1. 1 Cross-culturalInfluenceson Older Adults

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

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

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

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

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

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

8. 8 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 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

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

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

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

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

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

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

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

16. 16 Factors in racial and ethnic disparities 1.Patient Level Factors a)Clinical appropriateness of care b)Patient attitudes and preferences c)Expectations regarding healthcare d)Mistrust e)Treatment refusal f)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. 1.Patient Level Factors a)Clinical appropriateness of care b)Patient attitudes and preferences c)Expectations regarding healthcare d)Mistrust e)Treatment refusal f)Care-seeking behaviors: “culture match” Source: The National Academy of Sciences, Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed on April 14, 2004 from http://www.nap.edu/openbook/030908265X/html/125.html.

17. 17 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. 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.

18. 18 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. 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.

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

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

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

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

23. 23 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 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

24. 24 Questions?