Culturally Competent Care for Seniors and their Families: Addressing Behavioral Health & Psychosocial Challenges Ne w Je rse y Sta te wide Ne two rk fo r Cultura l Co mpe te nc e Co nfe re nc e , Se pte mb e r 12, 2014 Da le Ofe i-Ayisi, MA, L CSW Aruna Ra o , MA
Goals for this Workshop: Overview I . Pro vide a c o mpre he nsive intro duc tio n to Afric a n Ame ric a n a nd Asia n I ndia n immig ra nt e lde rs a nd the ir ne e ds I I . E xa mple s o f Ne w Je rse y Re so urc e s & Se rvic e s I I I . Pro vide Re c o mme nda tio ns fo r I nte rve ntio ns 9/ 25/ 2014 2
New Jersey Demographics T he e lde rly po pula tio n (65 ye a rs o ld a nd o ve r) g re w • b y 8.5% during the 1990s a nd 6.5% during the 2000s. 14% o f the c urre nt po pula tio n is 65 a nd o lde r • T he pro po rtio n o f se nio r c itize ns in Ne w Je rse y will • e xpa nd to 16.3% in 2020 a nd 19.9% in 2030 . I n 2030, o ur po pula tio n will b e • 46.3% White 26.7% Hispa nic 11.8% Afr ic an Ame r ic an 12.9% Asian 2.3% Na tive Ame ric a n & Multira c ia l US Ce nsus Da ta Pre pa re d b y NJ De pt. o f L a b o r & Wo rkfo rc e De v., Div. o f L a b o r Ma rke t & De mo g ra phic Re se a rc h; Pro je c tio ns o f Ne w Je rse y’ s Po pula tio n a nd L a b o r F o rc e b y Se n-Yua n Wu, Re se a rc h E c o no mist (De mo g ra phy) 9/ 25/ 2014 3
African American Elders Mental Health Care: Historical Context Afric a n Ame ric a n me nta l he a lth c a re ha s a lo ng , ye t • ve ry disto rte d histo ry in the U.S. Bla c k b e ha vio r a nd illne ss vie we d thro ug h ra c ist • ste re o type s a nd a ssumptio ns – so c ia l a nte c e de nts o f b e ha vio r a nd illne ss ig no re d. L a c k o f a c c ura te sc ie ntific re se a rc h a nd e xplo ita tive , • inhuma ne re se a rc h pro to c o ls. 1940’ s – T e nde nc y to o ve r-dia g no se (a nd o ve r-tre a t) • psyc ho sis a nd to unde r-dia g no se a ffe c tive diso rde rs. 1960’ s – Co nc e pt o f the b la c k fa mily a s “dysfunc tio na l” • pre do mina te s. 1980’ s – Gra dua l re c o g nitio n a nd a c c e pta nc e o f • disc rimina tio n a nd so c ia l ine q ua lity upo n me nta l he a lth a nd me nta l he a lth c a re . 9/ 25/ 2014 4
African American Elders Sociological Perspective Co ho rt who e xpe rie nc e d le g a lize d se g re g a tio n a nd • disc rimina tio n a s the so c ie ta l norm . Substa nda rd ho using a nd e duc a tio n; ine q ua lity in • o c c upa tio na l o ppo rtunitie s re g a rdle ss o f e duc a tio n. Infe rior a c c e ss a nd qua lity o f me dic a l a nd me nta l • he a lth c a re . Disre spe c tful, de huma nizing tre a tme nt; life -thre a te ning • e xpe rie nc e s (ra c e rio ts, lync hing ). F o ug ht va lia ntly to de fe nd o ur c o untry, b ut c o uld no t e njo y • fre e do ms the y fo ug ht ha rd to se c ure . Hig he r pro po rtio ns live in po ve rty, suffe r multiple • c hro nic illne sse s, mo re vulne ra b le to vic timiza tio n a nd ha ve fe we r fina nc ia l re so urc e s (e .g . histo ry o f e xc lusio n fro m o rig ina l So c ia l Se c urity Ac t, e tc .) 9/ 25/ 2014 5
African American Elders Sociological Perspective Histo ric re silie nc e de spite o ve rwhe lming o dds.. • Pre fe re nc e fo r a nd re lia nc e upo n info rma l suppo rt • syste m. K e e pe r o f the “fa mily na rra tive ” a nd fa mily histo ry. . • Pre se rva tio n o f fa mily unit de spite multiple • e nviro nme nta l stre sso rs – g ra ndpa re nts ra ising g ra ndc hildre n. I mpo rta nc e o f re lig io n a nd spiritua lity a s • c o rne rsto ne o f life . 9/ 25/ 2014 6
African American Elders Religion As “Protective” Factor Afric a n Ame ric a ns, e spe c ia lly wo me n, with stro ng re lig io us b e lie fs a nd who a tte nd re g ula r re lig io us se rvic e s a re sig nific a ntly le ss like ly to fe e l de pre sse d o r to b e suic ida l • So c ia l c o nne c te dne ss pro vide d b y fa ith c o mmunitie s. • Psyc ho lo g ic a l c o mfo rt a nd re info rc e s se nse o f ho pe a nd po we r o ve r a dve rsity • I nc re a se d se lf- e ste e m a nd impo rta nc e . • Re info rc e s sa nc tio n a g a inst suic ide . • I nc re a sing fa ith- ba se d initia tive s to • a ssist in e duc a tio n a nd linka g e to • me dic a l/ me nta l he a lth se rvic e s. 9/ 25/ 2014 7
African American Elders Primary Mental Health Issues Affecting AA Elders • Anxie ty , de pre ssion a nd de me ntia ma jo r MH pro b le ms a mo ng Afric a n Ame ric a n e lde rs. (So urc e : Vinso n, Cro wthe r, Austin a nd Guin, 2014). • Hig he st ra te s o f Alzhe ime r’ s dise a se tha n o the r po pula tio ns; c ultura l pe rc e ptio ns o f de me ntia . • I ssue o f stig ma in vie wing me nta l illne ss • Unde r-dia g no se d a nd unde r-tre a te d de pre ssio n 9/ 25/ 2014 8
African American Elders Family Caregivers Of Aa Elders Histo ric a l vie ws o f Afric a n Ame ric a n c a re g ive rs. • E lde r c a re g iving a s c o re “fa mily va lue ”; filia l • re spo nsib ility a nd re spe c t. Ma jo r c ha lle ng e s in pro viding c a re . • I mpa c t o f c ultura l tra ditio n o f “sta ying stro ng ” upo n • physic a l a nd me nta l he a lth. Ne g a tive e xpe rie nc e s within the me dic a l a nd • me nta l he a lth syste ms. 9/ 25/ 2014 9
African American Elders Impact of Health Care Disparities Among AA Elders: Dispro po rtio na te ly hig he r inc ide nc e s o f ma jo r • c hro nic illne sse s, inc luding c a nc e r, c a rdio va sc ula r dise a se s, dia b e te s, a nd Alzhe ime r’ s dise a se / re la te d de me ntia s. Dia g no se d a t la te r sta g e o f dise a se due to de la ye d • ide ntific a tio n/ a c c e ss. Ba rrie rs to a c c e ssing q ua lity c a re – tra nspo rta tio n, • insura nc e c o ve ra g e fo r spe c ia lists, fina nc ia l c o nstra ints fo r L T C re so urc e s, c ultura l b ia s o f he a lth c a re pro fe ssio na ls. Cultura l fa c to rs – mistrust a nd fe a r o f he a lth c a re • syste m; unde r-utiliza tio no f he a lth/ / so c ia l se rvic e s 9/ 25/ 2014 10
African American Elders Family Caregivers Of AA Elders: • Histo ric a l vie ws o f Afric a n Ame ric a n c a re g ive rs. • E lde r c a re g iving a s c o re “fa mily va lue ”; filia l re spo nsib ility a nd re spe c t. • Ma jo r c ha lle ng e s in pro viding c a re . • I mpa c t o f c ultura l tra ditio n o f “sta ying stro ng ” upo n physic a l a nd me nta l he a lth. • Ne g a tive e xpe rie nc e s within the me dic a l a nd me nta l he a lth syste ms. 9/ 25/ 2014 11
African American Elders Importance Of Respect • Use o f e lde r’ s la st na me , unle ss first na me b a sis is re q ue ste d b y e lde r, is c ritic a l to e sta b lish re la tio nship a nd ra ppo rt! • Ro o te d in Afric a n tra ditio n o f e lde rs a s re ve re d “te a c he rs”. • I mpo rta nt to re me mb e r tha t histo ric a lly, use o f fa milia rity with o lde r AA wa s a syste ma tic , de lib e ra te a tte mpt to disre spe c t, humilia te a nd sub jug a te b y the la rg e r so c ie ty 9/ 25/ 2014 12
African American Elders African-American Women and Anxiety: Amo ng the hig he st a nd lo ng e st- la sting ra te s o f • untre a te d a nxie ty diso rde rs o f a ny po pula tio n. F a c to rs c o ntrib uting to Anxie ty a mo ng AA wo me n: • o Co nc e pt o f b e ing a “Stro ng Bla c k Wo ma n”- fe a r o f a ppe a ring “we a k” to o the rs. o Multiple ro le s a nd pre ssure to live up to tho se ro le s. o So c io po litic a l re a litie s dispro po rtio na te ly impa c ting AA wo me n. F o o te r T e xt 9/ 25/ 2014 13
African American Elders Identification Of Depression Use o f sc re e ning to o ls a s pa rt o f a sse ssme nt (e .g . • Ge ria tric De pre ssio n Sc a le – Ye sa va g e ). Asse ss e duc a tio na l le ve l. Ada pt a sse ssme nt to inc lude o pe n e nde d q ue stio ns tha t • ma y ide ntify de pre ssio n: “Ho w o fte n? …” inste a d o f q ue stio ns e lic iting “Ye s/ No ” a nswe rs. o Ask a b o ut sympto ma lo g y o f d e pre ssio n ra the r tha n “Are yo u d e pre sse d ? ” o (e .g . lo ss o f a ppe tite , inso mnia , d e c re a se d e ne rg y, a nhe d o nia ). Pro vide e duc a tio n a b o ut de pre ssio n a s a hig hly • tre a ta b le me dic a l illne ss (“no t a we a kne ss o r a fa ilure ”). L o o k fo r sig ns o f “c o ve rt” suic ida l ide a tio ns: • No n c o mplia nt with me d ic a l re g ime n. o Be ha vio r tha t pla c e s pe rso n “in ha rms wa y”. o Co nside r re -e va lua tio n o f AA e lde rs dia g no se d with • me nta l illne ss in the ir e a rlie r ye a rs. 9/ 25/ 2014 14
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