Addressing Diversity of Older Adults

Culture

-The totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and though characteristics of a population of people that guide their worldview and decision making

-Is largely unconscious and has a powerful influence on health and illness

-The concept of culture generally includes all characteristics associated with race, ethnicity, age, religion, gender identity, sexual orientation, ability/disability status, socioeconomic conditions, and respecting the patient and family values, preferences, language and cultural traditions

Health inequity

-Preventable differences regarding the rates of disease incidence, prevalence, morbidity, mortality, or life expectancy between one population and another

-Socially disadvantaged populations are mainly affected by health inequities

Social Determinants of Health

Conditions that strongly influence life expectancy, health and functional status, health-related quality of life, and susceptibility to disease and disability

Health disparity or inequality

Measurable differences that are expected and common but not necessarily preventable

Cultural competence is critical in protomoting wellness

-Healthcare providers must recognize, respect, and integrate clients’ cultural beliefs and practices into nursing care plans

-Health care providers must be culturally aware, sensitive and have some degree of cultural competence to be effective integrating health beliefs and practices into care plans and interventions

-Increased diversity in health care workforce adds to improved care

-Cultural generalizations are helpful as a starting point but do not replace evaluation of the individual patient

Cultural awareness

Has more to do with an appreciation of the external signs of diversity, such as arts, music, dress and physical characteristics

Cultural sensitivity

Has more to do with personal attitudes and not saying things that might be offensive to someone from a cultural or thnic back ground different from the healthcare providers

Cultural competence

Entails “the ability to deliver health care with knowledge of and sensitivity to cultural factors that influence the health behavior and the curing, healing, dying, and grieving process of the person

Cultural humility

Humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot possibly know everything about other cultures, and approach leaning about other cultures as a lifelong goal and process

Characteristics of Cultural Competence

-Developing an awareness of one’s own culture, thoughts, and environment without letting them have an undue influence on those from other backgrounds

-Not assuming that provider’s beliefs and values are the same as the client’s

-Demonstrating knowledge and understanding of the client’s culture, health-related needs and meanings of health/illness

-Resisting judgmental attitudes (different isn’t as good)

-Accepting and respecting cultural differences

-Adapting care to be congruent with the client’s culture

-Being open and comfortable with cultural encounters

-Cultural competence should be manifested via an individualized plan of care that begins with performing an assessment through a cultural lens

Cultural self-assessment

An awareness-raising tool of gaining insight into the health-related values, beliefs, attitudes, and practices that have shaped and informed the person the nurse has become when providing care

Strategies that can mitigate the influence of implicit bais

-Cultural self-assessment

-Leverage available resources to learn more about cultural groups that are frequently under your care

-Ethnogeriatrics: the component of geriatrics that integrates the influence of race, ethnicity, and culture on health and well-being of older adults

-Realize that educational materials about cultural groups provide general info about particular groups but each group is made up of unique individuals. This info should be used as a beginning point for a personalized assessment

-All health care professionals are encouraged to contact local organizations to obtain culturally specific information about groups that reside in their locale

Language competence

-Health care services that are respectful of and responsive to a person’s linguistic needs, is one small part of providing culturally appropriate care

-Immigrants who come to the US as adults may be particularly disadvantaged

-The challenge of communicating with people who do not speak the same language or dialect is magnified when the person also has dementia or sensory impairments

-When caring for an older adult with limited English proficiency, it is imperative to make every effort to obtain certified interpreters rather than using family or friends to ensure accuracy and avoid breaches of confidentiality

-Mobile or internet-based language translation apps should bot be used in place of professional interpreters for communication about medical information

Communications with persons from diverse backgrounds

-Review that the conversation will remain confidential

-Talk to the older adult, not the interpreter

-Talk about only one topic at a time

-Use “plain” english, short sentences and simple vocabulary

-Avoid professional jargon, idioms, and slang

-Be aware that many words do not translate into another language

-Evaluate client’s health beliefs, see if these beliefs can be accommodated in plan of care

-Make sure that the same important, essential information is given to all persons including health promotion

African-American Older Adults

-Heterogeneous, have a wide range of socioeconomic conditions

-Less likely to live alone, may have multi-generational households

-Consequences of racism are still present and linked to health disparities

-Factors contributing to poor health outcomes include discrimination, cultural barriers, and lack of access to health care

-Suspicion of health care providers linked to history of disparities

-Trusted leaders/providers in community provides pathway to care- sometimes associated with religious institutions

Asian American Older Adults

•There is a large amount of diversity within the group that’s labeled “Asians and Pacific Islanders”

•Strong value on care of older family members

•Less likely to use nursing homes

•More accepting of mental decline in older adult

•Health is physical and spiritual harmony

Hispanic/Latino American Older Adults

•Diverse group

•Strong cultural respect for family and for older people

•Older adults frequently live with family members

•Health is a gift or reward given as G-d’s blessing

•Most in US speak both Spanish and English

Native American and Alaska Native Older Adults

•Value older members of the community, particularly with regard to their roles as grandparents and story tellers.

•Strong traditions related to spirituality and religious practices, with each tribe having unique expressions

•Belief in the connection among body, mind, and spirit

•High rates of all of the following conditions: diabetes, tuberculosis, heart disease, substance abuse, and certain cancers (e.g., liver, cervix, kidney, gallbladder, and colorectal

•Poorer health associated with low economic conditions, cultural barriers, access to care, and mistrust of health providers.