1. Chinh Duy Le, MD UCI Senior Health Center 1

2. Objectives:  1. To raise awareness of cultural affects in health care for Vietnamese American seniors.  2. To emphasize the importance of cultural- appropriate approach for health care in diverse society. 2

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4. 4 Strongly influenced by Chinese and French culture due to prolonged colonization by these governments in history ASDFGHJ. (2009). Location Vietnam ASEAN [vector graphics], Retrieved May 5, 2011, from: http://en.wikipedia.org/wiki/File:Location_Vietnam_ASEAN.svg.

5.  Mr. Nguyen is 75 y.o. Vietnamese male, walk-in for an assessment for weight loss.  He was doing fairly well until 3 months ago when he started losing his appetite and weight (~15 lbs/3 months).  Denies any symptom and depressed mood. 5

6.  PMHx: Lung TB diagnosed and treated in 1990 in VN Chronic hepatitis B  How Mr. Nguyen’s PMHx information would affect your clinical management for Vietnamese seniors? 6

7. TB in Orange County of 3 million people  300,000 persons with TB infection (latent TB).  200 active TB cases/ year, ~6.2 cases/ 100,000 residents (3.8/100,000 in States)  87.2% were among foreign-born; Vietnamese: 34%; Mexican: 25%; Philippines: 19%; Korean 6% Chronic Hep B and liver cancer. 7

8.  Social history: Finished high school in VN; joined the army until 1975; spent 8 years in communist re- education camp; speaks primarily Vietnamese at home; unable to complete your health screening form in English.  Would Mr. Nguyen’s social history give you any information that may affect your health care for Vietnamese seniors? 8

9. Vietnamese American: Immigration Waves First wave: April 1975. Speak more English. More acculturated to American culture. Second wave: 1978 – 1990. May have trauma from a dangerous journey Third wave: 1990 – 2000. May represent majority of VN American elderly. Most have trauma from war or re- education camp. 9 PH2 Phil Eggman. (1984). 35 Vietnamese Boat People 2 [photograph], Retrieved May 6, 2011, from: http://en.wikipedia.org/wiki/File:35_Vietnamese_boat_people_2.JPEG.

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12.  Identify structural brain alterations associated with THI and investigate association with posttraumatic stress disorder and depression.  Mean cortical thickness in some areas significantly thinner in ex-political detainees with THI compared to those without.  More depression and PTSD in ex-political detainees with THI compared to those without. 12

13. 13 Non-English at home, English spoken less than "very well" Non-English at home English spoken "very well" Only English at home

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16.  On physical exam you find lines of red bruises along ribs and midline in his back…. You probably would…. 16 Coin rubbing 1 Cupping therapy 2 1.Jugana Loder. (2008). Gua Sha [photograph], Retrieved May 6, 2011, from: http://en.wikipedia.org/wiki/File:Gua_Sha.jpg.http://en.wikipedia.org/wiki/File:Gua_Sha.jpg 2.Alanna Ralph. (2004). Fire cupping [photograph]. Retrieved May 6, 2011 from: http://en.wikipedia.org/wiki/File:Fire_Cupping.jpg.

17.  What are common cancers in VNese American seniors? White Men White Women VN Men VN Women All Cancer* 1432.0 1.00 907.8 1.00 883.7 0.66 534.7 0.63 Stomach 37.1 1.00 19.8 1.00 88.0 2.54 51.3 2.92 Liver 28.2 1.00 14.6 1.00 141.8 5.24 61.9 4.55 Cervix 7.7 1.00 13.7 1.74 Breast 129.3 1.00 23.5 0.19 Lung 454.3 1.00 206.8 1.00 285.5 0.64 114.2 0.56 17 *Death rate/100,000. Cancer Causes Control (2008) 19:135– Cancer death rates for older Asian-Americans_ Lauderdale, D.; Huo, D.

18.  After evaluation, you think Mr. Nguyen probably has depression and needs antidepressant treatment...  What could be cultural barriers in diagnosis and treatment of mental health issues in VNese elderly? 1. Social stigma. 2. Traditional health beliefs: Hot/cold (Yin – Yang) Herbal medicine (“northern medicine”, “southern medicine”) Acupuncture. 3. Lack of sensitive and specific testing instruments 18

19. Mr. Nguyen… General Issues in Health Care Mr. Nguyen… General Issues in Health Care Other cultural barriers in health care 1. Advanced directive 2. Responsible party 3. Death and dying truth telling 4. Care-giver burden 5. Attitude toward health maintenance 19

20. Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey, 2001–2002 20 MMWR, August 27, 2004

21. Cultural Aspect of Health Care in Vietnamese American Elderly_ Summary 1. Vietnamese American seniors do have difference in their medical profiles. 2. Culture and traditional health beliefs have strong impact on health care for VNese seniors. 3. A culturally appropriate approach is important in medical care for VNese elderly to improve our patient care. 21