Aging & Diversity
Resilient but Not Impenetrable
 25% of the 65 year old and over
population live in rural areas.
Rural elders are becoming
isolated.
 The proportion of older adults in
rural communities is larger than the
proportion in urban areas primarily
as a result of younger populations
moving to larger urban areas.
Along with the out-migration of
younger people is an in-migration
of retired elderly.
Resilient but Not Impenetrable
Rural elders are one of the greatest atrisk groups for experiencing physical &
mental health problems.
In many rural communities there are no
psychosocial services available to
meet the needs of the rural elderly.
"Take Care of Our Own" (Bushy, 2000)
 Traditional rural values stress:
 Self-reliance
 Conservatism
 Family network
 Work orientation
 Religion/ Fatalism
 Mistrust of health care professionals:
 Distrust of outsiders
 Fear associated with Tuskegee Syphilis Experiment
 "I don't know if that works for me."
Families: Family Structure
In the United states there are currently
many three, four, and five generation
families as a result of increased life
expectancy.
There are fewer persons born into each
generation therefore, family trees are
smaller.
The number of existing generations in
families along with the decreased numbers
in each generation has produced what
Qualls (1996) describes as “tall, skinny,
family trees.”
Families: Changing Family Structures
Living Apart Together (LAT): is a more recent
phenomenon, which seems to have the potential of
becoming the third stage in the process of the social
transformation of intimacy. In contrast to couples in
‘commuting marriages’, who have one main household in
common, couples living in LAT relationships have one
household each. This article presents data on the
frequency of LAT relationships in Sweden and Norway,
and explores the variation which exists within LAT
relationships. The article argues that the establishment of
LAT relationships as a social institution requires the prior
establishment of cohabitation as a social institution.
(Levin, I. (2004). Living apart together: A new family form. Current Sociology, 52(2), 223-240)
Gay & Lesbian Aged

Older lesbians & gay men have concerns that
are related to their age & sexual orientation.



Nursing home or inpatient placement for themselves or
their mates.
 May lead to loss of contact.
Often no legal capacity to make medical, financial or
burial decisions for mate.
Different from cohort of other older adults.
Homosexuality was not “accepted” before 1969
Gay & Lesbian Aged
Older lesbians & gay men have
concerns that are related to their age &
sexual orientation.
 Nursing home or inpatient placement for
themselves or their mates.
 May lead to loss of contact.
 Often no legal capacity to make medical,
financial or burial decisions for mate.
 Different from cohort of other older adults.
Homosexuality was not “accepted” before
1969.
Culture: Religion/Spirituality
 National surveys indicate that older adults attach a high value to
their religious beliefs & behaviors.
 This is particularly true of ethnic & minority elders who show a
high degree of religious involvement.
 The vast majority of research finds that religious involvement is
associated with greater well-being & life satisfaction, greater
purpose & meaning in life, greater hope & optimism, less anxiety
& depression, coping with stressful life events, more stable
marriages & lower rates of substance abuse.
McFadden, S.H. , 1996; Crowther, Parker, Larimore, Achenbaum, & Koenig,2002; Koenig,
1990; Dull & Skokan, 1995
The SPIRITual History
S
P
I
R
I
T
Spiritual belief system
Personal spirituality
Integration with a spiritual community
Rituals or Restriction
Implications for medical care
Terminal events planning
Maugans T. (1996). Arch Fam Med, 5: 11-16
SPIRITual History Questions
What does spirituality mean to you?
What aspect of religion/spirituality would
you like me to keep in mind as I care for
you?
Would you like to discuss the religious or
spiritual implications of your health care?
Maugans T. (1996). Arch Fam Med, 5: 11-16
1.
Which of the following would be good ways to promote cultural
competence in your workplace?
2.
Seek out information about the various customs, holidays and
religions of cultures different from your own that you will
encounter in your work.
3.
Try to bring your patients into mainstream American culture as
much as possible. It will be easier for them that way.
4.
Learn how to respectfully ask questions about cultural beliefs.
5.
Avoid talking to patients about anything other than medicine.
CULTURAL COMPETENCE IN
THE WORKPLACE
Integrated
Healthcare
Interdisciplinary Awareness
 Collaborative relations across disciplines
demonstrates a supportive, collaborative and
interdisciplinary team focused on improving
care for older adults.
 The structure of interdisciplinary teams has
evolved from a hierarchy, with the physician in a
"command" position, to a team interfacing many
different kinds of health care professionals,
each with separate and important knowledge,
technical skills, and perspectives.
(APA, 2007)
Interdisciplinary Teams: Balance Several Factors
(APA, 2007)
Older People & Health Care System
 Older people are disadvantaged by a health care
system not sensitive to their needs.
 Multiple morbidities
 Life span experiences
 Fragmented care
 Marginalization
 Ageism & Stigma
Everyone doesn’t need integrated model.
For example, someone with an earache.
However, because older adults often have
co-morbid conditions the integrated model
is very useful.
(APA, 2007)
1. What cultural factors could strongly influence a persons’
reactions to serious illness & decisions about healthcare?
GROUP QUESTION:
CULTURE & HEALTHCARE