Research Commentary  May 2017
Apr 1, 2017
The focus of this review is on the Health of Older Asian people. Census 2013 shows significant growth in the Asian population for over 75 years age group compared to Census 2006 (SNZ, 2013). There are many cultural reasons that may prevent families from seeking support for older family members. In collective cultures, it is important for elders to be looked after by their own family. Cultural factors may delay families from seeking support, leading to increased stress for both the carers and the older person. Language barriers are significant for non-English speaking older people (Ministry of Health, 2013).
The migrant experience for Asian older people can be particularly stressful due to factors such as limited or no English language proficiency, limited income, loneliness and isolation. Many CALD families experience confusion and stress when trying to navigate care and support services for their older relatives. As just one example, the Ministry of Health (2013) New Zealand Framework for Dementia Care, recognises that dementia care needs to be improved nationwide in a way that is inclusive of Asian and other ethnic minority groups. In 2011, 1838 (3.7 percent) of the estimated 48,182 people with dementia were Asian. By 2026, of the estimated 78,267 people with dementia in New Zealand, 6568 (8.4 percent) are expected to be Asian (Alzheimers New Zealand, 2012).
The CALD Older People Resource for Health Providers (WDHB eCALD®Services, 2017) which has been updated is intended to support the health and disability workforce to provide culturally competent care for older peoples from Asian, Middle Eastern and African backgrounds and their families.
The CALD Older People Resource for Health Providers. http://www.ecald.com/Portals/49/Docs/Toolkits/cald-older-people.pdf
New Zealand Framework for Dementia Care. http://www.health.govt.nz/system/files/documents/publications/new-zealand-framework-for-dementia-care-nov13.pdf
Statistics New Zealand (2013). 2013 Census QuickStats about national highlights. Available from www.stats.govt.nz. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-national-highlights.aspx
Commentary provided by Dr Annette Mortensen, eCALD® Project Manager: Research & Development.
The following are articles reviewed:
Article 1: Cultural and religious beliefs and values, and their impact on preferences for end-of-life care among four ethnic groups of community-dwelling older persons.
The aim of this Australian study was to explore specific cultural and religious beliefs and values concerning death and dying, truth telling, and advance care planning, and the preferences for end-of-life care among older persons from culturally and linguistically diverse backgrounds. A total of 171 community older persons who make regular visits to 17 day care centres expressed in a questionnaire their; (1) beliefs about death and dying, truth telling, and advance care planning, and (2) preferences for end-of-life care. The findings of the study were as follows:
Beliefs about death and dying, truth telling, and advance care planning
Whilst there was an acceptance of dying as a normal part of life, almost half of the respondents (n = 79) believed that death should be avoided at all costs. This view was held more strongly by the Eastern Europeans (64%) and Asia/Pacific groups (53%) than the Anglo-Celtic and Mediterranean groups.
Over 92% (n = 12) of people from the Asia/Pacific group strongly agreed or agreed that they have talked to their family about future care and treatment plans when they are really unwell and they were also more likely to have talked to their GP (84_62%, n = 11). 50% (n = 34) of people from the Mediterranean group reported that they have thought about the kind of medical care that they want when they are dying and over 54% (n = 37) of 71 people have talked to their family about future care and treatment plans when they are really unwell. However, only 27% (n = 19) of them have talked to their GP about future care and treatment plans.
Preference for end-of-life care
People with an Asia/Pacific background indicated strong preference for being in the hospital (60% disagreed or strongly disagreed with being at home) and for going to the hospital or the emergency room (86_67%) if they had a disease that could not be cured and if they could be taken care of at home.
Authors: S Ohr, S Jeong and P Saul.
Citation: Ohr, S., Jeong, S. & Saul, P. (2016). Cultural and religious beliefs and values, and their impact on preferences for end-of-life care among four ethnic groups of community-dwelling older persons. J Clin Nurs. 2016 Sep 7. doi: 10.1111/jocn.13572. [Epub ahead of print].
Article 2: Effect of nativity and duration of residence on chronic health conditions among Asian immigrants in Australia: A longitudinal investigation.
This study examined the effect of Asian nativity and duration of residence in Australia on the odds of reporting a chronic health condition (cancer, respiratory problems, cardiovascular disease (CVD) and diabetes mellitus). Data were from waves 3, 7 and 9 of the Household Income and Labour Dynamics in Australia (HILDA) longitudinal survey, and multi-level group-mean-centred logistic regression models were used for the analysis. After covariate adjustment, Asian immigrants were less likely to report cancer and respiratory problem compared with native-born Australians. While there was no significant difference in reporting CVD, they were more likely to report diabetes than native-born people. Asian immigrants maintained their health advantage with respect to cancer regardless of duration of residence. However, after 20 years of stay, Asian immigrants lost their earlier advantage and were not significantly different from native-born people in terms of reporting a respiratory problem. In contrast, Asian immigrants were not measurably different from native-born Australians in reporting diabetes if their length of stay in Australia was less than 20 years, but became disadvantaged after staying for 20 years or longer. There was no measurable difference in the odds of reporting CVD between Asian immigrants and native-born Australians for any duration of residence. On the whole this study found that health advantage, existence of healthy immigrant effect and subsequent erosion of it with increasing duration of residence among Asian immigrants depends upon the chronic health condition.
Authors: S.S.Pasupuleti, S.Jatrana & K. Richardson.
Citation: Pasupuleti, S.S., Jatrana, S. & Richardson, K. (2016). Effect of nativity and duration of residence on chronic health conditions among Asian immigrants in Australia: A longitudinal investigation. J Biosoc Sci. 2016 May;48(3):322-41. doi: 10.1017/S0021932015000206. Epub 2015 Jul 3.
Article 3: The mutual relationship between immigrants' disrupted everyday activities and their Health: A grounded theory of experiences of Korean immigrants settling in New Zealand.
For Asian immigrants, migration to a new and alien society disrupts familiar lifestyles. Adjusting to a new way of life is stressful and can impact on migrant’s health and well-being. This grounded theory study explored how immigrants adjust to a new environment by analyzing the experiences of 25 Korean immigrants in New Zealand. The findings suggest that immigration is stressful, requiring changes to valued ways of living for Korean families, with adverse impacts on health and mental health. For older people there were particular hardships adjusting to life in New Zealand.
This study shows that living in an unfamiliar culture leads to a loss of control over one’s life in the early and intermediate phases of settlement. That loss of control for Korean and other Asian immigrants can lead to psychological distress and physical frailty. One participant in the study stated that: “Without enough information, it was very hard and stressful for me to settle my family here. Now I have been diagnosed with diabetes. I assume that my diabetes is a result of anxiety and stress from those periods” (Ant). This conclusion is congruent with the finding that “the healthy migrant effect abates over time as acculturation occurs” (Mehta, 2012, p. xi).
The study has important implications for the role of social workers in assisting newcomers from CALD backgrounds through managing stress, reducing isolation and improving integration in the community.
Reference: Mehta, S. (2012). Health needs assessment of Asian people living in the Auckland region. Auckland: Northern DHB Support Agency. Retrieved from: http://www.ecald.com/Resources/Resources-Publications/ID/808/Health-Needs- Assessment-of-Asian-People-Living-in-the-Auckland-Region-2012.
Authors: H. Kim & C. Hocking.
Citation: Kim, H. & Hocking, C. (2016). The Mutual Relationship Between Immigrants' Disrupted Everyday Activities and Their Health: A Grounded Theory of Experiences of Korean Immigrants Settling in New Zealand. Soc Work Public Health, 31(3),113-26.
Article 4: Patient, family, nurse perspectives on Chinese elders' quality of life.
Families and nurses are important care-providers and proxies of older people. Their ability to assess the quality of life of elders in ways that align with how older people assess themselves has policy implications for allocating services and resources to older persons. This study aimed to investigate the alignment of perspectives of the quality of life held by older people, their families and nurses in China. The findings of the study were that on the more observable dimensions families and nurses were in close agreement with the older person in relation to quality of life reports. However, in the more subjective domains, family and especially nurses tended to estimate that the older person's suffering as more severe than they themselves thought. The perspectives of older patients and their family are more closely aligned regarding the older person's quality of life than that of nurses caring for them, a finding inconsistent with international research. The evidence suggests that nursing work assignment processes could influence the accuracy of nurses' perceptions of their patient's quality of life.
Authors: W. Wang & T. McDonald.
Citation: Wang, W. & McDonald, T. (2016). Patient, family, nurse perspectives on Chinese elders' quality of life. Int Nurs Rev. 2016 Nov 11. doi: 10.1111/inr.12333. [Epub ahead of print].