There are many cultural factors associated with elderly Asian Americans that impact health and the provision of healthcare. Relevant factors specific to this patient include the traditional beliefs and practices related to family relationships, social behaviors, and utilization of outside resources. The expectation of filial obligation and piety are among the most influential Asian cultural norms. Weng & Nguyen (2011) validate the prevalence of this cultural ideal citing a 2009 (Mellor) study showing 73% of Asian Americans feel obligated to provide support for elderly family members. As a result, multigenerational households are very common among Asian American families. A 2001 AARP study found that it is more than twice as common (43% vs. 19%) versus White American families (Weng & Nguyen, 2011).

The importance of family in Asian cultures is again displayed by the value traditionally placed on familial and collective interests over individual needs. This influences the willingness to disclose information to people outside of the family that maybe perceived as shameful or negative. Keeping personal and family matters private to preserve their reputation may cause important health information to be excluded. Mental illness and related treatments are prime examples of health issues stigmatized as shameful in Asian culture and therefore, often not disclosed to healthcare providers. This contributes to the underutilization of mental health services by Asian Americans as compared to other ethnic groups (USHHS, 2001).

This culture’s traditional emphasis on harmony leads to the avoidance of conflict (Ball et al., 2019; Weng & Nguyen, 2011). This avoidance prevents directly addressing or discussion of sensitive issues in a manner that may be perceived as confrontational. This cultural difference influences the communication techniques that should be used when interacting with this patient. Even prolonged direct eye contact may be perceived as rude in Asian culture (Ball et al., 2019). For JC, the elderly Asian American male living with his daughter, socioeconomic status is probably the most influential factor associated with his personal health and well-being. His financial and physical dependence strains already scarce resources worsening the burden of care on his daughter.

The amount of economic and social support he requires as a result of his medical conditions are directly correlated to the severity of this burden (Wang, et al., 2017). As the caregiver burden increases family conflict and tension rise necessitating intervention for the wellbeing of all parties involved. The financial strain and of this patient and his family increase his risk for physical and mental health problems. Limited socioeconomic resources, as seen in this case, have been proven to increase the rates of depression for elderly Asian Americans (Wang et.al., 2017; Weng & Nguyen, 2011). This patient’s verbalized feelings of burdening his daughter validates the adverse psychological and financial impacts documented by many studies care-giver burden has on Asian American families. His daughter’s willingness to provide continued support for her father will likely decline as his health needs increase and caregiver burden intensifies.

Her willingness to uphold traditional filial obligations may also be influenced as a result of acculturation to American customs regarding the treatment of elderly family members. It is imperative that the issues surrounding their lack of socioeconomic resources be addressed. This can be done by providing information on available social, healthcare, transportation, and financial resources from outside sources like Medicaid, SSI, respite care services, counseling, non-profit programs, and religious institutions. Ethnic community centers are also great sources for social interaction and networking with people who share similar cultural values. Seeking outside support in this setting may provide culturally relevant information and access to resources specific to this ethnicity from people who understand the burdens faced when caring for elderly family members without adequate assistance.

The reduced dependence on this patient’s daughter for emotional, social, financial, and other needs will lessen caregiver burden as well as the adverse mental health effects caused by lack of socioeconomic support. When interacting with this patient the provider needs to be sensitive to their communication style, the importance of confidentiality related to topics that may be perceived as shameful, the potential avoidance of mental health services, and who influences healthcare decisions. It is common for adult children, who are better accultured to American ways, take an active role in decision making in professional settings where there might be barriers to understanding. The provider should address the patient’s understanding of the language, services offered and utilization of them.

Targeted Questions: Do you have any difficulties obtaining your prescription medications? May I ask why you are currently taking Cipro four times a day? Are you aware of a rash or an infection that you have? How long have you been taking this and does it seem to help? (ask the OLDCART ?’s to assess for a better treatment option) Can you tell me about your typical diet? (Ensure nutritional content and low sodium) In what ways to you depend on your daughter? In what ways do you contribute to the household (childcare, cleaning, cooking, etc.)? (Help patient to realize his contribution not just his perceived burden on his daughter) Are you aware of the many different programs and resources available to you that may help alleviate some of the costs and other issues related to healthcare services? Have you spoken to your daughter about your feelings of burdening her? Will you please fill out this quick questionnaire (GAD-9) to assess how those feeling impact your mental health. Would you like her to be included in our conversations and/or your healthcare decisions?

Resources

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby

U.S. Department of Health and Human Services (USDHHS). (2001). Mental health: Culture,

race, and ethnicity—A supplement to mental health: A report of the Surgeon

General. Retrieved July 2, 2009, from http://download.ncadi.samhsa.gov/ken/

pdf/SMA-01-3613/sma-01-3613A.pdf

Wang, S. C., Creswell, J. W., & Nguyen, D. (2017). Vietnamese refugee elderly women and their experiences of social support: A multiple case study. Journal of Cross-Cultural Gerontology, 32(4), 479–496. https://doi.org/10.1007/s10823-017-9338-0

Weng, S. S., & Nguyen, P. V. (2011). Factors Affecting Elder Caregiving in Multigenerational Asian American Families. Families in Society: Journal of Contemporary Social Services, 92(3), 329–335. https://doi.org/10.1606/1044-3894.4133

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Solution

Caring for the elderly is a virtue that varies greatly among different cultures around the world as research indicates. The discussion post describes the cultural influences on family-oriented elderly care and its impact on both the caregivers and the patients. In this paper, I will respond to this discussion post and share my ideas with everyone for a better learning experience.

For this case, the patient, JC, is an Asian-American male who is living under the care of his daughter. In their culture, Asian-Americans believe that family is sacred. This means that they take care of each other and stay together in large households consisting of different family generations (Weng & Nguyen, 2011). This brings socio-economic strains on the families. As a result, it becomes hard to provide necessities such as good medical care especially to the elderly (Wang et al., 2017). As a PN, it is important to have this in mind when caring for these patients. Mr. JC feels that he is posing a burden on his daughter. It is be necessary to address this issue as a healthcare practitioner to ensure the safety of the patient.

The nurse should engage both parties in a discussion to decide on what is best for the patient. However, this should be done in a discreet manner that respects the socio-cultural beliefs of the family (Solomon et al., 2019). Moreover, decisions on care should be agreed upon by the family.

The patient’s caregiver should be advised on the right care the patient needs to receive. In the case that they are not able to provide this anymore and the patient’s health is in danger, counselling on alternative care methods such as adult care facilities should be done. This should be done while ensuring they don’t feel like they are abandoning their father.

References

Solomon, B. S., Dains, J. E., Ball J., Stewart, R. W., & Flynn, J. A. (2019). Seidel’s Guide to Physical Examination An Interprofessional Approach (9th ed.). Elsevier.

U.S Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity: A supplement to mental health a report of the surgeon general. PsycEXTRA Dataset. https://doi.org/10.1037/e415842005-001

Wang, S. C., Creswell, J. W., & Nguyen, D. (2017). Vietnamese refugee elderly women and their experiences of social support: A multiple case study. Journal of Cross-Cultural Gerontology, 32(4), 479-496. https://doi.org/10.1007/s10823-017-9338-0

Weng, S. S., & Nguyen, P. V. (2011). Factors affecting elder caregiving in multigenerational Asian American families. Families in Society: The Journal of Contemporary Social Services, 92(3), 329-335. https://doi.org/10.1606/1044-3894.4133