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Cultural competence and dementia care


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Webinar held June 28, 2011 with panelists: Shannon Marling, MSG, Tracey Gendron, MSG and moderator: E. Ayn Welleford, MSG, PhD

Webinar held June 28, 2011 with panelists: Shannon Marling, MSG, Tracey Gendron, MSG and moderator: E. Ayn Welleford, MSG, PhD

Published in: Health & Medicine

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  • Members of diverse cultural groups have found care provider language to be discriminatory and have even experienced their interaction as racist- this type of interaction leads to a decrease in trust between care partnersUnderstanding cultural diversities and implications with those whom we are in care partners situations with allows for individuals to recognize their individual ability to connect with others culturally We will be discussing culture in a very broad view and than we are going to spend more time talking about culture what culture means and what you can do to increase your cultural competency working with individuals with dementia disorders and their family memebers
  • ???? Unsure where the 30% came from the information I have is that african Americans will make up 11%The next few slides are designed to give us a snapshot of a few of the populations and projected population growth over the next 30 yearsAfrican American older adults will comprise 11% of the older adult total population by 2050Educational attainment was found to be directly correlated with health literacy an although the overall educational attainment of African Americans has increased since the 70’s , African Americans are still at risk for experiencing significant health disparitiesAfrican American Males and Females had lower rates of self reported good health as compared to the general adult populationOlder African Americans were reported as having at least one chronic condition with the most frequently reported condition being Hypertension
  • As previously mentioned regarding pereicved health needs and risks only 36% of Latino older adults received the vaccination for pneumoniaThe percentage of Latino's living along is lower than the general population of older adults, along with that Latino older adults are twice as likely to be living with other relatives as compared to the total older adult population
  • There is still a gap in the literature and research conducted with Asian older adults, although the gap is closing.Highest rates of academic attainment among all older groups, however, Asian older adults have a higher rate of poverty than the overall older adult populationAlso important to recognize is the higher rate of academic achievement and the implications for mental health assessments such as the Mini Mental SE- those with higher level of academic achievement can receive a mis-diagnosis
  • Estimates of the Gay, Lesbian, Bi-Sexual and Transgendered community are 3%-8% of the overall population*Approximately 1-2.8 Million older adults are GLBT elders*These numbers are considered an under estimate of the actual populationThe population projections above will be updated once the 2010 census data is compiled and released
  • Several studies have recently been released that have highlighted the unique challenges faced by the LGBT older adult population and how these issues have lead to wide spread health disparities, With in these studies it was noted that 70% of older LBGT adults live alongReliance upon informal care partners is higher among this populationWe are also entering into the first generation of older adults who are living HIV positive and with AIDS ??
  • *Only asking an individual if they are married, widowed or single*
  • Complexity in each faith tradition ….Faith traditions differ among racesTraditions and sacraments are specifically articulated in some beliefs and must be followed Doctrine and Dogmatic Interpretation impact of disease and decline have varying impact: As an example some faith traditions view Dementia mental illness while other faith traditions interpret the disease as Gods Punishment or consequences of wrong doings in the this or past livesOther Faith traditions may not have a language to express need for help in caring for ill parent or family member
  • Why are faith Traditions included in cultural competency and understanding well it’s because :Faith based organizations may be the only vehicle to reach individuals and care partners (especially in rural areas)Health Care organizations and older adult services need to recognize and understand that faith traditions have not always responded to older adults experiencing decline with compassion and sensitivity and there may be a need to provide an entire faith community with support and resourcesFaith traditions among BOTH health care provider and indiviudal have an impact on End of Life care issues: one study found that Health Care professionals level of engagement in faith based activities impacted how, when and what type of end of life care information was provided to patients
  • AS an intervention religiosity has constantly been correlated to positive outcomes both among care partners and individual with dementia
  • Intermediate Health LiteracyAbility to read a prescription instructions on a label and know what time to take the medicationBasic Health LiteracyAbility to read pamphlet and give 2 reasons a person with no symptoms should be testedBelow Basic Health LiteracyRead set of instructions and identify what is permissible to drink prior to a medical test
  • Read first bullet- Understanding the complexities of culture help guide care partners at all levels to understand how things such as language, perception, verbal and non-verbal communication, health literacy influence Factors such as values and belief systems, familial structure and roles within a particular culture,
  • So here is my empowerment resource for you. If you are interested in learning more about cultural competence and examining your own attitudes towards culture this is a great resource.Once you are at the website, you will find a very useful tool developed by the NCCC that can be a starting point for individuals to assess their own capacity for embracing cultural diversity in many settings
  • Dementia can be viewed in a variety of ways by people of different cultures and ethnicities. This is important to understand in terms of help seeking behaviors for diagnosis and treatments.One common view is dementia as a normal part of the aging process. This is important to understand because this view can delay help seeking and early intervention. Also, families may not seek help thinking it’s not needed despite high levels of stress. Considering that care is often provided by extended families in many ethnically diverse families, and long-term care is considered a last resort, caregivers often absorb the impact of the stress for care of their loved one with dementia. Delayed help seeking due to a view of dementia as normal aging exacerbates the problem.Looking at dementia as a mental illness or a disruption to social functioning, it is important to note that asianamerican older adults are particularly vulnerable to the stigma associated with mental illness. Within this culture, dementia is often viewed as a mental illness which can impact the moral status of the person with dementia. The moral status of someone with mental illness can be degraded because they can be viewed as personally responsible for their actions. Again caregivers can be in a double bind where they either don’t seek help or respite because of concerns for the family or they do seek care and feel shame for not caring for a family member. Finally, dementia as a culture specific syndrome can stem from religious beliefs, superstitions or folklore for some cultures.
  • Let’s briefly discuss some of the barriers to seeking and receiving care for individuals with dementia.No time to go indepth about all of these barriers so I will highlight a few. Finances – we know that 1/3rd of African americans live in poverty, preventing access to health care. As Shannon mentioned, Asians have the highest rate of uninsurance. Finances not only reflect poverty rate, heath insurance and disparities in covergae, it also impacts families that lack access to transportation.Finances also reflects affordability of medications, and other treatment options for dementia or respite.Clearly there can be language barriers that prevent good communication. However, we also need to be aware of various communication styles that reflect level of comfort, show of respect and demonstration of trust. For example, some cultures are typically more reserved and formal requiring personal space and little physical contact. Other ethnicities are comfortable with touch and closeness that reflects a closer, trusting relationship. This is not only important with the person with dementia but with the caregiver and extended family as well.It terms of dementia assessment – our screening tools impact diagnosis and assessment and there is a consensus that these tools lack both sensitivity and specificity for detecting dementia in culturally diverse populations. Culture, education and health literacy all play a role in the diagnosis of dementia and related disorders. Lack of validation of our assessment measures may account for the fact that ethnic minorities are judged to be cognitively impaired more often than non-hispanic whites.(Rowland Universal dementia assessment – being used in australia and other countries – deemed to have better specificity than MMSE but did not account well for educational level)Finally looking at knowledge, caregivers may be less knowledgable about dementia assessment centers and the full arra of available services. We also need to account for where people get their information from. Health care information is often received from media sources, like newspapers, tv and radio. It is also common for information to be passed in churches and social groups.The take home message is that health seeking behaviors are influenced by a variety of barriers to care within our culturally diverse communities.
  • So what can we do, as individuals to strive towards providing more person-centered culturally appropriate care to individuals with dementia and their family members?In this model, the most serious barrier to culturally appropriate care is not a lack of knowledge of any specific culture, but rather our own failure to develop self-awareness and a respectful attitude towards diverse points of view.As I discussed earlier, growing in our own self awareness and striving towards greater understanding of our client’s culture will set up a reciprocal relationship based on mutual trust and understanding. This can help us merge our own thoughts about goals of care and treatment with those of the client and family while accounting for the whole person.These 5 steps highlight the actions necessary to become culturally competent and to practice cultural humility. These steps reflect actions and choices that we can make as individuals, as practitioners, and as educators. These steps can also be applied to developing programs and services that reflect diversity and understanding. This applys to not only ethnocultural groups, but religious groups, sexual orientation and geographical divrsity. It’s my hope that these steps can also be used to help you think about shaping policy and procedures for your own organizations, agencies and institutions.
  • This last slide summarizes what we have discussed this hour.Providing culturally appropriate care means that we look at each person as unique. Not using their culture as a blueprint to predict who they are and what choices they will make, but using what we know about culture to understand their background and what might influence them or what their core beliefs may be. Take into account all the potential barriers that they may face when communicating with someone and their family, when developing a treatment regimine, when prescribing expensive medicine or even encouraging someone to eat certain foods. Respect different health care philosophy’s and decisions that result from that philosophy. And consider how the faith community plays a role in someone’s support system.
  • Transcript

      Tracey L. Gendron
      Shannon Marling
    • 2. THE SESSION
      Professional care providers working in culturally and linguistically diverse communities
      Professional care providers working with individuals with dementia
      Better understand the cultural perspectives they bring to the care situation.
      Make informed choices on managing day-to-day situations presented by culturally diverse individuals with dementia.
      Know where to find further information and support services.
      Communicate in a more culturally effectively way with individuals with dementia and their family members.
      LGBT Older Adults
      Asian Americans
      Latino Americans
      Diversity in Faith Traditions
    • 6. Black/African American Older Adults
      50% of African American older adults live in 8 states:
      New York
      North Carolina
    • 7. Latino American Older Adults
      70% of Latino older adults live in 4 states:
      New York
    • 8. Asian American Older Adults
      60% of the Asian, Hawaiian and Pacific Island older adult population reside in 3 states
      New York
    • 9. Gay, Lesbian, Bi-Sexual and Transgender Older Adults (GLBT)
      Please note that HRC estimates that the Census 2000 figures could undercount lesbian and gay families by as much as 62 percent. For more information, see Census 2000.
      *Source: Technical Resource Center, Promoting Appropriate LTC supports for LGBT Elders,
      U.S. Administration on Aging
    • 10. Challenges for GLBT Adults
      GLBT Elders Financial Wellbeing
      Health and Health Care
      Social Support and Community Engagement
    • 11. What Can Service Providers Do?
      Review documentation and assessment information for heterosexist language
      Improve coordination of services between LGBT services and older adult services
      Recognize and change policies and practices that discriminate or leave LGBT older adults ineligible for services
      Sue Rasmussen
      First openly Transgendered Mayor –
      Arlington, Oregon
    • 12. World Faiths expressed
      as a percentage of
      global population - 2005
      Note: Total adds up to more than 100% due to rounding up and using the upper bound estimates for each group
    • 13. Faith Traditions Impact on Care
      Faith based organizations may be the only vehicle to reach individuals with disease
      Faith Traditions have not always responded in a compassionate sensitive manner
      Faith traditions of health care provider have found to have an impact of End of Life Care access and information
    • 14. Religiosity Impact on Health Indicators
      Public religious engagement has been associated with positive health outcomes
      Positive correlation between level of religiosity and Quality of Life
      Religiosity and Religion have been associated with lower levels of caregiver burden
    • 15. Health Literacy
    • 16. Health Literacy
    • 17. In this context…
    • 18. Why is culture important to dementia care?
      'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
    • 19. How do we respond to cultural difference?
    • 20. Cultural Competence Resource
      The National Center for Cultural Competence at Georgetown University has developed this website especially for use by health practitioners.
      Click on the Cultural Competence Health Practitioner Assessment
      In order for us to work with individuals of diverse backgrounds, we must become culturally competent.  There are five elements for becoming culturally competent:
    • 24. 10 Steps To Providing Culturally Appropriate Dementia Care
    • 25. National Resource Center on LGBT Aging - 
      University of Southern California USC Libraries Resource Guide to Diversity on Aging -
      Alzheimer’s Association Cultural/ Ethnic Diversity -
      The Rowland Universal Dementia Assessment -
      Concise Cognitive Screen -
    • 26. Thank you!