Gwen Yeo

Ethnicity and the dementias

Risk of Dementia 1. Prevalence of Dementia among Different Ethnic Populations Assessment of Dementia in Diverse Populations 2. Overview of Psychiatric Assessment with Dementia Patients 3. Neurocognitive Assessment of Dementia in African American Elders 4. Assessment of Cognitive Status in Asians 5. Neuropsychological Assessment of Hispanics Elders: Challenges and Psychometric Approaches 6. American Indians, Cognitive Assessment, and Dementia Treatment and Management of Dementia 7. Overview of Treatment Alternatives for Dementing Illnesses Working with Families 8. The Family as the Unit of Assessment and Treatment in Work with Ethnically Diverse Older Adults with Dementia 9. Working with African American Families 10. Working with American Indian Families Working with Asian American Families 11. Asian Indian American 12. Chinese American 13. Filipino Americans 14. Hmong Americans 15. Japanese Americans 16. Korean Americans 17. Vietnamese American Working with Latino/Hispanic American Families 18. Puerto Rican and other Hispanic/Latino American Families 19. Cuban American 20. Mexican American 21. Working with Gay, Lesbian, Bisexual, and Transgender Families Community Partnerships for Support of Ethnic Elders and Families 22. Reaching Diverse Caregiving Families through Community Partnerships

How Will the U.S. Healthcare System Meet the Challenge of the Ethnogeriatric Imperative

Much of the geriatric imperative that is facing providers in the United States is an ethnogeriatric imperative, because one‐third of older Americans are projected to be from one of the minority populations by mid‐century, and that vastly underrepresents the actual diversity providers will see. Because of the vast heterogeneity of culture, language, health beliefs, risk for disease, and other factors, it is important for policy makers and health providers to be familiar with the diverse characteristics and needs of the various groups that will need geriatric care if they are to receive effective services. Challenges to high‐quality ethnogeriatric care include disparities in health status and health care, differences of acculturation level and other characteristics within the populations, language and limited English proficiency, health literacy, culturally defined health beliefs and syndromes, and specific beliefs and preferences about long‐term and end‐of‐life care. Some models of successful ethnogeriatric care have been identified and have in common the involvement of members of the target population in the development and design of the services and the use of cultural liaisons from the ethnic community being served, such as community health workers, or promatores. Thirteen recommendations are suggested for policy and practice changes in multiethnic and ethnic‐specific health programs to provide competent ethnogeriatric care in the U.S. healthcare system.

Curricular Framework: Core Competencies in Multicultural Geriatric Care

Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework.

Conceptions of Dementia Among Vietnamese American Caregivers

Abstract Understanding cultural conceptualizations of dementia and caregiving can assist health and social service providers to work more effectively with elders and their families. Interviews with nine Vietnamese American family caregivers in the San Francisco Bay Area were tape-recorded, transcribed and then content-analyzed for dementia labels and attributions. Labels fell into three main categories: (1) lŝn and closely related folk idioms that refer to age-cognitive decline and confusion in older adults, (2) folk and professional terms that refer to medical illness, and (3) folk and professional terms for mental illness or craziness. Attributions fell into four categories: (1) normal age-related, (2) physiological, (3) psychosocial, and (4) spiritual/religious. An additional theme that emerged from the analysis was the sense of obligation for family members to care for elders and the reluctance to use outside supportive and long term care services.

Systematic review of dementia prevalence and incidence in United States race/ethnic populations

To identify incidence and prevalence of dementia in racial and ethnic populations in the United States.

Causal attributions of dementia among Korean American immigrants.

To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.

Cardiovascular disease risk factors and attitudes towards prevention among Korean-American elders.

The leading cause of death among the aging population is cardiovascular disease. Cardiovascular disease prevention and modification of disease risk factors are important and worthwhile directions for study because this population is rapidly increasing. Past studies have shown the significance of modifying cardiovascular disease risk factors in Anglo populations where major risk factors of hypertension, elevated cholesterol levels, diabetes, obesity, physical inactivity and smoking have been identified. However, the prevalence of these risk factors and the attitudes towards modifying them have not been studied in the Korean-American elderly population. This preliminary study used questionnaires given to fifty older recently immigrated Korean-American participants of a Korean senior center. Results show that this population has a lower frequency of cardiovascular disease and all risk factors, except for diabetes compared to an Anglo elderly population In addition, older Korean-American elders were generally unaware of risk factors for cardiovascular disease and uninterested in changing their habits to avoid cardiovascular disease. Increased availability of educational campaigns and health care in Korean are recommended.

Chapter 7 Cultural Diversity in Geriatrics and Gerontology Education

The educational experiences available in cultural diversity and aging are almost as diverse as the elders themselves. Faculty in many disciplines have found many different ways to try to prepare students to meet the challenges of an increasingly heterogeneous population of older adults. The realizations that elders from populations defi ned offi cially as minorities will probably be one-third of older Americans by the middle of the 21st century (Federal Interagency Forum on Aging Related Statistics, 2000), that there is vast diversity within each of these populations and within the White majority, and that there are unique cultural needs and issues associated with each group have prompted increasing attention to cultural diversity in gerontology and geriatrics instruction during the last four decades.

The ethnogeriatric imperative.

Health care providers frequently hear that the United States is facing a “geriatric imperative.” Television and magazines are filled with phrases such as the “aging of the baby boomers” and the “graying of America.” The Institute of Medicine and other prestigious organizations have documented the dramatic undersupply of physicians and other health care providers trained in geriatrics who will be needed to care for the exploding population of older adults in the United States beginning in 2020 (Warshaw, Bragg, & Shaull, 2002). What we do not hear as much about is the increasing ethnic and cultural diversity within this projected enormous bulge in our population pyramid. The truth is that there is not only a geriatric imperative facing us but also an ethnogeriatric imperative. The numbers of elders in the categories who are classified as ethnic minority are growing dramatically, but probably more important, the diversity within the categories is multiplying rapidly. To provide even adequate, if not excellent care, it is essential that consideration be given to how our health care institutions should prepare for this ethnogeriatric imperative.

FACULTY DEVELOPMENT IN ETHNOGERIATRICS

Faculty members in health professions educational programs are recognizing the need for professional development that will enable them to prepare their students to meet the needs of the increasingly culturally diverse population of older adults. Reviews of textbooks in five health care disciplines and surveys of gerontological programs in the late 1980s revealed limited integration of ethnogeriatric information in textbooks and few models for ethnogeriatric curricula. The Stanford Geriatric Education Center and the affiliated gerontology lgeriatric programs at San Jose State University have developed strategies for faculty development in ethnogeriatrics, two of which are conferences and minifellowships. Three conferences have focused on curriculum content and instructional methodologies to teach students in health care programs from 11 disciplines the information and skills for cultural competence in ethnogeriatrics. Six months after the first conference, more than half of the participating faculty member...