Delivering Culturally Competent Care to Older Adults

Delivering Culturally Competent Care to Older Adults

Sergey Makov

New York City College of Technology

Geriatric Nursing

NUR 4090

Professor Lynda M. Konecny

March 12, 2014

DELIVERING CULTURALLY COMPETENT CARE TO OLDER 9

Delivering Culturally Competent Care to Older Adults

The uniqueness of nursing profession is that throughout our career we will meet a lot of people who identify themselves as members of one ethnic or religious group. In my assignment I will be focusing on Native Americans group and older adults who identify themselves as a gay.

Native Americans religious belief system is a very complex phenomenon which is based on living myths, sacred narratives. Members of Native Americans community identify the human body as an integral part of spiritual understanding. (Kristianto, 2013). Based on Native Americans living methodology transformation from human into non-living objects is common and both have equal status and qualities. Native Americans beliefs system is closely connected to the nature. Some Indian tribes believe that human spirit influenced by nature (Kristianto, 2013, p. 48).

Based on Department of Health and Human Services research approximately 1.74 and 4 million Americans ages 60 and over are identify themselves as lesbian, gay, bisexual, transgender. According to research data married and gay couples shared similar values and beliefs as heterosexual mans, such as relationship duration, relationship commitment. However, even in those homosexual relationships in which the partners consider themselves to be in a committed relationship, the meaning of "committed" or "monogamous" typically has different meaning something completely different than in heterosexual marriage. (Dailey,) Many homosexual men understood relationship outside the relationship to be the norm. Studies conducted by McWhirter and Mattison (1984) shows the percent of male reporting sexual fidelity in their relationship are 75.5 % of married males and 4.5 % of homosexual males. In their Journal of Sex Research study of the sexual practices of older homosexual men, Paul Van de Ven et al (1997) found that only 2.7 percent of older homosexuals had only one sexual partner in their lifetime.

Native Americans are carriers of values and traditions. For Native Americans the family can be seen as an integral part of their cultural and ethical development. The strong family orientation goes beyond the immediate nuclear family. Sometimes families unite up to hundred people. It is within the family Native Americans learn from different spiritual and cultural teachers. (Limb, Hodge, & Panos, 2008). Nurses must be aware that common Native American and Mainstream American Values can be different, for instance Native Americans believe in the interconnection of mind, body, and spirit, while for most Americans these values are independent from each other. (Limb et al., 2008, p. 390). Based on Charles Horejski the members of traditional Native American cultures adhere to other principles in life. The concepts such as competition among people and material possessions are simply not used by Native Americans.

According to the aging and health report the uniqueness of older LGBT community is

ability to care. The length of time that LGBT older adults have been providing care ranges from less than one month to 60 years; the median duration of providing care is approximately 4 years. (Fredriksen-Goldsen et al., 2011, p. 45). The gay community showed higher percentage of carrying behavior. (Fredriksen-Goldsen et al., 2011, p. 45). Based on research outcome data older males are shared similar beliefs and values similar to heterosexual males, such as felling of belongings. However the homosexual relationship has a numerous negative consequences, for instance as evidenced by scientific studies conducted by the U.S. Department of Justice confirm that homosexual and lesbian relationships had a far greater incidence of domestic partner violence than opposite-sex relationships including cohabitation or marriage. (Dailey)

The traditions and practices of Native Americans simply based on the central phenomena of the unity and non-separateness between the human body and the body of nature. (Kristianto, 2013, p. 44). This explains the widespread use of folk remedies such as herbs, minerals in the treatment of diseases. Imposing separateness between the human body and the bodies of other beings counters a natural harmony between three central entities, i.e. God, nature, and humanity, since they are “in physical and spiritual connection” (Kristianto, 2013, p. 44). In order to assess the Native American families’ issues we authors suggested using four-quadrant circle which represents significant aspects of life. (Limb et al., 2008, p. 389). According to Native American beliefs in order to maintain healthy state the individual must maintained all four components of the quadrant on adequate level. Those components are: context, mind, spirit, and body. (Limb et al., 2008, p. 389) This fundamental principle makes Native American traditions different from others. Native Americans also believe in the good or evil forces or punishment for acts. (Konecny, 2014)

Researchers found among lesbian and gay older people, adjustment to later life depends largely on the acceptance of ageing, maintenance of high life satisfaction and being active in the gay and lesbian community. (Addis, Dvies, Greene, MacBride-Stewart, & Shephered, 2009, p. 652) Lesbian and gay older people can feel marginalized as ageism also exists within the gay and lesbian communities. Isolation is likely to be a major threat to the well-being of older lesbian and gay people, placing individuals at higher risk of self-neglect, decreased quality of life and increased mortality. Examined the social networks of gay men aged 50 years and older and found that they largely consisted of partners and friends, with friends being a critical element. However, social networks were reported to include members of their families of origin and those

men who had children overwhelmingly indicated that sexual orientate on did not stand in the way of their relationship. (Addis et al., 2009, p. 653).

According to research conducted by American Journal of Alcohol and Substance abuse Native Americans are subjected to higher rates, heavier amounts, earlier onset, and more severe consequences of substance abuse. (Kulis, Hudge, Ayers, Brown, & Marsiglia, 2012). The unique health-related needs for Native Americans are to provide adequate substance abuse treatments that will facilitate Native Americans and Alaska Natives to stop abuse substances. The researchers hypothesized the key factors which lead to substance abuse. According to research data inadequate access to substance abuse program, living in poverty, and socioeconomic status were identified as key determinants (Kulis et al., 2012, p. 447)

Based on report from Institute of Medicine LGBT adults are one of the least understood group in terms of their aging and their health-related needs. The Centers for Disease Control and Prevention (CDC) stated that research on sexual orientation is one of the most pronounced gaps in health disparities research (Fredriksen-Goldsen et al., 2011, p. 7). Lesbians, gay man, bisexual women, and bisexual men age 50 and older have higher rates of disability and mental disorders than heterosexual peers of the same age and older gay men are prone to poor physical health. The unique needs of older gay mans in the community is adequate access to health care. Based on research evidence older gay man are experiencing fears of being rejected from community health settings because of the stigma and prejudice. Since the depression, bereavement, poor mental health, and substance abuse are higher among older gay males in comparison to heterosexual peers the need for community based centers with educational programs greatly increased for the last decades.

American Indians and Alaska Native (AI/AN) populations experience significant health disparities compared to non-Hispanic white populations. Cardiovascular disease and related risk factors are increasingly recognized as growing indicators of global health disparities. (Hutchinson & Shin, 2014, p. 1). Based on health statistics majority of Native Americans are experience health disparities because of their socioeconomic status, including worse living condition, lower income, and greater barrier to health care compared to non-minority population. Based on the author’s statement the disparities are not narrowing with improvements in health care. In fact, about six percent of quality measures had worsening disparities between 2002–2003 and 2007–2008 and 84% had stable disparities (Hutchinson & Shin, 2014, p. 2).

LGBT members of community face unique disparities in their access to health care. Financial access to healthcare can be viewed as an external barrier, the fear of how one will be treated because of sexual orientation or gender identity can be viewed of as an internal barrier. More than one in ten (13%) of LGBT older adult participants report being denied or provided inferior healthcare because they are LGBT, and 4% have experienced this three or more times in their life (Fredriksen-Goldsen et al., 2011, p. 31). While the vast majority of gay older adults are covered by healthcare insurance, primarily Medicare, their ability to access healthcare varies. Access to healthcare for gay older adults depends primarily on their socioeconomics and educational level. The less income and education one has the more difficult it can be to access health-care. Race and ethnicity also matter in access to healthcare, regardless of whether one is lesbian, gay, bisexual, or transgender (Fredriksen-Goldsen et al., 2011, p. 33). Majority of older gay mans are using the primarily physicians on a regular basis. The numbers of emergency department visiyst are not significantly different from heterosexual peers.

According to CDC and U.S Census Bureau (2010) the leading causes of death among Native Americans are heart disease, cancer, and unintentional injuries. The factors, such as geographic isolation, economic factors, and suspicion toward traditional spiritual beliefs are some of the reasons why health among Native Americans is poorer than other groups. Other factors that contribute to poorer health outcomes for Native Americans include cultural barriers, geographic isolation, inadequate sewage disposal, and economic factors. The use of herbs and hallucinogens during spiritual ritual are also were identified as possible cause of health deterioration (“Center for Disease Control and Prevention”, 2010). Native Americans mothers had the second highest infant death rate compared with other mothers. The infant death rate was second to the rate among African American mothers and 48.4% greater than the rate among white mothers. In 2007 Native Americans populations had the highest rate of motor vehicle-related deaths, one of the highest rates of suicides, and the second highest death rate due to drugs (includes illicit, prescription, and over-the-counter) in comparison to other ethnic groups. ("Centers for Disease Control and Prevention," 2010)

The older gay adults are experiencing different health risks. According to research the most important factors is HIV risk behaviors. Despite nearly three decades of education efforts on HIV transmission, there are 48,200 – 64,500 new HIV infections annually in the U.S. 15 HIV risk behaviors contribute to an individual’s risk for transmitting or acquiring HIV. Eighteen percent of gay older adult participants report they have engaged in at least one HIV risk behavior in the past 12 months: 16% have engaged in unprotected anal sex, 8% have been treated for a sexually transmitted disease, 4% have exchanged money or drugs for sex, and 0.3% have used intravenous drugs. The rates of engaging in an HIV risk behavior for distinct gay older adult groups are 26% of gay men. (Fredriksen-Goldsen et al., 2011, p. 36)

References

Addis, S., Dvies, M., Greene, G., MacBride-Stewart, S., & Shephered, M. (2009). The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health and Social Care in the Community, 17 (6), 647-658. http://dx.doi.org/eds.b.ebscohost.com.citytech.ezproxy.cuny.edu

American Indian & Alaska Native Populations. (2010). Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

Dailey, T. J. Comparing the Lifestyles of Homosexual Couples to Married Couples. Retrieved from http://www.frc.org/get.cfm?i=IS04C02

Fredriksen-Goldsen, K. J., Kim, H., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., ... Petry, H. (2011). The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. Institute for Multigenerational Health., 1-87.

Hutchinson, R. N., & Shin, S. (2014). Systematic Review of Health Disparities for Cardiovascular Diseases and Associated Factors among American Indian and Alaska Native Populations. Plos One , 9(1), 1-9. http://dx.doi.org/ebscohost.com.citytech.ezproxy.cuny.edu

Konecny, L. M. (2014). Delivering Culturally Competent Care to Older Adults [PowerPoint presentation]. Retrieved from http://bbhosted.cuny.edu

Kristianto, B. (2013). The Notion of the Body and the Path to Healing. The International Journal of Religion and Spirituality in Society, 2, 42-53

Kulis, S., Hudge, D., Ayers, S., Brown, E., & Marsiglia, F. (2012). Spirituality and Religion: Intertwined Protective Factors for Substance Use among Urban American Indian Youth. The American Journal of Drug and Alcohol Abuse, 38 (5), 444-449. http://dx.doi.org/ebscohost.com.citytech.ezproxy.cuny.edu

Limb, G., Hodge, D., & Panos, P. (2008). Social Work with Native People: Orienting Child Welfare Workers to the Beliefs, Values, and Practices of Native American Families and Children. Journal of Public Child Welfare, Vol 2 (3), 383-397.