Social and Health Disparities among Elders in Hawai‘i: Implications for Health Literacy

1. Social and Health Disparities among Elders in Hawai‘i: Implications for Health Literacy Colette V. Browne, DrPH & Christy Nishita, PhD, Center on Aging; Kathryn Braun DrPH, Office of Public Health Studies; and Noreen Mokuau, DSW, Lana Sue Ka‘opua, PhD, and Paula Higuchi, MSW, Hā Kūpuna: National Resource Center for Native Hawaiian Elders, University of Hawai‘i Myron B. Thompson School of Social Work Abstract Importance of Examining Transitional Long-Term Care and AA & NHOPI Elders Implications and Proposed Topics for a Future Research Agenda The U.S.’s increasingly multicultural population challenges our health care system to be more responsive to diverse needs. Recent federal policy directions support individual preferences for home and community-based long-term care. We looked at four Asian American and Pacific Islander elder populations in Hawaii to illustrate that differing health profiles and cultural values can impact the type of care and support needed, as well as preferences for long-term care supports. Both may impact health literacy and the ability to make informed decisions and meet care preferences. Despite compelling demographic trends around aging and diversity, a research gap exists linking these key concepts to transition care and health literacy. Directions for a future research agenda to investigate relationships among age, ethnicity/culture, health literacy, and transitional care are suggested. Asian American (AA) and Native Hawaiian and Other Pacific Island (NHOPI) older adults—a diverse population growing at a rate that exceeds all other populations—have some of the nation’s greatest and shortest longevity, and other distinct health and social disparities. Rapid increase nationally—3.7 million in 1980 to 7.3 million in 1990 and approximately 18 million in 2010. From 1990 to 2000, the increase in the Asian population ranged from 48% to 72% (depending on subgroup). Historical patterns and traditions emphasize cultural values in eldercare—e.g., preferences for family-centered care and culturally informed service providers. Trends indicate more AA and NHOPI elders will transition home, presenting opportunities and challenges to health care professionals. AA and NHOPI elders are important targets in researching the influence of culture on transitional care. Cultural values and health literacy play important roles in the transition planning process and ensuring a successful life in the community. But research on the role of these variables on the nursing home to home transition is lacking. Taken together, these six areas suggest the need for a conceptual framework that explores the interaction between advanced age, minority status, culture, language, and health literacy in transitional care. Health Literacy of the Family Caregiver. Investigate and assess family [long-term care] health literacy, taking into account subgroups within AA and NHOPI populations. Measurement Issues in Health Literacy in Ethnic Minority Elders. Develop a comprehensive method for the assessment of cultural-linguistic factors and conceptual knowledge of key long-term care concepts for these populations. Culture, Health Literacy, and Decision-Making. Design intervention studies aimed at improving spoken and written literacy for those with poorest health profiles. Development of Transition Planning Tools. Move beyond English translation of educational materials toward study of cultural variations in contextual definitions of disease and disability, and preferred modes of educational instruction. Congruency between Health Care Workers and Elder/Family Transition Care Knowledge Needs and Preferences. Develop a clear health literacy screening tool for the nursing home-to-home transition that can assist nursing home staff better understand and help prepare diverse populations for a return home and assist in decision-making. Impact of Long-term Care Literacy on Elders and Family Health Status and Quality of Life. Investigate the effectiveness (both quality and cost) of designing and delivering culturally competent, linguistically appropriate transition tools and on health and quality of life of older adults and family members in a variety of settings. Photo courtesy of the Mokuau ‘Ohana A Focus on Hawai‘i’s AA & NHOPI Populations Hawai‘i is the nation’s 50th and most multicultural state—with a population composed of 60% Asian American and NHOPI (e.g., Japanese, Filipino, Hawaiian, Samoan, etc.) —and a natural laboratory to study the influence of culture on transitional care. Compared to the US, Hawai‘i has a higher percentage of AA (60.9% vs. 2.4%) older adults and NHOPI (5.5% vs. 0.1%) older adults and a smaller percentage of White (23.5% vs. 86.0%) and Black (0.4% vs. 8.5%) older adults. Research conducted by the Hā Kūpuna: National Resource Center for Native Hawaiian Elders at the University of Hawai‘i, provides evidence of variations in life expectancy, morbidity, health practices, and elder and family service preferences across AA and Pacific Islander elder populations. Background Health literacy needs present challenges for diverse older adults and their family members– this is compelling given the nation’s shifting demographics in age, ethnicity and culture. By 2050, 40% of the nation’s 65 and older age group will be people of color. Ethnic/minority Americans suffer disproportionately from a number of ailments, diseases, and low health care utilization rate, calling for more study to identify and understand root causes of these and other problems. Older adults are the primary consumers of health care and long-term care services, with preference to “age-in-place” during and after health care transitions. Nursing home residents and families face complicated health literacy challenges and decisions—who will provide care, where will this care will be provided, and how will it be paid for? Life Expectancy Conclusion Health care transitions require elders and families to understand the complex and fragmented long-term care system, regardless of setting (home, nursing home, community-based program). Clinicians and policy makers will benefit from research on individual and joint contributions of health literacy and ethnic/cultural influences on the older adult and family ability to engage in informed decision making in long-term care. E-mail us:hakupuna@hawaii.edu Website:http://manoa.hawaii.edu/hakupuna