NOTRE DAME OF TACURONG COLLEGE

COLLEGE OF NURSING
Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines
Telephone No.: (064) 200-3631 Fax No.: (064) 200-4131

Subject: Care of the Older Adult Schedule:

Placement: First Semester, BSN 3 Course Credit: 2 units lecture;1unit RLE
Instructor: Elmer G. Organia, RN, MAN

LESSON 5

DIVERSE GROUPS OF OLDER ADULTS

Objectives:

After reading this chapter, you should be able to:

1. Describe projected changes in the diversity of the older population
2. Describe unique views of health and healing among ethnic groups.
3. Identify ways in which nursing care may need to be modified to accommodate
persons of diverse ethnic backgrounds.
Contents:
INCREASING DIVERSITY OF THE OLDER ADULT POPULATION

Population projections support the view that the older population in the United
States is becoming more ethnically and racially diverse. Nearly one in eight people in the
United States speak a language other than English at home, with one-third of these
people speaking Spanish (Wan, Sengupta, Velkoff, & DeBarros, 2005). In 2000,
approximately 84% of older Americans were non-Hispanic White, while it is projected that
this population will decrease to 64% by 2050. During this same period, there will be a
dramatic growth among Hispanic older adults, who will represent nearly 20% of the older
population. Black individuals will grow from 8% to over 12% of the older population
during this time. By 2020, one-quarter of America’s older population will belong to a
minority racial or ethnic group (Administration on Aging, 2014; U.S. Census Bureau,
2014). And, in addition to racial and ethnic diversity, there will be growing numbers of
lesbian, gay, bisexual, and transgender persons entering their senior years who will
present a unique set of challenges.

The growing diversity of the older population presents challenges for gerontological nursing in
providing culturally competent care. Essential to the provision of culturally competent care is
an understanding of:

The experiences of individuals of similar ethnic or racial

backgrounds Beliefs, values, traditions, and practices of
various ethnic and racial groups
Unique health-related needs, experiences, and risks of various ethnic and racial groups
and persons of similar sexual orientation
 One’s own attitudes and beliefs toward people of various ethnic and racial groups, and
persons of similar sexual orientation, as well as those attitudes of coworkers
Language barriers that can affect the ability of patients to communicate health-related
information, understand instructions, provide informed consent, and fully participate in
their care

An understanding of cultural, ethnic, and sexual orientation differences can help to erase the
stereotypes and biases that can interfere with effective care and demonstrate an appreciation
for the unique characteristics of each individual.

DIVERSE GROUPS OF OLDER ADULTS

People from a variety of countries have ventured to America to seek a better life in a new
land. To an extent, they assimilated and adopted the American way of life; however, the
values and customs instilled in them by their native cultures are often deeply ingrained, along
with their language and biological differences. The unique backgrounds of these newcomers
to America influence the way they react to the world around them and the manner in which
that world reacts to them. To understand the uniqueness of each older adult encountered,
consideration must be given to the influences of ethnic origin.
Members of an ethnic or cultural group share similar history, language, customs, and
characteristics; they also hold distinct beliefs about aging and older adults. Ethnic norms can
influence diet, response to pain, compliance with self-care activities and medical treatments,
trust in health care providers, and other factors. The traditional responsibilities assigned to
the aged of some ethnic groups can afford them opportunities for meaningful roles and high
status.
Studies of cultural influences on aging and effects on older adults have been sparse but
are growing. Experiences and observations can provide insight into the unique characteristics
of specific ethnic groups. Although individual differences within a given ethnic group exist and
stereotypes should not be made, an understanding of the general characteristics of various
ethnic groups can assist nurses in providing more individualized and culturally sensitive care.

ASIAN GROUPS

In the early 1700s, Filipino people began immigrating to America, but most Filipino
immigrants arrived in the early 1900s to work as farm laborers. In 1934, an annual
immigration quota of 50 was enacted; this quota stayed in place until 1965.
In the early 1900s, Korean people immigrated to America to work on plantations.
Many of these individuals settled in Hawaii. Another large influx of Koreans, many of
whom were wives of American servicemen, immigrated after the Korean War.
The most recent Asian American immigrants have been from Vietnam and Cambodia.
Most of these individuals came to the United States to seek political refuge after the
Vietnam War.
Although differences among various Asian American groups exist, some similarities are
strong family networks and the expectation that family members will care for their older
relatives at home. Asian Americans represent about 2% of the total nursing home population.

MUSLIMS

There are over a billion Muslims in the world who share a common culture based on the
 belief that Allah is God and Muhammad is his messenger. Muslim customs and traditions are
centered on religious beliefs and customs derived from Muslim’s holy book, the Quran.
Older adults represent less than 1% of the Muslim population. They are viewed with
high esteem and treated with respect; mothers are especially honored. The tradition has
been for older Muslims to be cared for by their families, although this is anticipated to
change as more Muslim women enter the workforce.
Muslims eat only meat that has been slaughtered according to religious requirements
(halal meat) and do not eat pork or pork products. Water typically is consumed with every
meal. Muslim patients who adhere strictly to fasting may not take medications during
fasting times; sensitivity to this practice may require an adjustment of medication
administration times.
A Muslim patient may prefer to be cared for by a person of the same sex and to have
exposure of the body kept to a minimum. Muslims do not like to have their head touched
unless it is part of an examination or treatment.
Muslim patients who are unconscious or terminally ill should be positioned so that their
face is turned to face Mecca, which typically is west to northwest. Family and friends may
recite the Quran or prayers in front of the patient or in a nearby room. If a chapel is provided
for praying, it is important that no crosses or icons be present. The family should be asked if
they would like their religious leader to visit.

Gay, Lesbian, Bisexual, and Transgender Older Adults

Despite the growing awareness and acceptance of gay, lesbian, bisexual, and
transgender (LGBT) persons in society as a whole, there has been minimal consideration
of the challenges and needs of these individuals when they reach late life. In fact, they
are referred to as a largely invisible population (Fredriksen-Goldsen et al., 2011). This
invisible population is growing, however; as much as 10% of the population identifies
themselves as being lesbian, gay, bisexual, or transgender; the LGBT population is
projected to double by 2030.
This generation lived through a period when considerable prejudice and
discrimination existed against persons who were LGBT; therefore, these individuals may
not be open about sexual orientation when seeking health services. Studies have found
that LGBT older adults in community and long-term care settings reported being fearful of
rejection and neglect by caregivers, not being accepted by other residents, and being
forced to hide their sexual orientation (Stein, Beckerman, & Sherman, 2010). In addition,
among LGBT elderly (Fredriksen-Goldsen et al., 2011):

Nearly one half have a disability and nearly one third report depression.
There are higher rates of mental distress and a greater likelihood of smoking and
engaging in excessive drinking than heterosexual persons.
Almost two thirds have been victimized three or more times.
Thirteen percent have been denied health care or received inferior care.
More than 20% do not disclose their sexual or gender identity to their physician.

Recent years have noted progress in addressing the needs of the LGBT population.
The American Association of Retired Persons has created an online LGBT community,
the American Society on Aging has an LGBT Aging Issues Network, and the Joint
Commission has added respect for sexual orientation to the rights of residents of
assisted living communities and skilled nursing homes. In addition, Services and
Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE) and the
Movement Advancement Project (MAP) have been aggressively addressing policy and
regulatory changes that are needed to address the needs of this population.
Nurses need to appreciate that the LGBT elder population represents unique
individuals with different experiences, profiles, and needs. As with any patient,
individualized approaches are essential, and stereotypes need to be avoided. Nurses
should inquire about their partners. These patients may desire to have involved with the
care and should include these partners as desired by the patients. Further, nurses need
to assure that LGBT individuals can receive services without prejudice, stigmatization, or
threat.

NURSING CONSIDERATIONS FOR CULTURALLY

SENSITIVE CARE OF OLDER ADULTS
Numerous minority, ethnic, or cultural groups that have not been mentioned also possess
unique histories, beliefs, and practices. Rather than viewing differences as odd and forcing
patients to conform to “American” traditions, nurses should respect the beauty of this diversity
and make every effort to preserve it. The beliefs, values, relationships, roles, and traditions
associated with cultural and ethnic identity add a special significance to life.
The effectiveness of care can be largely influenced by the initial impression made by
the nurse. Nurses need to reflect on any personal feelings or attitudes that could
influence the nurse–patient relationship or convey a prejudicial attitude. For example, if a
nurse comes from a religious belief that homosexuality is abnormal and sinful, the nurse
may display discomfort in the nurse–patient interactions when faced with a patient who is
gay. As a result, the patient may sense the nurse is prejudiced and be reluctant to share
all aspects of his history and problems. Likewise, if the nurse has had limited
experiences with persons of a different racial group, he or she may appear uneasy or
unnatural in communicating with those individuals. Reflection on their feelings and
discussing these issues with other professionals can assist in preventing personal
feelings from interfering with the professional relationship.
Nurses need to be careful not to stereotype patients based on race, ethnicity, sexual
orientation, or other factors. All patients should be addressed by their last name unless
they request otherwise. Recognizing that based on their cultural or ethnic backgrounds
some persons may be guarded with the personal information, nurses should explain the
reason various questions will be asked during the interview. Ample time should be
allotted for patients to share their histories and cultural or religious practices. The use of
touch (e.g., patting the person’s hand or touching an arm) often demonstrates caring and
assists in putting a person at ease; however, be aware that in some cultural groups,
being touched by a stranger is viewed as inappropriate. The same holds true for the
spatial distance between the nurse and the patient during the interview. This reinforces
the importance of nurses becoming familiar with the beliefs and practices of various
groups.
Dietary preferences should be accommodated, adaptations made for special practices,
and unique ways of managing illness understood. Consideration should be given to
differences in the expression of pain, fear, and other feelings. Reactions to illness and care
can vary. For example, one person may view illness as punishment for wrongdoing; however,
another sees it as part of the normal human experience. Some individuals may desire the
active participation of family members or traditional healers in their care, whereas others,
 even those whose ethnic or cultural group traditionally do desire these things, do not.
If nurses are unfamiliar with a particular group, they should invite the patient and the family
members to educate them or contact churches or ethnic associations (e.g., Polish National
Alliance, Celtic League, Jewish Family and Children’s Services, and Slovak League of
America) for interpreters or persons who can serve as cultural resources. One powerful means
to learn about cultural influences for individual patients is to ask them to describe their life
stories (see Chapter 4). Nurses convey sensitivity and caring when they try to recognize and
support patients’ ethnic and cultural backgrounds. Nurses also will become enriched by
gaining an appreciation and understanding of the various interesting ethnic groups.

The U.S. Department of Health and Human Services has developed standards for
culturally and linguistically appropriate services that can guide clinical settings in working
with diverse populations; their Web site can be accessed at http://minorityhealth.hhs.gov.
The increasing diversity of future aged populations will affect services in a variety of ways.
Among the needs that could present are:

Institutional meal planning that incorporate

ethnic foods Multilingual health education
literature
Readily available translators
Provisions for the celebration of holidays (e.g., Chinese New Year, St. Patrick’s Day,
Black History Month, Greek Orthodox Easter)
Special interest groups for residents of long-term care facilities and assisted living
communities

An uncomfortable reality that a nurse may face is the prejudicial comment by a patient. As
patients will reflect the society in which they live and with prejudices, unfortunately, being
alive and well in society, it stands to reason that the nurse will encounter prejudiced patients.
For example, a patient may refuse to receive care from a nurse of a different race. At times,
persons who are highly stressed or who have dementias may use offensive racial language.
Understandably, this can be hurtful to the nurse. The individual patient and situation, as well
as the nurse’s experience in handling these situations, will determine the action the nurse
should take; options include requesting the patient not to make the comment, asking the
patient if he or she would prefer to have someone else assigned as his or her nurse, asking
to be reassigned, and discussing the situation with one’s manager.
Nurses need to ensure that cultural, religious, and sexual orientation differences of older
adults are understood, appreciated, and respected. Demonstrating this sensitivity honors
the older adult’s unique history and preserves the familiar and important. The challenges
faced by older adults need not be compounded by insensitive or prejudicial behaviors by
nurses.

Evaluation
To pass the subject, you must:
1. Read all subject readings and answer the pre-assessment quizzes, activities,
expected output, and assignments.
2. Submit the expected output on time.
3. Pass the midterm and final exams.
Grading System:
Classwork = 60%
 Examination = 40%
100%

Reference

Eliopoulos, C. (2018). Gerontological Nursing, 9th edition. Wolters Kluwer. New

York

Prepared by:

ELMER G. ORGANIA, RN, MAN

Instructor
 NOTRE DAME OF TACURONG COLLEGE
COLLEGE OF NURSING
Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines
Telephone No.: (064) 200-3631 Fax No.: (064) 200-4131

Name of Student: _________________________________Year/Level: _________

Date Submitted: __________________________________ Score: ____________

The Aging Population

Book Title: Gerontological Nursing, 9th edition (2018)
Author: Charlotte Eliopoulos, Ph.D., MPH, RN

LESSON 5

Theories of Aging

Instructions: Answer the following questions. Hit the point and get a mark.

Questions:

1.What would you do if faced with a situation in which an older client refused to allow you to
provide nursing care for him because you are of a different ethnic or racial group?
2.Discuss the preferred care and treatment of Filipino older adults.
3.Discuss the considerations in caring for a Muslim older adult.
4.How will you ensure satisfying/ fulfilled old age for gay, lesbians, and other members of
the LGBT?
5.Discuss your personal plans and strategies to make your old age a fulfilling one.

Note: Answers should be in Arial size 11 if typewritten. For handwritten answers, please
write legibly. You may attach an additional sheet for your answers.

Deadline: October 7, 2020, @11:59 pm.