
11
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
12
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
13
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
14
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.
15
Factors in racial and ethnic disparities
1. Patient Level Factors
a)
b)
c)
d)
e)
f)
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.
16
Factors in racial and ethnic disparities
2. System-Level Factors
a) Insurance Coverage
b) Limited English Proficiency (LEP)
c) Ad hoc Interpretation
d) 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.
17
Factors in Racial and Ethnic Disparities
3. Care-Process Factors
a) Physician biases
b) Stereotyping
c) 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.
18
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
19
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
20
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?
21
Considerations: Care-giving Settings
Home Care / Assisted Living
Nursing Home
Hospital
22
Culturally appropriate assessments
• 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
23
Questions?
24
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Cross-cultural Influences on Older Adults