Abstract
Older adults represent 12.9% of the U.S. population, numbering at 39.6 million people or 1 in every 8 Americans (Administration on Aging; http://www.aoa.acl.gov/Aging_Statistics/Profile/index.aspx). Racial and ethnic minority populations have increased from 6.1 million in 2002 (17% of the elderly population) to 8.9 million in 2012 (21% of the elderly) and are projected to increase to 20.2 million in 2030 (28% of the elderly). There is a growing diversity of older adults not only in the United States but also worldwide. In the United States, White (non-Hispanic), Hispanic, African American (non-Hispanic), American Indian/Native Alaskan, and Asian groups are expected to increase by 54%, 155%, 104%, 116%, and 119%, respectively, by the year 2030. With these increasing numbers, health care providers will be expected to provide culturally congruent health care to traditionally underserved populations, specifically to the older adult cohort.
Concerns have been raised about lack of cultural competence among health care providers. However, the aging population is often ignored as a “cultural” group in itself. Older adults, who come from various racial and cultural backgrounds, may present with unique, unmet needs, which in turn may result in poor health outcomes as a result of misunderstandings and poor communication skills. During a time when older adults may suffer from cognitive impairments, sensory losses, and chronic diseases, a foundation in cultural congruent health care for the older adult is essential not only for the patients but also for families and communities. Better education and training for all health care providers is necessary to improve culturally competent care for our growing number of older adults who live in the home, in long-term care facilities, and in the community.
The older adult has the right to make life choices, especially related to health care. In the United States, we encourage the right to treatment choices, informed consent, veracity, and open communication. We believe in sustaining life with a goal of quality of life. However, these core values may not be congruent with other health care customs. The values about health and life in the United States may not be valued in other countries, cultures, and ethnic backgrounds. These conflicts may lead to health care disparities, which can be seen in fragmented care, poor symptom management, miscommunication, and a poor end-of-life/death experience. While the goal of Western medicine for older adults is to maximize function and maintain quality of life, other cultures may not have this goal.
The influence on culture, especially for an older adult, must be respected and valued. Health care providers must understand how this influence affects the behavior, attitudes, preferences, and decisions about end-of-life care. An assessment should be made on the preference of the patient and the family on end-of-life decisions. Many families who are from different cultural and ethnic backgrounds may be acculturated and may not associate with the assumed culture. Language skills of the older adult must also be addressed. It is also important to examine time in the country, immigration experiences, former occupations, and level of education.
Providing culturally competent care involves a process including desire, awareness, knowledge, skills, collaboration, and encounter. To care for the older adult involves individualized health care services or patient-centered care. There is no place for prejudice, stereotyping, or bias. In order for a trusting relationship to occur, communication is essential.
I am pleased to offer this issue of Journal of Transcultural Nursing that is totally dedicated to culturally congruent health care for older adults. This issue provides some of the most up-to-date research on issues related to the care of older adults across the globe. We have provided you with theoretical perspectives on caring for the aging as well as research related to mammography use in older women, preferences for end-of-life decisions, and the influence of pain on sleep in older adults with arthritis. There are several articles related to organizational issues including perceptions of caring for older adults in long-term care and elder abuse. A literature review on communication styles of nursing assistants with older Korean adults with dementia is included. Furthermore, we provide a clearer understanding of students’ perspectives of caring for older adults including knowledge, attitudes, preferences, and bias. We hope you enjoy this issue of Journal of Transcultural Nursing to improve and advance the knowledge of culturally congruent health care of all older adults despite race, culture, or ethnicity.