1. Aging & Diversity

3. Resilient but Not Impenetrable  25% of the 65 year old and over population live in rural areas.  Rural elders are becoming isolated.  The proportion of older adults in rural communities is larger than the proportion in urban areas primarily as a result of younger populations moving to larger urban areas.  Along with the out-migration of younger people is an in-migration of retired elderly.

4. Resilient but Not Impenetrable  Rural elders are one of the greatest at- risk groups for experiencing physical & mental health problems.  In many rural communities there are no psychosocial services available to meet the needs of the rural elderly.

5. "Take Care of Our Own" (Bushy, 2000)  Traditional rural values stress:  Self-reliance  Conservatism  Family network  Work orientation  Religion/ Fatalism  Mistrust of health care professionals:  Distrust of outsiders  Fear associated with Tuskegee Syphilis Experiment  "I don't know if that works for me."

6. Families: Family Structure  In the United states there are currently many three, four, and five generation families as a result of increased life expectancy.  There are fewer persons born into each generation therefore, family trees are smaller.  The number of existing generations in families along with the decreased numbers in each generation has produced what Qualls (1996) describes as “tall, skinny, family trees.”

7. Families: Changing Family Structures  Living Apart Together (LAT): is a more recent phenomenon, which seems to have the potential of becoming the third stage in the process of the social transformation of intimacy. In contrast to couples in ‘commuting marriages’, who have one main household in common, couples living in LAT relationships have one household each. This article presents data on the frequency of LAT relationships in Sweden and Norway, and explores the variation which exists within LAT relationships. The article argues that the establishment of LAT relationships as a social institution requires the prior establishment of cohabitation as a social institution. (Levin, I. (2004). Living apart together: A new family form. Current Sociology, 52(2), 223-240)

8. Gay & Lesbian Aged  Older lesbians & gay men have concerns that are related to their age & sexual orientation.  Nursing home or inpatient placement for themselves or their mates.  May lead to loss of contact.  Often no legal capacity to make medical, financial or burial decisions for mate.  Different from cohort of other older adults. Homosexuality was not “accepted” before 1969

9. Gay & Lesbian Aged  Older lesbians & gay men have concerns that are related to their age & sexual orientation.  Nursing home or inpatient placement for themselves or their mates.  May lead to loss of contact.  Often no legal capacity to make medical, financial or burial decisions for mate.  Different from cohort of other older adults. Homosexuality was not “accepted” before 1969.

10. Culture: Religion/Spirituality  National surveys indicate that older adults attach a high value to their religious beliefs & behaviors.  This is particularly true of ethnic & minority elders who show a high degree of religious involvement.  The vast majority of research finds that religious involvement is associated with greater well-being & life satisfaction, greater purpose & meaning in life, greater hope & optimism, less anxiety & depression, coping with stressful life events, more stable marriages & lower rates of substance abuse. McFadden, S.H., 1996; Crowther, Parker, Larimore, Achenbaum, & Koenig,2002; Koenig, 1990; Dull & Skokan, 1995

11. The SPIRITual History  SSpiritual belief system  P Personal spirituality  IIntegration with a spiritual community  RRituals or Restriction  IImplications for medical care  TTerminal events planning Maugans T. (1996). Arch Fam Med, 5: 11-16

12. SPIRITual History Questions  What does spirituality mean to you?  What aspect of religion/spirituality would you like me to keep in mind as I care for you?  Would you like to discuss the religious or spiritual implications of your health care? Maugans T. (1996). Arch Fam Med, 5: 11-16

13. CULTURAL COMPETENCE IN THE WORKPLACE 1.Which of the following would be good ways to promote cultural competence in your workplace? 2.Seek out information about the various customs, holidays and religions of cultures different from your own that you will encounter in your work. 3.Try to bring your patients into mainstream American culture as much as possible. It will be easier for them that way. 4.Learn how to respectfully ask questions about cultural beliefs. 5.Avoid talking to patients about anything other than medicine.

14. Integrated Healthcare

15. Interdisciplinary Awareness  Collaborative relations across disciplines demonstrates a supportive, collaborative and interdisciplinary team focused on improving care for older adults.  The structure of interdisciplinary teams has evolved from a hierarchy, with the physician in a "command" position, to a team interfacing many different kinds of health care professionals, each with separate and important knowledge, technical skills, and perspectives. (APA, 2007)

16. Interdisciplinary Teams: Balance Several Factors (APA, 2007)

17. Older People & Health Care System  Older people are disadvantaged by a health care system not sensitive to their needs.  Multiple morbidities  Life span experiences  Fragmented care  Marginalization  Ageism & Stigma Everyone doesn’t need integrated model. For example, someone with an earache. However, because older adults often have co-morbid conditions the integrated model is very useful. (APA, 2007)

18. 1.What cultural factors could strongly influence a persons’ reactions to serious illness & decisions about healthcare? GROUP QUESTION: CULTURE & HEALTHCARE