ETHNIC/CULTURAL PATTERNS & HEALTH CARE: AGED EMPHASIS

1. ETHNIC/CULTURAL PATTERNS & HEALTH CARE: AGED EMPHASIS SOC 5760 – “Society & Aging: Mary C. Sengstock, Ph.D., C.C.S. Certified Clinical Sociologist Professor of Sociology Wayne State University

2. OBJECTIVES • Analyze Major Ethnic/Cultural Patterns in 21st Century U.S. • Analyze the Impact These Patterns May Have Upon Health Care • Suggest Ways Health Care Professionals May Deal with these Patterns in Health Care Settings

3. ETHNICITY: 21ST CENTURY U.S. • U.S. History of Immigration • Cultural Differences Based on Numerous Factors: • Race • Religion • Nationality, Language • 1968 Federal Laws Increased Rate of Immigration

4. DETROIT AREA ETHNICITY • Race • Foreign Born • Home Language Other Than English • Nationality Identification • 2000 Census • 2006 Estimates

5. TRI COUNTY ETHNICITY 2000 • Total Population: 4,043,467 • Foreign Born: 325,994 ( 8.1%) • Foreign Language: 438,582 (10.8%) • Black: 1,002,038 (24.8%) • Asian: 101,386 ( 2.5%) • Total Non-White: 1,103,424 (27.3%)

6. MAJOR NATIONALITY GROUPS • German: 641,304 (15.9%) • Polish: 440,914 (10.9%) • Irish: 410,930 (10.2%) • Italian: 265,214 ( 6.6%) • French: 163,500 ( 4.0%) • Hispanic: 118,641 ( 2.9%) • Arabic: 19,185 ( 0.5%) • Iraqi (+Chaldean): 10,104 ( 0.2%)

7. CHANGES 2000 to 2006 2000 2006 Population 4,043,467 4,018,500 For. Born 325,994 (8.1%) 367,013 ( 9.1%) For. Lang. 438,582 (10.8%) 480,695 (12.0%) Black 1,002,038 (24.8%) 1,014,715 (25.2%) Asian 101,386 (2.5%) 141,363 (3.5%)

8. DEMOGRAPHIC SUMMARY • Area Population Decreasing Slightly • Minority Population Increasing • Black Population Increasing • Asian Population Increasing • Middle Eastern Population Increasing • Sizeable Foreign Born/Language Population • Continued Importance of Ethnic Identity

9. ETHNIC IDENTITY – RELEVANCE • Racial Groups (Blacks, Asians) Have Different Health Problems, Patterns • Language Differences Affect Understanding of Health Requirements • Nationality Groups Have Persistent Differences in Personality Traits, Religious Beliefs, Which Can Affect Health Perceptions

10. CAUTIONS • Focus of Lecture Is NOT to Summarize All Ethnic Groups & Their Practices – Too Many! • No Single Pattern Fits Any Given Ethnic Group • Whites Include Many Nationalities • Hispanics Include Central & South Americans • Blacks Include Descendants of Slaves, Immigrants from Africa & Caribbean • Cannot Assume Any Individual Fits the Pattern • So Many Cases No Lecture Can Include All!

11. 2 DIMENSIONS OF ETHNICITY AND AGING • Minority Aging: How Do Minorities Experience Aging Differently Than Dominant Middle Class Whites? • Ethnic Aging: How Do Ethnic Differences Impact on the Way Aging Is Experienced – and How Can Professionals Help?

12. MINORITY AGING – SUMMARY • TRIPLE JEOPARDY: • OLD • POOR • MINORITY RACE/ETHNICITY • ALL THE DISADVANTAGES OF EACH!

13. MINORITY AGING – OVERALL • Fewer Aged: More Births; Short Life Expectancy • Lower Incomes (Pre & Post Retirement) • Health Is Poorer • Usually More Urban • Usually Higher Status Within Ethnic Community • Usually More Family And Community Support & Responsibility For Aged • Highly Resilient Aged – Probably Because They Are “Survivors”

14. ETHNIC AGING:3 IMPORTANT ISSUES • 1. HEALTH PROBLEMS OF GROUP • 2. CULTURAL DIFFERENCES - Usually Affect Immigrants and Their Children • 3. SOCIAL DIFFERENCES - Can Persist for Several Generations

15. HEALTH PROBLEMS:AFRICAN-AMERICANS • 2X As Many Chronic Diseases as Whites • Higher Incidence Than White Elders of: • Hypertension Heart Disease • Cancer Diabetes Depression • Obesity Kidney Failure • Decline in Functional Ability • Diabetes 2X As High Among Black Women • Breast Cancer Particularly Virulent

16. HEALTH PROBLEMS:HISPANICS • Great Diversity Among Groups (Cubans Healthier Than Mexican or Puerto Rican) • Immigrant Hispanics Have BETTER Health Than the American-Born! • Smoking A Particular Immigrant Problem • Diet & Cultural Patterns Change in U.S. • Smoking, Alcohol & Drug Use Increases • Breast Feeding & Fiber Consumption Decline

17. HEALTH PROBLEMS:ASIAN-PACIFIC ISLANDERS • Great Variability Among Various Groups: • Japanese & Chinese Elders Healthier Than U.S. Population in General (Healthier Diet?) • Japanese: Higher Rate of Digestive Cancers, Suicide • Native Hawaiians: Higher Mortality Due to Heart Disease & All Causes of Death • General: Higher Rates of Hypertension, Cholesterol, Osteoporosis, Cancer • Particularly Among Low Income Groups

18. HEALTH PROBLEMS:NATIVE AMERICANS • Poorest Health of All Americans • Higher Incidence Than White Elders of: • Diabetes Hypertension Accidents • Tuberculosis Heart Disease Strokes • Liver & Kidney Disease Pneumonia • Influenza Hearing & Visual Impairments • Gallbladder Arthritis • Problems Related to Obesity

19. CULTURAL DIFFERENCES • LANGUAGE • MYTHS • BELIEFS • ORIENTATION TOWARD WORLD • PROPER DEMEANOR

20. LANGUAGE DIFFERENCES • People With First Language Not English • Most Immigrants • Some Second Generation • Speakers of “Non-Standard” English • African-Americans – “Black English” • Appalachian Whites

21. FOREIGN LANGUAGE – CONSEQUENCES • Misunderstand Instructions • Even When They Know English • EX: 24 Hr Urine Specimen • “Partitioned Language” (Israeli Colleague) • Translation Necessary – Problems: • Arabic Mother-in-law As Translator • Child as Translator • Café Au Lait Vs. Café Au Lit

22. GERIATRIC IMPLICATIONS • 2nd Language Speakers • May “Forget” 2nd Language When Old or Sick • 2 Types of Foreign-Born Elderly: • Immigrant Elderly (Worked – Became Acculturated) • “Invited” Elderly (Came Retired; Not Acculturated – Less Likely to Know English)

23. MYTHS • What Cures or Prevents Disease: • Laos: Hair Prevents Disease (Drs. Shave for Surgery, Treatments) • Folk Medicine • Dependence on Folk Medicine First (Delay Doctor Visits) • Hispanics: The Group Helps You Heal (Medicine Separates You)

24. BELIEFS • Southern Blacks: • Polio Shot = Flu Shot = Blood Test • Mexicans: • Blood Sample = Blood Donor • Understanding of Medicines: • All Heart Medicines Are the Same

25. GERIATRIC IMPLICATIONS • Chinese: Bad Omens – EX: • Do Not Discuss Illness or Death With Aged • Japanese: Dementia Seen as Shameful • Reluctant to Acknowledge Mental Disease • High Rate of Suicide • Mexicans: Many Folk Beliefs – EX: • No Cure for Heart Disease – Death Sentence

26. ORIENTATION TO WORLD • Present Vs. Future Orientation • Fatalism: • Arabs, Irish: Treatment Defies God’s Will • Hispanics: Stoicism • Evil Eye (Many Peasant Cultures – Even Religious People Believe It) • Reaction To Pain • Italians, Arabs: Yell, Avoid Anesthetic • Irish: Suffer In Silence

27. PROPER DEMEANOR • Close Physical Contact In Conversation vs. Respectful Distance • Appropriateness Of Eye Contact • Preference for Direct vs. Indirect Conversation • Formal vs. Informal Agreements • Distrust Consent Forms (esp. Women) • Reluctance to Accept Youth & Women in Formal Statuses

28. GERIATRIC IMPLICATIONS • Prefer Informal Care: • Home Care Is Expected • Exceptions (Japanese for Mental Problems) • Formality in Care: • Prefer Formal Means of Address (Polish) • Differential Address for Staff v. Patients • Polish Discomfort with Informal Visits • Irish Preference for Independence

29. CONSEQUENCES FOR PHYSICIANS, NURSES • Makes It Difficult to Interpret Level of Pain or Need for Treatment • Need to Consider Possible Ethnic Traditions • Not Easy to Determine Patient’s or Family’s Ethnic Background • Language Use or Names May Not Indicate Ethnic Background or Traditions! • Name Changes Due to Marriage or Immigration

30. SUMMARY OF CULTURAL DIFFERENCES • These Include Cultural Ethnic Patterns: • Beliefs, Myths, Omens • Attitudes: Fatalism, Orientation to Present • Demeanor: Formal, Informal, Independent • Cultural Patterns Tend to Disappear Once Initial Generation Is Acculturated or Dies • 2nd Generation Becomes More Used to Urban, Industrial Society Environment

31. SUMMARY OF SOCIAL DIFFERENCES • Differences in Social Patterns (vs Culture) • These Differences Can Persist For Several Generations!(Long After Individual Identifies as “Ethnic”!) • This is Because They Are NOT Seen as “Ethnic” … • But Rather as “Normal Human Behavior”

32. SOCIAL DIFFERENCES • Family Structure: • Family Statuses; Roles for Women; Roles for Children • Social Practices Based on Beliefs About the Family and Society: • Living Arrangements; Inter-Relations Between Generations; Child-Rearing Practices; Visiting Practices; Beliefs About Privacy; Acceptance of Professional “Helpers”

33. FAMILY STRUCTURE • Family Statuses: • Who is Head of Family? • Who Can Instruct a Man? • Who Can Instruct an Older Person? • Nature of Husband – Wife Relations • Who Decides Whose Health Care?

34. FAMILY STRUCTURE (ctd) • Roles for Women: • Can Women Make Own Decisions? • Roles for Children: • Do Children and Adults Interact Much? • Can Children Serve as Adult’s Interpreter or Instructor? • Will They Have the Information to Be Effective? (EX: Vietnamese Sex Taboo)

35. SOCIAL PRACTICESBased On Beliefs Re Family • Family Living Patterns: • Inter-Generational Households • Close Neighbors • Functionally Extended Households • Inter-Relation Between Generations: • Italians: Adults Not in Children’s Activities

36. SOCIAL PRACTICESBased On Beliefs Re Family • Child-Rearing Practices: • Who Is Child’s Caregiver: Mother? • Or Grandmother? • Visiting Practices: • Irish (& Arabs): Long, Casual Visits (& Loud!) • Polish: Short, Announced Visits (Patient “Receives”) • Blacks Need/Want Privacy

37. SOCIAL PRACTICESBased On Beliefs Re Family • Acceptance of Professional “Helpers” • Many Groups Resist Professional Helpers – Especially with Psychological Services • Irish: Good at Deflecting Information Requests • Nature of Family Support: • Jewish: Social Support Is Critical – Not Acts • Polish: Acts Important – Not Feeling

38. GERIATRIC IMPLICATIONS • Most Prefer Family Care of Elderly (Chinese, Japanese, Arabs, Chaldeans, Polish, Italians, Others) • Elderly Depression if Family Not Close (Arab/Chaldean Study) • May Produce Great Family Stress (“Sandwich Generation”) • Must Respect Status of Elders

39. WHAT TO MAKE OF ALL THIS? • How to Keep Track of All These Different Types of People? • How to Find Out Who Is Who & Who Follows Which Pattern? • No Easy Answers – No Clear Outline of Ethnic Differences • Sensitivity to the Needs of Patients Is Critical

40. WHAT CAN DOCTORS DO? • Watch For Signs of Non-Compliance – Inquire Why • Do Not Assume a Family Translator Will Be Honest or Effective • Use Paid Translators If Possible • Try to Match Patient and Interviewer • Age, Gender, Race or Ethnicity

41. WHAT CAN DOCTORS DO? (ctd) • Watch for Indications the Patient or Family Is Uncomfortable With Someone • Do Not Assume Family Members Can or Will be Acceptable/Effective Caregivers • Do Not Assume Non-Family Caregivers Will Be Acceptable/Effective

42. RESPECT TRADITIONS • Try Not to Force Patients to Accept Unfamiliar Patterns • Respect Patients’ Desire for Formal Titles • Accommodate Food & Social Patterns Where Possible • Accommodate Needs of Family Members to Accompany Patient • Recognize the Role of Social & Cultural Patterns in Recovery

43. MEDICAL PROFESSIONALS’ COMPENSATION • A More Satisfied Patient & Family • A Patient More Likely to Respond Well • Patients More Likely to Return • Patients Willing to Refer Others • Good Will for Practice & Hospital • Feeling Physician Has Done a Good Job