Cultural Competency and Older Adults The extent to which health care providers can treat patients/clients in a culturally competent manner will have a lasting impact on the care given to individuals and the success of our health care system. Take a moment to re-read the case example given in the PowerPoint presentation. This illustration highlights the importance of cultural competency and the impact that it has on health care: An elderly Hmong woman fell and broke her wrist. She was taken to an orthopedic doctor and received a cast to help her mend. When she came back in two weeks for a check-up without the cast on, the orthopedist became very upset. The orthopedist gave the woman another cast and told her that she had to keep this one on if she wanted her arm to heal. An interpreter translated what the doctor said and asked if the woman understood the instructions. The woman smiled and nodded, and said, Yes, yes. Another two weeks later she went back to the orthopedist for a check-up and again, the cast was off. This time the orthopedist was really upset. He told her that her wrist would never heal without the cast and he put the cast back on her arm. After this happened, the woman went to see a family doctor who happened to be a young Hmong woman. The patient trusted her new doctor and asked her how she would be able to heal if her shaman couldn t put healing herbs on her arms. She said she wouldn t tell this to her orthopedist, because she didn t trust him to understand. The primary physician addressed the concern of the patient by replacing the existing cast with one that had a bottom and a removable top. With this cast, the woman could take off the top and have her shaman put herbs on her arms. Writing Exercise: Stop for a moment and notice how this case study makes you feel. Take some time to examine your emotional reactions. Do you feel sad? Angry? Do you empathize with the patient? The orthopedist? Write down these reactions and think about what causes them.
What is Cultural Competency? Today the aging population is more diverse than ever in terms of race, ethnicity, gender, sexual identity, language, acculturation, socioeconomic level and education (Dorsett, 2006). In order to serve all older adults within these changing demographics, the care provided by health and social service programs must also change to address the health literacy and cultural competency needs of older adults (Dorsett, 2006). In order to understand the concept of cultural competency it is important to first understand culture. Culture is defined as, The integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious or social group (Brach & Fraser, 2000, p.182). Understanding culture helps people recognize how others interpret and navigate their environments (Administration on Aging, 2001). The importance of culture is heightened for minority patients who receive health care from systems that are run mostly by the majority group members (Brach & Fraser, 2000). Service providers need to deliver culturally competent and health literate programs. Writing Exercise: How would you define cultural competence in your own words? Write down a definition that makes sense to you. Compare the definition you came up with to the following: Cultural competence is the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients (Ihara, 2004, p. 1). A culturally competent health care system can help improve the health outcomes and quality of care for patients, and can contribute to the elimination of racial and ethnic health disparities (Ihara, 2004). Was your definition similar? The specific way we define cultural competence is not nearly as important as our understanding of how it affects the lives of the people we serve. More on Cultural Competency Brach and Fraser write, Cultural competency goes beyond cultural awareness or sensitivity. It includes not only possession of cultural knowledge and respect for different cultural perspectives but also having skills and being able to use them effectively in cross-cultural situations (2000, p.183). To increase the cultural competence of the health care delivery system, health professionals must be educated on how to provide services in a culturally competent and sensitive manner (Ihara, 2004). Cultural competence can increase the quality of services provided to diverse groups, including older adults.
Why is Cultural Competency Important? More and more federal and state laws, regulations, and standards are passed to guarantee that health systems respond to the diversity of their patients (Brach & Fraser, 2000). By 2050, it is estimated that ethnically and racially diverse minorities will make up about 35 percent of the population over the age of 65 (Ihara, 2004). The need for culturally competent care is not just a focus for younger populations, but older populations as well. Older adults have more chronic conditions than younger populations, which increases their interaction with the health care system (U.S. Department of Health and Human Services, n.d.). Racial and ethnic minorities face many barriers while receiving care including: Difficulties with language and communication, feelings of isolation, encounters with service providers lacking knowledge of their culture, and challenges related to their socioeconomic status (Administration on Aging, 2001). If providers, organizations, and systems are not working together to promote and provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care (Ihara, 2004). Racial and ethnic minorities have higher morbidity and mortality from chronic conditions than their white counterparts (Ihara, 2004). In fact, more African Americans and Latinos than Whites report that they suffer from at least one of seven chronic conditions that rank as the most costly medical conditions in America; including asthma, cancer, heart disease, diabetes, high blood pressure, obesity, and anxiety/depression (Ihara, 2004). Higher proportions of minorities compared to Whites do not have a usual source of care or health insurance (Ihara, 2004). This can result in more serious health conditions and create a higher financial burden for minority older adults, thus making culturally competent health provisions vitally important for older adults. Test Your Understanding: Which of the following would be good ways to promote cultural competence in your workplace? 1. Seek out information about the various customs, holidays and religions of cultures different from your own that you will encounter in your work. 2. Try to bring your patients into mainstream American culture as much as possible. It will be easier for them that way. 3. Learn how to respectfully ask questions about cultural beliefs. 4. Avoid talking to patients about anything other than medicine.
How did you answer? If you chose 1 and 3 as good ways to promote cultural competence in the workplace, you are well on your way! Part of becoming culturally competent is learning about cultures different than your own. While it is imperative to remember that each individual is different and may subscribe to the norms of their culture in varying degrees, it is helpful for health care professionals to know about the beliefs of the cultural groups they will encounter. This will help practitioners avoid costly mistakes like the one of the orthopedist in our earlier case example. Things to Know about Somali American Older Adults Demographics Minnesota is home to the largest Somali population in the United States. It is currently estimated that Minnesota has anywhere between 20,000 and 40,000 Somali immigrants with a high proportion residing in Minneapolis, St. Paul, Eden Prairie, Rochester, Owatonna, and Mankato The Metropolitan Area Agency on Aging estimated in February 2005 that there were approximately 1,178 Medicaid-eligible Somali older adults in the Twin Cities Metro Area. (2006). 85% of Somalis living in Minnesota are estimated to be between the ages of 20 and 40. In 1994 the literacy rate in Somalia was 24%, but with increasing political unrest education opportunities have decreased. The relatively young population of Somalis creates the need for research about Somali American older adults. Due to resettlement and refugee situations, only 1 in 4 Somali children in Minnesota are living with both parents. Cultural Beliefs and Religion Traditionally, Somalis believe that diseases and medical conditions are caused by Allah. Therefore, since the disease comes from Allah, many Somalis believe that suffering will bring about forgiveness by God. Somalis may also believe that treatment for disease only comes through the will of God and this belief holds true whether seeking traditional care or Western medical care. Family Dynamics Social structure is based on family and clan group. Somali people tend to be loyal to immediate family, their clans, and friends. Tips for care professionals One of the most important things that health care providers should know is that circumcised women generally feel normal because in their culture many people are circumcised.
Things to Know about Hmong American Older Adults Demographics St. Paul is home to the second largest Hmong community in the country, next to Fresno California. The Metropolitan Area Agency on Aging estimates that there are 2,957 Hmong older adults residing in the Twin Cities Metropolitan Area. It wasn t until the 1950 s that the Hmong had a written language; prior to that the Hmong culture was an oral one. Because of this, some Hmong persons residing in Minnesota, especially older adults, might not be able to read or write in their native tongue. Cultural Beliefs and Religion Hmong people traditionally believe that the primary cause of illness is the loss of a soul. The soul may leave the body when a person is depressed, lonely, suffering from a loss, or is frightened. It is a common belief among some Hmong persons that talking about a medical problem will ensure its existence. Many Hmong persons go to health care providers seeking symptom relief and will mix traditional approaches with Western medicine until they are satisfied. The shaman plays a pivotal role in the health care of Hmong American older adults. Family Dynamics The Hmong family does not consist of a nucleus mother, father, and children. It includes numerous clans, each that has a different surname like Vang, Lee, or Thao. Each clan is very close and an elder male is designated as the leader. A Hmong person s medical decisions are often made by family. A clan elder, father, older brother, uncle, in-law, shaman, or the wider community may be involved in making decisions about the person s care. Common Health and Disease Hmong people often suffer from infectious diseases such as malaria, tuberculosis, and hepatitis. Other diseases commonly found in the Hmong community include diabetes and hypertension. Things to know about Vietnamese American Older Adults Demographics Between 1975 and 1996 Minnesota received about 20,000 refugees from Vietnam. The Metropolitan Area Agency on Aging found that 2,672 of Vietnamese persons ages 50 and over reside in the metropolitan area.
Cultural Beliefs and Religion Some Vietnamese persons practice the Buddhist traditions and worship their ancestors, but many are Catholic. Mental illness is stigmatized in the Vietnamese culture. Many people view mental illness as a supernatural phenomenon that can bring bad luck or shame to the family. Family Dynamics Family identity is extremely important in the Vietnamese culture and families are very interdependent on each other. It is common for Vietnamese people living in Vietnam to live with extended families, including grandparents, parents, and children. Common Health and Disease Depression and post-traumatic stress disorder are common in the Vietnamese culture due to the loss of family members, language and cultural barriers, social isolation, and separation from family. Many Vietnamese persons, particularly those who lived during the Vietnam War, are still experiencing the physical and psychological effects related to the communist regime. Tuberculosis and hepatitis are common in the Vietnamese culture and screening for these diseases is essential. Cancer is the leading cause of death for both Vietnamese men and women. Tips for care professionals It is common to find that Vietnamese persons tend not to be direct, and it isn t uncommon for messages to be relayed through other persons. Things to Know about Latino American Older Adults Demographics Latino older adults are expected to grow faster than any other minority group. The Latino older adult population is expected to grow 3.9% each year from 1990 to 2050, and Latino older adults will comprise nearly 16.4% of the older adult population by 2050. Latinos are the least likely of all the ethnic groups in this country to have health insurance. In 1999, the U.S. Census estimated that 35.5% of Latinos were uninsured compared to 11.9% of non-latino Whites. Cultural Beliefs and Religion Latinos are much more likely to report fair or poor health than their White counterparts. Socioeconomic status can partially explain this phenomenon, but the bigger factor seems to be acculturation issues. Limited English proficiency and skills has been found to be a major barrier to accessing medical and social services for older adults. Most Latino older adults share a common belief in the retention and use of the Spanish language. Approximately 60% of Latino adults speak Spanish at home. Those persons who speak Spanish likely have a more traditional Latino worldview, and they typically have less knowledge of the U.S. health care system
Family Dynamics Common cultural themes found in the Latino population include the importance of family at the nuclear, extended, and fictive kin levels. Needs of the family take precedence over the individual and mutual reciprocity is expected. It is common in Latino culture for relatives to live together, and there is an ongoing debate about whether older adults live with family as a result of their health conditions, economic necessity, or cultural norms. Collective loyalty to the extended family is more important than individual needs and therefore family support systems need to be consulted when caring for an older adult. Tips for care professionals It is essential for health care providers, and the population, to remember that there is great heterogeneity among Latino populations. What one culture believes might not be applicable to another group, so it is very important for service providers to view each person as an individual and not to group all Latinos into the same category. Things to Know about Chinese American Older Adults Demographics 80% of Chinese older adults are foreign born. In 1990, 89% of Chinese older adults in the U.S. spoke a language other than English, and 73% said that they spoke English poorly. Cultural Beliefs and Religion The utilization of U.S. health care services by Chinese American older adults largely depends on acceptance by the patient and family, and barriers like mistrust, money, saving face, and family responsibilities. Other barriers to accessing the U.S. healthcare system include lack of language, limited levels of culturally competent care by service providers, geographic barriers, and economic barriers. Confucianism, Taoism, and Buddhism are the three religions or philosophies that greatly impact the Chinese culture and way of life. Taoism, which expanded to include the phrases, Yin and Yang, is the dominant concept that Chinese persons use to navigate the health care system. In Chinese culture, health is seen as the harmony between the Yin and the Yang, and between the body and the environment. Many Chinese persons still believe in and practice traditional Chinese medical treatments. Examples of these traditional Chinese practices include, acupuncture, cupping, herbology, Yin/Yang concepts, and meditation/exercise. Family Dynamics The family is the center of Chinese life, and the family comes before the individual, with the father being the head of the family.
Common Health and Disease The suicide rate for elderly Chinese immigrants is 3 times higher than that of U.S. born older Chinese adults. Chinese American women aged 65+ have three times the suicide rate than white women, and for those 75+ the rate is seven times greater than white women. Tips for care professionals It is not uncommon for Chinese American older adults to hesitate to make direct eye contact, ask questions or voice concerns in order to not inconvenience others or seem disrespectful. Physicians are expected to make decisions and give instructions. Conclusion To conclude, it is important to realize that as health care professionals we will never be truly competent in a culture other than our own. However, being aware of the various cultural traditions that may be important to patients and clients will greatly enhance the quality of care we can provide. Hopefully this module has provided useful information about a number of the ethnic groups you will likely encounter in your work.
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