Monday, February 27, 2017

Cultural Diversity & Senior Health Care

Race, Ethnicity & Culture:  Health Disparities and Outcome

As is widely recognized, today's older adult population is highly diverse, with one's ethnic minority status being an important source of this diversity.  According to recent U.S. Census Bureau reports (2015), members of minority groups currently represent over one-third of the American population.  Looking into the future, we can expect faster growth among elder ethnic minorities than among Caucasians.  By 2042, the U.S. is poised to become a minority-majority nation.

Recent research findings by cultural anthropologists are enhancing our understanding of health and morbidity-related data among various groups (Lehman, 2011).  While great variability is recognized, several common, recurring themes are noteworthy as follows:
  • ·        For most elders of color, their resources and social status reflect discriminatory social, economic, and educational practices that were experienced in early life.  They are often among those who have a history of being marginalized and under-served.  e.g. elder immigrants with cultural and language barriers.

  • ·         In general, most share the following socio-demographic characteristics:  poverty, malnutrition, sub-standard housing, and poor health.

              Exception:  Japanese Americans & Chinese Americans, who have longer life expectancies.
  •       There are higher rates of mortality from the following diseases:  diabetes, heart diseases, and cancer, as well as higher rates of functional disabilities.

In efforts to interpret the impact of these findings upon health disparities, researchers underscore the inter-relatedness of race, ethnicity, and culture (Hooyman & Kiyak, 2011).  Historically, one's socio-economic status is directly linked to health and longevity.  Accordingly, poor people of all ages and cultural origins are at greater risk of health problems and related disabilities.

Among the oldest-old (those age 85+), there is increased likelihood of multiple chronic health conditions occurring simultaneously. However, research indicates that the origins of long-term illness often begin in early childhood.  Risk continues to be heightened throughout the life course by factors such as financial instability and educational disparities.  In other words, economic and health conditions experienced early in life appear to have long-term adverse consequences for adult health (World Health Organization, 2014). 

Under-Utilization of Health & Social Services
In general, ethnic minority members under-utilize health and social services.  Among the primary contributing factors are:  cultural and language difficulties, physical isolation, financial impoverishment, culture-based values and expectations, distrust, and structural barriers to service accessibility (Hooyman & Kiyak, 2011).

While the above findings paint a bleak picture of health disparities and hardships, we also need to acknowledge and celebrate the considerable strengths and resilience of some elders of color.  This is especially true among the oldest-old, a finding of The New England Centenarian Study, as well as several cultural anthropological studies (Sokowsky, 2012).

Cultural Competencies

Definition of "Culture:"
Learned or shared knowledge, beliefs, traditions, customs, rules, arts, history, folklore, and institutions of a group of people.  These are then used to interpret experiences and to generate social behavior.    (Sokowsky, 2012).

Definition of "Cultural Competence:"
The ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients.  (Campinha-Bacote, 2012).

Central Concepts:
As minority groups within the older adult population increase in numbers throughout the U.S., the importance of cultural competence is becoming more evident.  The need for cultural awareness, knowledge, skills, and considerations is pronounced.  Key concepts include:
  • ·         Language & Effective Communication
  • ·         Trans-Cultural Education
  • ·         Understanding specific cultural values, beliefs, practices
  • ·         Self-Awareness & Consideration of healthcare provider bias / prejudice
  • ·         Demonstrating respect & Fostering trust
  • ·         Recognizing "folk medicine" & non-traditional health care practices.

Cultural Beliefs & Practices:  Impact upon Health

It is now generally recognized that cultural beliefs and practices often influence an individual's health and behavior.  This includes choices, utilization, and compliance. (McBride, 2015).  As healthcare leaders, cultural competence must be a high priority for quality patient-centered care.   All health institutions must make it known that the care they provide will respect cultural differences and that they will adapt services in order to effectively address patients' cultural needs. 

It is critical that healthcare providers be educated on population-specific health related cultural values, beliefs, and behaviors (McBride, 2015).  If all facilities provide education and support the basic tenets of developing cultural competencies among all practitioners, elders can be provided with consistent quality care. 

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Campinha-Bacote, J. (2012, May).  The Process of Cultural Competence in the delivery of    Health Care Services.  Retrieved on February 25, 2017 from
Hooyman, N., & Kiyak, H. (2011). Social Gerontology: A Multidisciplinary Perspective (9th ed.).      Boston: Allyn and Bacon.
Lehman, D. (March/April 2011). 21st Century Caregivers:  Diversity in Culture.  Aging Well.  2(2), 26-29.
McBride, M. (2015). EthnoGeriatrics and Cultural Competence for Nursing Practice.  Hartford Institute for Geriatric Nursing.  Retrieved on May 6, 2016 from
Sokolovsky, J. (2012). The Cultural Context of Old Age (3rd ed.).  Santa Barbara: Greenwood Press.
U.S. Census Bureau.  Statistical Abstract of the United States (2014). (132nd ed.).  Washington, D.C.  Retrieved on January 6, 2017 from
World Health Organization. (2014). Active Aging: A Policy Framework.  Paper presented at the third United Nations World Assembly on Aging, Madrid, Spain.

Cultural Competencies in Senior Health Care

Training / Curricula Modules
·         Campinha-Bacote, J. (2012, May).  The Process of Cultural Competence in the delivery of Health Care Services

·         Hartford Institute for Geriatric Nursing.  EthnoGeriatrics and Cultural Competence for Nursing Practice.   under “geriatric topics,” click onto “ethnogeriatrics and cultural competence.”

·         Office of Minority Health.  Center for Linguistics & Cultural Competence in Health Care.

·         Office of Minority Health.  Think Cultural Health.

·         Stanford School of Medicine.  EthnoGeriatrics.

·         Sokolovsky, J. (2012).  The Cultural Context of Old Age: Worldwide Perspectives.  (3rd ed).  Santa Barbara: Greenwood Press.

·         Vaughn, L., & Cruz, D. (2017).  EthnoGeriatrics: Health Care Needs of Diverse Populations.  London: Springer Publishing.

Blog Author:  Donnelle Eargle, PhD, MEd   Contact:

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College.  Standish, Maine.

Thursday, February 02, 2017

The Mentoring Relationship

Being part of a mentoring relationship can have a positive and long range impact on professional goals and aspirations. For students, mentoring introduces them to the working world that they are studying, and gives realistic and clear views of what an organization or position entails. As a professional, a mentoring relationship furthers goals, enhances relationships and deepens knowledge and critical thinking skills to more than succeed in professional life.

The mentoring relationship is considered a caring, supportive partnership that responds to needs in one person’s life by enhancing growth, knowledge and skills.  Mentoring programs not only support and encourage individual professional growth, but can have great benefits for an organization that embraces and promotes a mentoring philosophy.

In healthcare, many organizations seek out formal mentorship programs to provide effective success sharing models that grow committed and valuable leaders.  Many professional associations and groups also provide mentorship programs that can be initiated and instituted in hospitals and other organizations. Some of these programs include those designed by The American Nurses Association, The American Health Information Management Association, and the American College of Healthcare Executives.

For a mentoring relationship to be effective and successful, consider these tips from both the mentee and the mentor perspective.

For the Mentee:
  • ·         Remember that your mentor is a volunteer. While giving time to guide, partner and provide insights, respect their time, and carefully consider their advice.
  • ·         Take responsibility to learn: a mentor will provide resources and knowledge. It’s up to the mentee to take advantage of that knowledge.
  • ·         Be specific and clear about your goals. This is both being respectful of your mentor’s time, and helps you stay on task to produce lasting results.
  • ·         Be flexible, and take risks! Open yourself up to new learning opportunities. Remember, your mentor has the experience and knowledge to allow you to grow.

For the Mentor:
  • ·         Be genuinely interested in your mentee. This is probably the most important skill to have as a mentor. Be invested in their success.
  • ·         Expect and encourage a specific agenda. Having clear insights into the mentee’s goals will help you set the course for optimum results.
  • ·         Encourage problem solving. Don’t just give advice. Encourage your mentor to brainstorm, share, and critically think through situations and problems. Then give them your viewpoint.
  • ·         Be a positive role model. Be confident in your relationships with others, model ethical behavior in all decision-making, and just as you encourage them, never be afraid to learn new things, and be open to new opportunities.
  • In today’s multi-generational and diverse working world there is an urgent need for committed and successful mentoring relationships. Allowing those that seek stronger skills and leadership opportunities from those that have that knowledge and competencies to share is certainly a win-win. Mentoring will build stronger teams and provide better outcomes, no matter what the organization or profession.

Some Mentoring References:

Submitted by Katie Cross, MSN, RNC-OB, LCCE, Adjunct  Faculty , Saint Joseph's College