1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 3 Diversity

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction The older adult population is becoming increasingly racially and ethnically diverse Increasing numbers of Hispanic and black older adults in the U.S. population Essentials of culturally competent care Lack of research related to cultural influences of aging

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics Shared by Ethnic Groups History Language Customs Beliefs about aging Key point: there are individual differences within ethnic groups so it is important not to stereotype

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Influenced by Ethnic Norms Diet Response to pain Compliance with self-care and treatments Trust with health care providers Responsibilities and roles in old age

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hispanic Americans Variety of Spanish-speaking persons –Immigrants from Spain, Mexico, Cuba, and Puerto Rico Increasing percentage of the population Different immigration periods for each Hispanic subgroup

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hispanic Americans Perspectives related to health and illness Traditional practitioners: curanderos, sobadores, espiritualistas, brujos, señoras Views of older adults in the Hispanic culture Expectations of children as caregivers English as a second language

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Black Americans 13% of the American population is black, but older black adults represent only 8% of the population Commitment to family and aging relatives Lower standard of living and less access to health care –Lower life expectancies

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health-Related Characteristics of Black Americans More health problems May hold unconventional beliefs related to health and illness Family decision making versus formal health service agencies Cautious while interacting with health care providers

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment and Health Conditions of the Older Black Population Differences in assessment for people with black skin More prevalent health problems: –Hypertension, heart disease, cancer, diabetes, and HIV/AIDS

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Asian Americans Currently 4% of the population of the United States Diverse group of individuals from various countries: –China, Japan, the Philippines, Korea, Vietnam, and Cambodia

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chinese Americans Life as an early immigrant Cities with the largest Chinese population Chinese medicine and medical traditions –Yin and yang –Traditional treatments Older adults are held in high esteem Role of the family unit

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Japanese Americans Japanese immigration Lower unemployment rate and higher percentage of professionals States with the largest Japanese populations Japanese traditions and generations Families care for elders Aged are viewed with respect

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Asian Groups Filipino Korean Vietnamese Cambodian

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Jewish Americans Jewish faith Immigration Leadership in business, arts, and sciences 2.2% of the total population Religious traditions Modern medical care Death rituals Family bonds

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Native Americans Population increasing States with highest population rates Indian Health Service Reverence for the Great Creator Health beliefs Spiritual rituals and treatment of illness

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Native Americans Ambivalence related to health care services Death rituals Rise in preventable diseases: diabetes, obesity, hypertension, stroke, and rheumatoid diseases Lowest cancer survival rate

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Older Prisoners Older adult prisoners as a subculture Poorer health and significant health challenges related to poor socioeconomic status and prior lack of access to health care Need for improved gerontological care and advocacy in the prison setting

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Considerations for Culturally Sensitive Care of Older Adults Unique histories, beliefs, and practices Respect for diversity Accommodation of dietary preferences Adaptations for special practices Understanding of health practices Culturally and linguistically appropriate services