Write an opinion on the health needs of an elderly refugee
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W8AccommodatingCulturalDiversityattheCommunityLevel.docxAccommodating Cultural Diversity at the Community Level:
Older Adults in Different Ethnic and Cultural Contexts
This section describes intergroup and intragroup differences in how older adults’ life experiences will shape their responses in seeking health care. Some older adults experienced living through the Depression, seeing the invention of television, computers, and video teleconferences, migrating to find employment, and fighting in an international conflict. European Americans in their 90s may have been young adults fleeing Poland or Germany before World War II. Older Southeast Asian adults in their 60s may have fled Cambodia, Laos, or Vietnam when conflict and political unrest enclosed around them. Political refugees from countries in East Africa and immigrants from Eastern bloc nations who have lived through civil wars and political revolution could well have depleted their coping mechanisms as younger adults fleeing their homeland. As a newer wave of older adult immigrants, they may experience adjustment problems that warrant care in the health and mental health care system, but at the same time they may distrust the system or have no previous experience in seeking health care. Nurses who are providing care to clients whose background differs from their own are usually sensitive to assessing the client’s culture. Individuals who have immigrated from the same country or region will differ in their needs and in the ways that their cultural background influences their health- and illness-related actions. These differences are based on a number of factors:
• Regional or religious identity
• Situation in their homeland that may have prompted them to emigrate
• Length of time they have spent in the United States including degree of acculturation,
• Proximity to immediate family or extended family members, • Network of friends and social support from their homeland, and/or
• Link with ethnic, social, and health-related institutions.
In the total Hispanic American population, persons of Mexican descent are most numerous (54%), Cubans represent 14%, Puerto Ricans 9%, and other Spanish-speaking countries represent 24%. Patterns of immigration and repatriation vary among these Hispanic groups and lead to substantial differences in the proportion of elderly Hispanic Americans. Many educated and professionally well-established Cubans immigrated to the United States in the 1960s and have remained here and are now retired. In contrast, families leaving from Mexico have been younger, some older Mexican immigrants returned to their homeland, and older Mexican Americans do not have as long a life expectancy as their Cuban American peers.
More attention should be given to understanding the diversity among Asian American, Native Hawaiian, and other Pacific Islanders as there are more than 40 distinct ethnic groups. Of the immigrant groups that have been represented in the United States for several generations (Chinese, Japanese, and Filipinos), the Chinese and Filipino elderly are the most numerous. Newer immigrants include Koreans and Thais, and among the refugees, the Vietnamese elderly are more numerous than Cambodians, Laotians, and Hmong.
Culture influences how individuals view aging, define health, manage interpersonal crises, and face alterations in health that accompany aging. Nurses should consider that for older adults, health has multiple dimensions: physical functioning, social and emotional well-being, plus quality-of-life measures, including life satisfaction and happiness. Older adults differ in their perceptions of health but generally regard their physical activity and psychologic well-being as indicators of health. Only 7% of older White Americans typically regarded their health as poor, whereas some older individuals from Latin American cultures were more inclined to state they had poor health (Jang, Chiriboga, Herrera, & Branch, 2009). Poor health refers to self-reported problems with physical functioning or a need for assistance to complete daily activities. Older adults are inclined to seek health information and to make behavioral changes to maintain their independence into old age. Older adults who use self-help strategies to maintain their health generally report better psychologic well-being and physical functioning than older adults who do not use these approaches. Older adults who decide to adopt positive health behaviors such as stopping smoking or starting exercise go through phases in making their decisions. Nurses typically provide information about the risks of not exercising as well as the benefits of increasing activity or stopping smoking or adopting healthy eating habits. Nurses may also ask older clients about the circumstances that lead to a lack of exercise and then help clients to take small steps such as seeing how others fit exercise in their lives. Nurses aware of cultural variations can appreciate that older individuals will have different value orientations underlying their decisions to adopt healthy behavior over at-risk behaviors. Older adults who have peer support, anticipate a possible setback in changing a behavior and plan how to get past a challenge, and use incentives through self-talk and rewards will be more likely to make positive health changes.
Practitioners should seek to understand the difficulties and different approaches that affect individual case management (Tanner, 2007). Interventions should take into account older adults’ cognitive ways of coping and practical strategies, and support these strategies (Tanner, 2007). For example, the matriarch of an extended family who has always valued the social benefits that come from sharing meals with family members may be reluctant to stop that practice and substitute exercise and low-fat meals. Older adults will also have learned responses in their helpseeking behavior to cope with chronic illness and to assess new illness symptoms. Some older African Americans have been more resourceful in their problem solving, planning, and coping that may be due in part to the lack of access to health care that they may experienced over time.
Culture will influence the older person’s expectations of what constitutes illness and will also influence whether the older adult maintains the use of traditional sources of health care in place of or in addition to the use of biomedical sources of care. Some older clients will prefer the use of traditional medicine from their native country or practices that they recall from their childhood. Researchers have described the simultaneous use of Western medicine and traditional Chinese health practices that focus on restoring harmony and balance in the body and spirit among some groups of Chinese immigrants (Lai & Surood, 2009; Miltiades & Wu, 2008). The use of traditional sources of health care concurrently with or in place of the biomedical health care system is not limited to members of recently migrated cultural groups but is common to nearly all individuals. Several chronic conditions that often accompany age including osteoarthritis or diabetes increase the likelihood that older adults will use traditional sources or self-care to treat their symptoms.
The older adult may resort to an over-the-counter medication and may use other popular remedies before, during, or after the use of prescribed sources of care. Nurses can show an interest in the client and ask them about any actions they take to treat their conditions, in order to assess the older client’s concurrent use of traditional practices, folk medicine, or popular medicine.
Case Study 8-1 illustrates that assessing the client’s use of alternative sources of treatment is useful in developing a care plan that the client will accept. Older adult clients may also use traditional medicine or practices from their family of origin to prevent illness. Preventive measures may combine a magical or religious element, such as burning a candle, offering cornmeal to the spirits, wearing an amulet, or reciting a prayer. To assess the older adult’s cultural beliefs and practices, the nurse can demonstrate a nonjudgmental attitude and ask questions like the ETHNIC.
In planning nursing care, nurses should consider that older adults from different backgrounds might share experiences of migration, changing social and family structures, structural forces or institutional racism that include discrimination, and historical events that include political conflict. The hardships that older clients have endured may increase their striving for autonomy in later years and push the client toward self-reliance. The older client may need time to reflect on decisions and may tend to regard health care cautiously. Some older clients will be fatalistic about many losses in life and weigh options about health care in relation to their fatalistic views. Support groups for older adults who have had age-related sensory losses or chronic illness have been found to have a positive effect on the quality of life for these patients. Similarly, in research with older Whites and African Americans, the older adults who had health challenges but also had positive perceptions of vitality and well-being maintained or enhanced their mental health. Because an overall sense of well-being affects the influence of physical health on mental health, interventions may succeed by targeting the individual’s sense of vitality and well-being (Jang, Chiriboga, Borenstein, Small, & Mortimer, 2009). Nurses may implement educational or support programs focused on promoting positive perceptions of personal health and increased vitality that may help protect older adults from negative emotional consequences stemming from physical health conditions (Jang, Chiriboga, Borenstein, Small, & Mortimer, 2009).
Older clients may preserve their traditional values that connect them to their origins and give meaning to their lives. Nurses can provide culturally sensitive care when they identify that older clients retain traditional values or blend traditional values and practices with biomedical beliefs and practices. Many older clients could have grown up with limited preventive care and associate health care only with emergent conditions, so nurses should assess the older client’s previous experiences in the health care system.
Understanding Culture Change in Older Adults
Some older adults have relocated to different regions of the country or have made a significant transition in their late adult years to be close to younger family members. Older clients may have the common experience of relocating or migrating, but the length of time that they have resided in one area may vary. A study of older Hispanic immigrants in Miami found that a more positive neighborhood social environment was associated with better mental health for these urban residents (Brown et al., 2009).
Older immigrants may have lost their social positions and may be clinging to family roles considering the stress of acculturation that reduces their status. A study of Central American immigrants to a metropolitan area in the United States indicated that their perceived stress was correlated with their psychologic health (Dunn & O’Brien, 2009). The psychologic stress related to cultural change is more intense for older refugees. Elderly ethnic Vietnamese, Chinese Vietnamese, and Laotians who resided with immediate family members had a higher sense of social adjustment compared to older refugees who shared a living space with many extended family members and non-kin. The older refugee has sometimes left behind a career and a status associated with that career.
