When elders and medical cultures collide
by Isabel Fawcett, SPHR
As America's melting pot ages, healthcare professionals may need to more effectively balance the many socio-cultural influences at work in elders' lives, starting with the 80-somethings, 90-somethings, and their generational contemporaries. In their elder life transitions the 80-plus generation is stoic, or stubborn, depending on their carers' perspectives. The cultural meltdown is underway.
Eldercare's Cultural Issues
The 2010 United States Census Bureau's slogan was, "We can't move forward until you mail it back." Although it will be months before the U.S. Census Bureau "moves forward" in delivering population information to Congress, for apportionment, the aging population demographic in the U.S. continues burgeoning. The U.S. Census 2010 includes a headcount of America's Baby Boomers, reportedly 40 million strong by various unrelated estimates.
Eldercare's Melting Pot
Perhaps the Statue of Liberty and Ellis Island, in New York City, are the most visible symbols of America as the great melting pot of immigrant cultures. With America's aging population "Give me your tired and your poor," may now be America's culturally diverse population in need of eldercare services. The cultural melting pot may, or may not be as harmonious, as it plays itself out in long-term care.
Consider the following published trends.
- In 2003, 83 percent of older adults in the United States were non-Hispanic white; 8 percent were non-Hispanic black; 6 percent were Hispanic; and 3 percent were Asian. (1)
- By 2030, the changing face of older adults in the United States will be evident: 72 percent of this population will be non-Hispanic white; 11 percent will be Hispanic; 10 percent will be black; and 5 percent will be Asian. (1)
- One (2007) report estimates that Native American Indians are among the transitional groups with the proportion of elderly expected to double in the next 50 years.
I am not unique in having experienced multiple global cultural influences in my life. When I consider elder population trends in context of modern healthcare practices, I can't help but cringe. The great melting pot is already rife with its cultural stickies.
Cultural insensitivity in eldercare would add insult to the injury of chronic disease processes - literally and figuratively speaking. As a caregiver to an octogenarian whom I dearly love, I remain an unapologetic patient advocate for Mom, and other elders, across generations and cultures.
I'm rooting for all of us caregivers who advocate for greater cultural sensitivity in eldercare and healthcare practices.
A Couple of Eldercare Perspectives
Baby Boomers' Aging Culture: Perhaps prior to baby boomers' arrival on the scene, the widespread perception of growing older has been stagnant. Baby boomers, who have been described as "wanting it all," are not about to grow older by fading into the sunset in rocking chairs. At least some of us boomers will not.
Some boomers have started living their golden years on cruise ships, year-round, after having sold their homes. Others have taken to the great American road, living in their jazzed-up motor homes, sightseeing across the U.S.A. Among my own 50 plus peers, there is creative talk of how we might share expenses as we age, relative to our respective long-term care circumstances and elder housing needs. One of my friends lives on a boat half the year, and rents an apartment the remainder of the year.
Another Cultural Perspective: One of my many lifetime memories in caring for a chronically ill mature adult hails from a foreign (ethnic) culture. The individual was one of my godparents.
When my godmother started experiencing symptoms of malaise, she waited almost a year before going to see her doctor. In fact, other than immunizations, I don't think she had ever seen a doctor before her symptoms started. In retrospect, I believe she would have waited longer than a year. However, her friends, including my parents and others, strongly encouraged her to just go to the doctor. A fainting spell while at work was the straw that finally broke the camel's back for her.
With great fear and trepidation, she yielded to the social pressure, and with a friend to accompany her, she went to the doctor. She'd never taken a day off work before. She was a nervous wreck leading up to the day of the appointment. She did make one thing clear. Whatever "it" was that was "wrong" with her, she didn't want to be told.
Strange as it may sound to others, her cultural mindset was neither unheard of, nor was it uncommon among her peers. It is a world and a mindset that I understand, respect, and in which I am able to offer compassionate and non-judgmental care.
Such are conversations I've known, and comfortably been able to join, in different cultures at different times in my life's journeys. National origin is not germane to what I'm trying to say in this limited context, since no two individuals are alike regardless of their national origin. The whole point in context of this issue is that an elder's cultural mindset is not a minor thing.
Far be it from me to judge my godmother's, and her peers', mindset. All I know is that she died from an aggressive form of cancer less than 12 months after her memorable doctor's appointment.
In my younger years, cancer was a dirty word to many men and women who were all my elders. "The Big C," it was called, and dreaded for its ravaging effects on the human body. If "the Big C" was even suspected, even if not medically diagnosed, it was not uncommon for elders and entire families to mentally circle the wagons of protection to avoid medical treatment, hospitalization and surgery.
Some even believed that surgery "fed" cancer cells with "air" they needed to thrive. Others would not ascribe any power to the word by even mentioning it. "The Big C" defined a generations' fears.
My godmother authorized her doctors to tell her primary caregivers whatever they needed to know about her medical condition. Her doctors cooperated with her medical power of attorney. She chose to entrust and defer her course of medical treatment to her doctors and her primary caregivers. If anyone, including her doctors and/or primary caregivers tried to initiate any conversation about her medical condition, she promptly re-directed her focus and attention. Counseling? Not on her life! She wasn't confused. She was as clear as she was adamant.
She was also well-educated, with an advanced degree. She was gainfully employed as a school principal and financially independent. Her mindset, therefore, did not arise from socio-economic poverty and/or lack of formal education. In many ways, she was simply a cultural product of her generation.
Although my godmother's situation is but one example of a differing cultural mindset, her circumstances illustrate many elements of when and how elders' and medical cultures collide. What then? Mine may be a lone advocacy voice in such circumstances, but elders' voices need to be heard. I can only hope that long-term care and regulatory entities are paying attention. Some elders will not be led like lost sheep, unless they are actually lost.
I understand. Then again, I've lived my life in caregiving trenches actively listening with no heartburn whatsoever. In eldercare, as in life, all that remains is compassion and human dignity.
(1) "The State of Aging and Healthcare in America 2007," Centers for Disease Control in collaboration with Merck Company Foundation.
American Society on Aging