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Ethnogeriatric Assessment

Ethnogeriatric Assessment. University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Supported by:. The Ethnogeriatric Assessment: Five Domains. Client Background Clinical Domains Problem/Condition Specific Information Intervention Specific Data

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Ethnogeriatric Assessment

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  1. Ethnogeriatric Assessment University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Supported by:

  2. The Ethnogeriatric Assessment: Five Domains • Client Background • Clinical Domains • Problem/Condition Specific Information • Intervention Specific Data • Outcome Criteria

  3. Client Background Domains 1. Ethnicity2. Level of acculturation Placing older patients on the continuum of acculturation can help providers avoid mistaken assumptions about expected differences or similarities from mainstream elders. Informal indicators of acculturation that can be used quickly are: 1. Length of time older patients or their ancestor have been in the U.S.2. Language used at home, fluency in spoken and written English 3. Degree of ethnic affiliation 4. Religion or Spirituality 5. Patterns of decision-making 6. Preferred Interaction patterns a. Languageb. Direct/indirect communicationc. Formal vs. informald. Other (see communication section)

  4. Cohort Analysis for AI/AN Elders • A cohort analysis is an examination of historical events that may have impacted the lives of a particular group of people born within the same time period, in this case an ethnic group. • The following should be considered in using a cohort study as a starting point for gathering information: 1) Effect of age of elder at the time of event2) Not all AI/AN elders are impacted by the same events3) Relevance of social histories in provision of clinical care

  5. Clinical DomainsHealth and Social History Consideration of the elder’s family members and community when doing an assessment is important Native American elders are at great risk of diabetes, heart disease, cancer and substance abuse Elder abuse may be apparent at any point, but particularly in the following portions of the assessment: physical exam cognitive and affective status functional status family assessment Particularly consider when: (1)there are physical signs (bruises, burns, etc.) and/or (2)behavioral symptoms (e.g. depression) (Tatara, 1999).

  6. Clinical Domains Physical Examination • Cross gender physical examinations are unacceptable in many cultures • Ask for preference of presence of other family members during physical exam. • Throughout the assessment, inform elder of procedures and ask for permission to examine different areas of the body. • Preferred amount and type of information communicated to the elder and their family during and after the physical exam varies cross-culturally. • Symptom recognition, meaning, and report is expressed differently by elders of different cultures [e.g. "air heavy" or "air not right" may mean dyspnea for some Native American elders (Kramer, 1996); "heavy heart" may indicate depression among Chinese]

  7. Clinical DomainsCognitive and Affective Status Criteria for mental disorders may not be applicable as there are vast differences in cultural (tribal) beliefs about mental illness, cultural labeling of different emotions, and conceptual language differences (Manson et al., 1985). Dementia and depression are considered mental illness in some cultures and highly stigmatized. In others dementia is seen as a normal part of aging and define it as a minimal problem.

  8. Clinical Domains Functional status • Activities of Daily Living and Instrumental Activities of Daily Questions can be translated, if needed, and administered orally or in writing if literacy and reading levels are adequate. • Drawings, illustrations, and other culturally appropriate symbols may also be used. • Appropriateness of commonly used ADL and IADL scales should be assessed. For example: • what kind of activities is the elder used to doing? • Did they ever use a telephone or balance a checkbook? • Or, did they chop wood and carry water, or engage in activities such as leatherwork, beading, or weaving?

  9. Clinical DomainsHome Assessment Living patterns: Who lives in the home, relationship to elder, and length of time in the home Support from those people who live with the elder Safety, comfort, and convenience of the home to elders health status Economic stability and adequacy

  10. Clinical Domains Family Assessment • Composition and structure • Kinship patterns: • Decision-making: • Spokesperson • Gender sex-role allocation • Support from family members • Family connectedness.

  11. Clinical Domains Community and Neighborhood Assessment • Overall features of the community and neighborhood • Population characteristic • Environmental and safety conditions • Services available and used by elder and their family • Support from neighborhood and community members

  12. Clinical Domains End of life preferences • Preparation for death including availability of advance directives. Since talking about death is considered inappropriate in some cultures (e.g., Chinese, Navajo) the issue should be approached carefully and sensitively, and only in the context of an established trusting relationship. A possible introduction after several visits might be, "In case something happens to you and you are not able to make decisions about your care, we need to know what your preferences are.” • Preference for hospital or home end of life care • Rituals for care of the body and mourning behaviors during and after death • Attitudes about organ donation and autopsy

  13. Problem or Condition Specific Data Elicit Explanatory Models of Illness from Patient and Relevant Family Members • What do you think caused your problem? • Why do you think it started when it did? • What do you think your sickness does to your body? How does it work? • How severe is your sickness? • How long do you think it will last? • What are the main problems your sickness has caused you? • Do you know others who have had this problem? What did they do to treat it? • Do you think there is any way to prevent this problem in the future? How?

  14. Problem or Condition Specific DataCultural Competency A “problem” oriented format may be offensive and patronizing to many older American Indians as it implies a power differential between the health care “provider”(usually a member of the dominant society) and the “person with the problem”. HANDOUT: Table 5. EXAMPLES OF AMERICAN INDIAN/ALASKA NATIVE; EXPLANATORY MODELS FOR DEMENTIA

  15. Intervention Specific Data What are you and/or your family doing for this problem? What kinds of medicines, home remedies, or other treatments have you tried for this sickness? Have they helped? What type of treatment do you think you should receive from me? Elicit cultural specific content as needed for specific interventions. For example, if dietary recommendations are being made, elicit data about food preferences and practices; if discharge planning is needed, elicit information regarding family care patterns, resources, and residential preferences Is there any other information that might help us design a treatment plan? How should family be involved: family structure, roles, and dynamics, and life style and living arrangement need to be identified. How should family members treat one who has this condition/problem? Does anyone else need to be consulted? (Tripp-Reimer, Brink, & Saunders, 1984)

  16. Outcome Specific Data “Negotiating outcome criteria with older adults/family members. The western biomedical linear model may be in conflict with the circular model, more common in most Indian cosmology.” Questions to consider: What are individual/family expectations for quality care? What are the most important results you hope to receive from this treatment? What is best outcome from family/individual perspective? What is worst outcome from family/individual perspective?

  17. ReferencesAs cited in the ‘CURRICULUM IN ETHNOGERIATRICS CORE CURRICULUM AND ETHNIC SPECIFIC MODULES’ • Kleinman, A., Eisenberg, L. Good, B. (1978). Culture, illness, and care. Annals of Internal Medicine, 88; 251-258. • Kramer, J. (1996). American Indians. Chapter 3. In J.G. Lipson, S. L. Dibble, P. A. Minarik Culture & Nursing care: A Pocket Guide., (pp. 11-22). San Francisco, CA: UCSF Nursing Press. • Manson, S. M., Shore, J. H., & Bloom, J. D. (1985). The depressive experience in American Indian communities: A challenge for psychiatric theory and diagnosis. In A. Kleinman & B. Good (Eds.), Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder. Los Angeles: University of California Press. • Tatara, T. (1999). Understanding elder abuse in minority populations. Ann Arbor: Braun-Brumfield. • Tripp-Reimer, T., Brink, P. J., & Saunders, J. M. (1984). Cultural assessment: Content and process. Nursing Outlook, 32(2), 78-82. • Yeo, G. & Gallagher-Thompson, D. (Eds.). (1996). Ethnicity and the dementias. Washington, DC, USA: Taylor & Francis

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