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.

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