Aging and Diversity Within racial/ethnic minority groups there is further diversity. For example,...

Aging and DiversityAging and Diversity

bull Within racialethnic minority groups there is further diversity For example Asian Americans comprise 26-census-defined sub-ethnic groups While some segments of the Asian population have been in the United States for many generations others have arrived only recently They have come from more than two dozen countries They do not share a common language a common religion or a common cultural background


bull Approximately three million foreign-born persons 65 years of age or older live in the United States Among them more than one third were born in Europe one third in Latin America and one fourth in Asia

bull In the future increasing numbers of foreign-born older adults will likely be from Latin America and Asia ( He 2002 )

bull In 2050 16 million of the projected 81 million elderly will be foreign born (Pew Center 2008)


bull Older women represent over 58 percent of the population aged 65 years and over more than two-thirds (69 percent) of the US population aged 85 years and over and 80 percent of the population aged 100 years and over

bull The US Census Bureau projects that by 2030 the number of women aged 65 years and over will double to 40 million (US Census Bureau Population Division 2006)


bull The number of lesbiangaybisexualtransgender

(LGBT) older adults is increasing The National Gay and Lesbian Task Force estimated that one to three million Americans over 65 have LGBT sexual orientation By 2030 roughly four million older Americans will identify as lesbian gay bisexual or transgender (National Gay and Lesbian Task Force 2005)


bull At later life this issue commingles with age in many ways that expand the need for cultural competencies beyond that of just getting older and have an LGBT identity If the essence of cultural competence is to affirm and value the dignity of the person different from the mode then issues of age and LGBT require special attention

(National Gay and Lesbian Task Force 2006 and the Task Force on Appropriate Therapeutic Responses to Sexual Orientation 2009)


bull As the baby boomer generation in the US ages the rates of disability have dropped considerably According to data from the National Long-Term Care Survey (NLTCS) the chronic disability fell from 265 in 1982 to 19 in 2005 suggesting that older adults are becoming healthier and less disabled

bull In fact the brunt of the disability process appears to occur earlier in the life span and not in old age (Martin Freeman Schoeni amp Andreski 2009)


bull Unfortunately racialethnic older adults and those living in poverty do not share the same advantages as older adults with greater lifetime resources amp access to health care (Bowen amp Gonzaacutelez

2008)

ndash Among African American elders 257 report mobility disability

ndash Native American or Alaska Native elders (or both) 206 percent report disability

ndash Hispanic older adults the rates of disability appear to be similar to those of older Whites at 18 and

ndash Asian elders 20


bull Although racialethnic minority groups have also shown a decline in disability over the decades those who are living in poverty have shown the smallest declines in disability (Schoeni Martin Andreski Freedman 2005) ndash Thus the intersection of race ethnicity and

poverty can account for increased disability


bull Mental disabilities in late life are also on the rise as the number of people with severe and persistent mental illnesses are receiving better healthcare overall and are living longer than in the past (eg Palmer Heaton amp Jeste 2004)


bull While most older adults are not poor there are a significant number of older Americans living below the poverty line ndash 34 million older persons - and an

additional 22 million ldquonear poorrdquo

ndash The proportion of older adults living in financially strained circumstances (living at or below 50 of their area median income the definition HUD uses to determine eligibility for

social programs) is even higher and is estimated to be approximately 10 of the older population


bull Raciallyethnically diverse older adults experience poverty at a disproportionate rate 219 of elder African-Americans and 218 of elder Hispanics were poor in 2001 compared to 89 of older Whites


bull Almost half of older Hispanic women and African-American women who live alone or with non-relatives are poor (Proctor amp Dalaker 2002)

bull The median income for Native American men aged 65 or over is $9967 as compared to $14775 for comparable white males

bull For women in this age group the median income is $6004 for Native Americans compared with $8297 for whites Overall 20 of Native Americans (versus 10 of whites) 65 years or older live below the official poverty level


bull While we celebrate the rich diversity among older adults we recognize that culturally diverse older Americans often are at greater risk of poor health social isolation and poverty than are their younger counterparts

bull Evidence of racial and ethnic disparities can be found across a broad spectrum of health conditions and outcomes

bull Excessive deaths and excess morbidity and disability are prevalent among racial and ethnic minority elders


bull A higher incidence of obesity diabetes and hypertension as well as an earlier onset of chronic illness is evident in minority older adults as compared to majority older adults (AOA 2008)

bull Regarding older adults with an LGBT identity the challenges are many including poorer health care and securing reasonable housing and caregiving services

Resilient but Not Impenetrable 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

Resilient but Not ImpenetrableResilient but Not Impenetrable

Rural elders are one of the greatest at-risk groups for experiencing physical amp mental health problems

In many rural communities there are no psychosocial services available to meet the needs of the rural elderly

Take Care of Our Own (Bushy 2000)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 dont know if that works for me

Families Family StructureFamilies 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 ldquotall skinny family treesrdquo

Families Changing Family StructuresFamilies 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 lsquocommuting marriagesrsquo 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)

Gay amp Lesbian AgedGay amp Lesbian Aged

Older lesbians amp gay men have concerns that are related to their age amp 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 ldquoacceptedrdquo before 1969


Older lesbians amp gay men have concerns that are related to their age amp 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


Culture ReligionSpiritualityCulture ReligionSpirituality

National surveys indicate that older adults attach a high value to their religious beliefs amp behaviors

This is particularly true of ethnic amp 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 amp life satisfaction greater purpose amp meaning in life greater hope amp optimism less anxiety amp depression coping with stressful life events more stable marriages amp lower rates of substance abuse

McFadden SH 1996 Crowther Parker Larimore Achenbaum amp Koenig2002 Koenig 1990 Dull amp Skokan 1995

The SPIRITual HistoryThe SPIRITual History

S Spiritual belief systemP Personal spiritualityI Integration with a spiritual communityR Rituals or RestrictionI Implications for medical careT Terminal events planning

Maugans T (1996) Arch Fam Med 5 11-16

SPIRITual History QuestionsSPIRITual History Questions

What does spirituality mean to you

What aspect of religionspirituality 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


CULTURAL COMPETENCE IN THE WORKPLACECULTURAL 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

Integrated HealthcareIntegrated Healthcare

Interdisciplinary AwarenessInterdisciplinary 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)

Interdisciplinary Teams Balance Several FactorsInterdisciplinary Teams Balance Several Factors

(APA 2007)

ResponsibilitiesGoals about

careresearch outcomes

Skills

Role as a team member in

shared decision making

Knowledge

Values

Older People amp Health Care SystemOlder People amp 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 amp Stigma

Everyone doesnrsquot 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)

1 What cultural factors could strongly influence a personsrsquo reactions to serious illness amp decisions about healthcare

GROUP QUESTION CULTURE amp HEALTHCAREGROUP QUESTION CULTURE amp HEALTHCARE

Joe an 85 year old African American male was diagnosed with hypertension 15 years ago Joe exhibits dramatic fluctuations with his blood pressure due to noncompliance with prescribed treatment regimens Joersquos physician discusses how Joe should manage his ldquohypertensionrdquo

1 What wording could the physician have used to help Joe understand his condition

2 What other disciplines may have been involved in helping Joe manage his hypertension better

CASE VIGNETTE JOECASE VIGNETTE JOE

CULTURAL HUMILITYCULTURAL HUMILITY

ldquoWith so many factors to consider how does one move forward with developing cultural competence without being overwhelmed with the complexity and the dangers of stereotyping or reifying the culture of others Practicing ldquocultural humilityrdquo is the keyrdquo

California Health Advocates 2009

1 Identify your own cultural and family beliefs and values

2 Define your own personal cultureidentity ethnicity age experience education socio-economic status gender sexual orientation religionhellip

3 Are you aware of your personal biases and assumptions about people with different values than yours

4 Challenge yourself in identifying your own values as the ldquonormrdquo

5 Describe a time when you became aware of being different from other people


GROUP EXERCISEGROUP EXERCISE

Cultural Humility DefinedCultural Humility Defined

A lifelong process of self-reflection and self-critique ldquoThe starting point for such an approach is not an

examination of the clientrsquos belief system but rather having health careservice providers give careful consideration to their assumptions and beliefs that are embedded in their own understandings and goals of their encounter with the client

In practicing cultural humility rather than learning to identify and respond to sets of culturally specific traits the culturally competent provider develops and practices a process of self-awareness and reflectionrdquo

Dr Melanie Tervalon and Jann Murray-Garcia California Health Advocates 2009

Cultural Humility ValuesCultural Humility Values

Openness Appreciation Acceptance Flexibility

Mia Luluquisen Katherine Schaff amp Sandi Galvez Alameda County Public Health Department (2009)

Cultural Skills Across DomainsCultural Skills Across Domains

Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal


Personal Ability to regularly conduct self-evaluation about how

values and beliefs impact worldviews

Interpersonal Ability to communicate with others who have different

language and worldview

Capability to translate ways of seeing and behaving from one culture into another


Program Planning Ability to show respect for another culturersquos values and

identity Capacity to include the cultural social and environmental

influences on communities in program design Talent for building trust developing relationships and

working with culturally diverse community members

Organizational Ability to establish organizational vision and leadership that

promotes a positive multicultural work environment Capability to create and implement policies and procedures

to foster diversity and inclusion


Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf


American Geriatrics Society Position Statement on Ethnogeriatrics

httpwwwamericangeriatricsorgproductspositionpapersethno_committeeshtml

Use of Interpreter During Clinical Encounters Position Statement

httpwwwamericangeriatricsorgproductspositionpapersinterpreter_022307PFshtml

American Psychiatric Association Ethnic Minority Elderly Curriculum

httpwwwaagponlineorgprofpdfs08cultcompcurpdf

American Psychological Association Task Force on Diversity Education Resources Teaching and Learning about Aging (2008)

httpteachpsychorgdiversityptdeagingphp


Stanford University Geriatric Education Center Curriculum in Ethnogeriatrics httpsgecstanfordeduresourcesethnohtml

Ethnogeriatric Educational Resources including emergency preparedness mental health and diabetes and on line training manuals on improving communication with elders of different cultures and diversity healing and healthcarehttpsgecstanfordeduresources

Our Ethnogeriatric Imperative Powerpoint by G Yeo httpsgecstanfordedupdf-wordGwen_AAHPMpdf


Initiative to Eliminate Racial and Ethnic Disparities in Health (httpraceandhealthhhsgov)

Health Disparities Collaborative (httpwwwhealthdisparitiesnethdchtmlhomeaspx)

American Public Health Association ldquoEliminating Health Disparities Toolkitrdquo (2004) httpwwwaphaorgNPHWtoolkit-PHW04-LRpdf

Suggested Future ReadingsSuggested Future Readings

American Society on Aging (2002) Recognizing diversity in aging moving toward cultural competence Generations 26(3)

Jackson JS Brown E and Antonucci TC (2004) A cultural lens on biopsychosocial models of aging In P Costa amp I Siegler (Eds) Advances in Cell Aging and Gerontology Vol 15 (pp 221-241) New York Elsevier

Xakellis G Brangman S A Ladson Hinton W Jones V Y Masterman D Pan C X Rivero J Wallhagen M amp Yeo G (2004) Curricular framework Core competencies in multicultural geriatric care Journal of the American Geriatric Society 52 137-142

Yeo G amp Gallagher-Thompson D (Eds) (2006) Ethnicity and the dementias (2nd ed) NY Taylor amp Francis


LaVeist TA (2005) Minority Populations and Health An Introduction to Health Disparities in the United States San Francisco CA Jossey-Bass Publication

Williams DR Collins C (2001) Racial residential segregation A fundamental cause of racial disparities in health disparities Public Health Reports 116 404-416

Baicker K Chandra A Skinner JS Wennberg JE(2004) Who are you and where you live How race and geography affect the treatment of Medicare beneficiaries Health Affairs (wwwhealthaffairsorg)

Lu MC amp Halfon N (2003) Racial and ethnic disparities in birth outcomes A life course perspective Journal of Maternal Child Health 7 (1) 13 130

Satcher D amp Pamies RJ (2006) Multicultural Medicine and Health Disparities New York NY McGraw-Hill Medical Publishing Division 2006

Slide 1

Aging and Diversity

Aging and Diversity (2)













Resilient but Not Impenetrable


Take Care of Our Own (Bushy 2000)

Families Family Structure

Families Changing Family Structures

Gay amp Lesbian Aged


Culture ReligionSpirituality

The SPIRITual History

SPIRITual History Questions

Cultural Competence in the Workplace

Integrated Healthcare

Interdisciplinary Awareness

Interdisciplinary Teams Balance Several Factors

Older People amp Health Care System

Group Question Culture amp Healthcare

Case Vignette Joe

Cultural Humility

Group Exercise

Cultural Humility Defined

Cultural Humility Values

Cultural Skills Across Domains

Cultural Skills Across Domains (2)



Cultural Competency amp Cultural Humility

Slide 42

On-line Resources

On-line Resources (2)



Suggested Future Readings

Suggested Future Readings (2)


bull Approximately three million foreign-born persons 65 years of age or older live in the United States Among them more than one third were born in Europe one third in Latin America and one fourth in Asia

bull In the future increasing numbers of foreign-born older adults will likely be from Latin America and Asia ( He 2002 )

bull In 2050 16 million of the projected 81 million elderly will be foreign born (Pew Center 2008)















2008)
















































































(APA 2007)


(APA 2007)



Skills



Knowledge

Values




(APA 2007)


























Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources




















2008)
















































































(APA 2007)


(APA 2007)



Skills



Knowledge

Values




(APA 2007)


























Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources

















































































(APA 2007)


(APA 2007)



Skills



Knowledge

Values




(APA 2007)


























Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources







(APA 2007)



Skills



Knowledge

Values




(APA 2007)


























Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources









(APA 2007)


























Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources































Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources






























































Slide 1

Aging and Diversity






























Case Vignette Joe

Cultural Humility

Group Exercise








Slide 42

On-line Resources






Aging and Diversity Within racial/ethnic minority groups there is further diversity. For example,...

Documents

Transcript of Aging and Diversity Within racial/ethnic minority groups there is further diversity. For example,...