CULTURAL DIVERSITY Aging Health and Care Jennifer May

CULTURAL DIVERSITY Aging, Health and Care Jennifer May Licardo Education Coordinator

AGING POPULATION ● seniors 65 y/o make up 13. 7% of Canada’s population l senior population — in 2005 - 4. 2 million — between the year 2005 to 2036 4. 2 to 9. 8 million; will account for about 25% of the total population - Statistics Canada

CULTURAL DIVERSITY • in 2001 census - > 200 ethnic groups reported • in 2006 census - 150 languages identified - Statistics Canada

CULTURE ● a health determinant - attitudes of the predominant culture influence the well being of other cultural groups: • marginalization • stigmatization • loss or devaluation of language • lack of access to culturally appropriate health care services - Public Health Agency of Canada

HEALTH ● ‘a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity’ - World Health Organization ● healthy aging - ‘a lifelong process of optimizing opportunities for improving and preserving health and physical, social and mental wellness, independence, quality of life and enhancing successful life-course transitions’ - Health Canada

aging culture Cultural competency health care

CULTURAL COMPETENCY - “a set of behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations” - (Cross et al 1989)

CULTURAL COMPETENCY -“in health care describes the ability of systems to care for patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural and linguistic needs” - (Betancourt et al 2002) -“is a process in which healthcare providers continually strive to work effectively within the cultural context of a patient” - (Brown & Rhymes, 2006)

CULTURAL COMPETENCY In our setting: Organizations and healthcare providers need to recognize and value cultural diversity among seniors.

CULTURAL COMPETENCY CHALLENGES Organizations: ● Policies - mission statements - staffing ● involve community, families, and person in meetings and assessments ● use of interpretation services and community health workers ● culturally and linguistically friendly physical environment (interior design, pictures, posters, art works)

CULTURAL COMPETENCY CHALLENGES Organizations: ● Policies - mission statements e. g. Christianity – belief that Jesus Christ was the son of God and He came to earth as a man to restore the relationship between humans and God - staffing e. g. French speaking staff in a long-term care facility

CULTURAL COMPETENCY CHALLENGES Organizations: ● involve community, families, and person in meetings and assessments

CULTURAL COMPETENCY CHALLENGES Organizations: ● use of interpretation services and community health workers e. g. Language Access Interpreter Services (204) 788 -8585 free services Winnipeg Health Region

CULTURAL COMPETENCY CHALLENGES Organizations: ● culturally and linguistically friendly physical environment (interior design, pictures, posters, art works, food and celebrations)

CULTURAL BELIEFS/ISSUES ● Judaism – Kosher symbols ● Southeast Asian refugees ● India – leather ● Hinduism – beef ● Islam – pork, Ramadan ● Buddhism - vegetarian

CULTURAL COMPETENCY CHALLENGES Healthcare providers: • become familiar with core cultural issues of the groups with whom you work • assess your own attitudes and values, knowledge and skills — recognize that people from other cultures may not share your own beliefs

CULTURAL COMPETENCY CHALLENGES Healthcare providers: con’t. • enhance person-provider communication and trust — build skills that enhance communication • promote mutual respect

CULTURAL COMPETENCY CHALLENGES Healthcare providers: ● become familiar with core cultural issues of the groups with whom you work

CULTURAL BELIEFS/ISSUES - CHINA § role of Confucianism - filial piety (“xiao”) - father - undisputed head of the family § role of Buddhism - emphasize “face” & dignity § role of Taoism - selflessness, cleanliness, emotional calm § illness as an imbalance of Yin & Yang

CULTURAL BELIEFS/ISSUES - BUDDHISM § pain and suffering can provide valuable lessons in life - AFRICA § elders believed as representatives of ancestors & mediators between them and kin-group - ABORIGINAL § in many communities, age is not defined by chronology

CULTURAL COMPETENCY CHALLENGES Healthcare providers: ● assess your own attitudes and values, knowledge and skills

CULTURAL BELIEFS/ISSUES - SOUTHEAST ASIA § traditional remedies: ‒ herbal medicine ‒ therapeutic burning ‒ coin rubbing ‒ acupuncture ‒ cupping

CULTURAL BELIEFS/ISSUES - PAKISTAN § does not require much personal space - ABORIGINAL § women expected to be primary caregivers - BUDDHISM § strive for deep insight into true nature of life

CULTURAL BELIEFS/ISSUES - HINDUISM § belief that every soul is trapped in a cycle of birth and then death and then rebirth; aim is to be better than the life before § belief in “Karma”

CULTURAL BELIEFS/ISSUES - ISLAM § heart of faith for all Muslims is obedience to Allah’s will § upon death: prefer that body not be touched by non-Muslims § important to wash in running water (face, ears, forehead, feet, arms to the elbows) and rinse nose and mouth before prayer

CULTURAL COMPETENCY CHALLENGES Healthcare providers: ● enhance person-provider communication and trust

CULTURAL BELIEFS/ISSUES - INDONESIA § touching head of an elder is rude - JAPAN § direct eye contact may be intimidating or sexual - PAKISTAN § generally enjoy close interpersonal relationship § do not appreciate discussing about women in public

CULTURAL BELIEFS/ISSUES - INDIA § winking, whistling , pointing with fingers, touching someone’s ears or pointing your feet at someone considered rude § feet are considered unclean - if feet make contact, expect to apologize § use of first name is considered impolite § left hand considered unclean, use right hand for eating - ABORIGINAL § tend not to use direct physical or eye contact when speaking to another person

CULTURAL COMPETENCY CHALLENGES Healthcare providers: ● promote mutual respect

CULTURAL COMPETENCY CONSIDERATIONS ● avoid generalizations or stereotypes ● maintain a non-judgmental attitude ● practice person-centered care

CULTURALLY COMPETENT HEALTHCARE PROVIDER WARMTH - acceptance, liking, commitment, and unconditional regard EMPATHY - ability to perceive and communicate, accurately and with sensitivity, the feelings of an individual and the meaning of those feelings GENUINENESS - openness, spontaneity, and congruence

REFERENCES: Statistics Canada. 2007. Detailed Mother Tongue (186), Knowledge of Official Languages (5), Age Groups (17 A) and Sex (3) for the Population of Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2001 and 2006 Censuses - 20% Sample Data (table). Topic-based tabulation. 2006 Census of Population. Statistics Canada catalogue no. 97 -555 -XCB 2006015. Ottawa. Released December 04, 2007. http: //www 12. statcan. ca/english/census 06/data/topics/Print. cfm? PID=89201&GID=837928&D 1 =0&D 2=0&D 3=0&D 4=0&D 5=0&D 6=0 (accessed February 20, 2008). Statistics Canada. 2007. Manitoba (table). 2006 Community Profiles. 2006 Census. Statistics Canada Catalogue no. 92 -591 -XWE. Ottawa. Released March 13, 2007. http: //www 12. statcan. ca/english/census 06/data/profiles/community/Index. cfm? Lang=E (accessed February 22, 2008). Public Health Agency of Canada. Population Health. What Determines Health? Key Determinants. www. phac-aspc. gc. ca/ph-sp/phdd/determinants. html Statistics Canada. 2007. “A Portrait of Seniors in Canada” Catalogue no. 89 -519 -XIE. www. statcan. ca/english/freepub/89 -519 -XIE/2006001/findings. htm

REFERENCES: Public Health Agency of Canada(PHAC). “Healthy Aging in Canada: A New Vision, A Vital Investment. ” Division of Aging and Seniors. www. phac-aspc. gc. ca/seniors-aines/pubs/haging-newvision/pdf/vision_rpt_e. pdf National Advisory Council on Aging (2005). “Seniors on the Margins: Seniors from Ethnocultural Minorities. ” Minister of Public Works and Government Services Canada. Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and their Families. January 2001 Manitoba’s Office of Rural and Northern Health. Multicultural Reference Guide: Etiquette & Religion. October 2006. Brown, D. and Rhymes, J. 2006. Cultural Competence for Primary health Care in Nova Scotia: A DVD and Discussion Guide Wieland, D. et al. 1994. Cultural Diversity and Geriatric Care. Kratiuk-Wall, S. et al. 1997. Cultural Diversity and Dementia.