1. Chapter 2 Addressing diversity of older adults

2. Is the following statement true or false?
Question
Is the following statement true or false?
The populations of Australia and New Zealand, including older adults, are increasing in diversity.

3. Answer
True. The increasing diversity that is characteristic of all age groups in Australia and New Zealand affects almost every facet of healthcare because cultural background significantly influences values, communication, health beliefs and health-related behaviours, and many other aspects of daily life.

4. Cultural diversity in Australia and New Zealand
Increasing in diversity
See Figures 2-1 and 2-2

5. Health disparities
Significant differences in regard to the rates of disease incidence, prevalence, morbidity, mortality or life expectancy between one population and another
Members of ethnic groups experience many health disparities and these have significant implications

6. Question
Is the following statement true or false? Health disparities are significant differences in regard to the rates of disease incidence, prevalence, morbidity, mortality or life expectancy between one population and another.

7. Answer
True. Health disparities are significant differences in regard to the rates of disease incidence, prevalence, morbidity, mortality or life expectancy between one population and another. Members of racial or ethnic groups experience many health disparities and these have significant implications for older adults.

8. Health literacy
A major determinant of health outcomes and a measure of quality of care.
The ability to access health information and interpret conflicting advice critically, navigate the healthcare system and communicate effectively on health-related matters.
Lower for some diverse groups of older adults.

9. Cultural competence
The Holistic Nursing Scope and Standards of Practice define cultural competence as “the ability to deliver health care with knowledge of and sensitivity to cultural factors that influence the health behavior and the curing, healing, dying, and grieving process of the person” (Mariano, 2009, p. 47).

10. Linguistically and culturally competent care
Assessing own attitudes and learning
Need to be linguistically competent and to use resources to address needs of patients who are not proficient in English

11. Cultural self-assessment for nurses working with older adults
What self-identity influences my world view?
How has my cultural background influenced me?
What is my attitude towards people who
are immigrants?
have difficulty with the English language?
have difficulty communicating?
have a cultural background different from my own?
look or act like the stereotype of people who are gay, lesbian or transgender?

12. Cultural self-assessment for nurses working with older adults (cont.)
What are my attitudes about and experiences with health practices that differ from my own?
How well do I communicate and understand?

13. Cultural perspectives on wellness
Explore what health and wellness mean to individuals
Definitions of health and wellness are rooted in the three major health belief systems

14. Question
What major paradigm believes that the origins of illness include sorcery, breach of a taboo, intrusion of a disease object, intrusion of a disease-causing spirit, and loss of soul?
Magico-religious paradigm
Holistic paradigm
Scientific paradigm
Biomedical paradigm

15. Answer
A. Magico-religious paradigm The magico-religious paradigm believes that the origins of illness include sorcery, breach of a taboo, intrusion of a disease object, intrusion of a disease-causing spirit, and loss of soul.

16. Health belief system Health-related attitudes, beliefs and practices
Integrate beliefs from two or all of these paradigms, but some people are firmly entrenched in one health belief system

17. Magico-religious paradigm
Supernatural forces dominate
Origins of illness include sorcery, breach of a taboo, intrusion of a disease object, intrusion of a disease- causing spirit, and loss of soul
Illness is initiated by a supernatural agent with or without justification, or by a person who practises sorcery or engages the services of sorcerers

18. Magico-religious paradigm (cont.)
Health is a gift or reward given as a sign of God’s blessing and goodwill
Health and illness belong first to the community and then to the individual, so there is a strong sense of community
Common among Latino, African, Caribbean, African American and Middle Eastern groups

19. Holistic paradigm Forces of nature must be kept in balance or harmony
Human life is only one aspect of nature and a part of the general order of the universe
The whole person is viewed in the context of the total environment
Disease is caused by an imbalance or a disharmony among the human, geophysical and metaphysical forces of the universe

20. Holistic paradigm (cont.)
Illness is not an intruding agent, but is a natural part of life’s rhythmic course
Diseases of civilisation are just as much illnesses as are biomedical diseases
Health and healing reflect the quality of wholeness associated with healthy functioning and wellbeing
Common among Asian, North American Indian groups

21. Scientific (biomedical) paradigm
Life is controlled by a series of physical and biochemical processes
Principle of determinism
Principles of mechanism
Principle of reductionism

22. Scientific (biomedical) paradigm (cont.)
Disease is a breakdown of the human machine as a result of stress, internal damages, or external trauma or invasion
Health is the absence of disease
Common among most Western cultures, including Australia and New Zealand

23. Obtaining information about culturally diverse groups
Research on incidence of specific conditions in different population groups
Studies that examine the effectiveness of a treatment in a specific patient population
Studies that compare similar actions or outcomes of two or more culturally diverse groups
Randomised clinical trials to determine the extent to which specific treatments ameliorate health disparities among diverse populations

24. Overview of cultural groups of older adults in Australia and New Zealand
Both Australia (Figure 2-6) and New Zealand (Figure 2-2) have many CALD groups
Both countries have an Indigenous population: Indigenous Australians and Māori (Figures 2-3 & 2-5).