Explore the Role of Culturally Competent Care in Reducing

Health Disparities and Promoting Optimal Health in

the Elderly

Laurie Brummett, RN

&

Susan Goo, RN

Nurses Improving Care for Healthsystem Elders (NICHE)

• Developed by the Hartford Institute for Geriatric Nursing

• More than 225 hospitals in both the U.S. and Canada are participating

• NICHE has ways to improve elderly care

(Wood, 2009)

Geriatric Institutional Assessment Profile

• Skin care• Restraint use• Incontinence• Sleep issues• Attitudes and

perceptions about caring for elderly patients

(Wood, 2009)

What the NICHE Program Entails

• Training program about sensory changes r/t advancing age

• Plans to differentiate delirium and dementia

• Programs to assess fall risks

• Programs on best practices for relating to older adults.

(Wood, 2009)

John Muir Health is Utilizing NICHE

• Coordinate with existing outpatient geriatric program

• Biannual geriatric interdisciplinary professional development

• Geriatric nurse resource program

• Specialized Med/Surg unit focused on needs of the elderly

(Wood, 2009)

Stereotype of Minorities Taking Care of Their Elders

• Commonly held belief that minority families need less assistance with elders

• Research does show– Unmarried elderly African

Americans are 2x as likely as Caucasians to live with family

– Hispanic and Asian American elders are 3x as likely

– ½ of urban Native American elders live with family

(____, 2001)

Caring for Elderly Family Members

• Research shows taking care of elder family members can be overwhelming.

• Does living with extended family mean minority elders do not need formal support services?

• (______, 2001)

Wisdom Center, in Santa Maria, CA

• Adult Day Health Care (ADHC)

• Activity program• Dietary services• Meals• Medication

management• Occupational therapy• Physical therapy

• Physician services• Psychology/Psychiatry• Skilled nursing• Social Work/Services• Speech therapy• Transportation

(Santa Barbara County, n.d)

Wisdom Center

• Adult Day Program (ADP)

• Activity program• Care and supervision• Meals• Social Services• Transportation

(Santa Barbara County, n.d)

Who does the Wisdom Center serve?

• Payments accepted– Medi-cal– Veteran’s benefits– Private insurance– Private pay

(Santa Barbara County, n.d.)

• Languages spoken– English

– Spanish

– Tagalog

Emic Perspective of the Elderly on Health

• Elderly people may have a different definition of health than the younger population

• Objectives may be related to maintaining functional status, instead of preventing or eliminating disease

(Miller & Iris, 2002)

•Being healthy has been defined by the elderly as:

–Functional independence

–Self-care management of illness

–Positive outlook

–Personal growth

–Social contribution

(Miller & Iris, 2002)

Emic Definition of Health• Being healthy = actively

pursuing a healthy lifestyle

• Strategies to stay healthy include participating in healthy activities and engagement

• Motivators include social support, challenge, past activities and getting better (Miller & Iris, 2002)

“When you get into your 80’s, little pieces of you kind of break off and fall astray…most of us have some little thing going

on.”

• There is a connection between mental attitude and physical health

(Miller & Iris, 2002, p. 255)

Strategies Older Adults Use to Promote Health

• Physical– Physical activity and

exercise– Change unhealthy eating

and alcohol habits– Participate in tx and

management of illness and disability

– Use of assistive devices to maintain mobility

• Cognitive– Learn new things– Take classes– Stay up on current

events– Participate in

activities and in the community

(Miller & Iris, 2002)

Strategies Elderly Use to Maintain Health

• Psychosocial– Positive attitude– Set priorities– Avoid dwelling on

problems– Capitalize on previous

successes– Participate in activities

based on interest, needs and limitations

– Express feelings– Have fun

• Interpersonal– Volunteer– Join activities– Share experiences– Remain connected

with family & friends– Make new friends

and acquaintances

(Miller & Iris, 2002)

Emeritus Programs

• Adult fitness• Computers• Literature by local authors• Music arts• Pastel drawing & painting• Yoga• Nutrition and health• Exploring cultural and

natural wonders• Reminiscing for frail older

adults(Cuesta College, 2009)

Crabby Old Man• What do you see nurses? . .

What do you see?What are you thinking . . . . when you're looking at me?A crabby old man, . . not very wise,Uncertain of habit . . . . . with faraway eyes?

Who dribbles his food . . . . . . and makes no replyWhen you say in a loud voice . . 'I do wish you'd try!'Who seems not to notice . . . the things that you do.And forever is losing . . . . . . . A sock or shoe?

• Who, resisting or not . . . . . . . . . lets you do as you will,With bathing and feeding . . . . . . The long day to fill?Is that what you're thinking? . . . Is that what you see?Then open your eyes, nurse . . . . you're not looking at me.

I'll tell you who I am, . . .. . .. as I sit here so still,As I do at your bidding, . . . . as I eat at your willI'm a small child of Ten . . . . with a father and mother,Brothers and sisters . . . . . . . who love one another

Crabby Old Man• A young boy of Sixteen . . with

wings on his feetDreaming that soon now . . . . a lover he'll meet.A groom soon at Twenty. . . . . .My heart gives a leap.Remembering the vows . . . . . that I promised to keep.

At Twenty-Five, now . . . . . . . I have young of my own.Who need me to guide . .. . And a secure happy home.A man of Thirty . . . . . . My young now grown fast,Bound to each other . . . . . . With ties that should last.

• At Forty, my young sons . . have grown and are gone,But my woman's beside me . . .. . . . to see I don't mourn.At Fifty, once more, . Babies play 'round my knee,Again, we know children . . . . . . My loved one and me .

Dark days are upon me . . My wife is now dead.I look at the future . . . . . . . . .. . I shudder with dread.For my young are all rearing . . . . . . young of their own.And I think of the years . . And the love that I've known.

Crabby Old Man• I'm now an old man . . . . . and

nature is cruel.Tis jest to make old age. . . . . look like a fool..The body, it crumbles . . . . . . . . . . grace and vigor depart.There is now a stone . . . . . . where I once had a heart.

But inside this old carcass . . A young guy still dwells,And now and again . . . .. . my battered heart swellsI remember the joys . . . . . . . . . . I remember the pain.And I'm loving and living . . . . . . . . . . .. life over again.

•I think of the years . all too few . . . . . gone too fast.And accept the stark fact . . . . . . . that nothing can last..So open your eyes, people . . . . . open and see..Not a crabby old man Look closer . . see . . . . ME!!

(Anonymous, n.d.)