Cultural Diversify and Geriatric Care: Challenges to the Health Professions Danyl Wieland, Donna Benton, B. Josea Kramer ana Grace D. Dawson (Eds.); New York, NY: The Haworth Press, Inc.; 1994; 116 pages
This book consists of articles based on presentations at a conference held in Los Angeles in 1993. Topics were approached from the perspective of cultural relativity and cross-cultural comparisons. The importance of communication to bridge different expectations was stressed throughout.
In the first chapter, Judith Barker discusses the importance of health professionals recognizing the wide varieties in world views among different cultures and age groups. She provides several examples to clearly illustrate beliefs of the American health care system which conflict with those of different cultures, and especially with those of older people. She identifies the mechanisms by which these incongruities cause difficulty in the patient-provider relationship. Specific strategies for circumventing these difficulties are not included.
In the second chapter, Rubenstein and Kramer draw on national data sets to present intercultural differences in the pattern of aging. The authors briefly summarize national life expectancy and mortality data, clearly delineating the "cross over" in life expectancy between whites and nonwhites after the age of 65. The authors discuss intercultural differences in disease, disability and functional status. They provide a good analysis of the causes of these discrepancies and conclude witì a coherent discussion of the limitations of existing national databases.
In Chapter 3, DamronRodrigues, Wallace and Kingston present data on health service utilization to demonstrate that minority older persons are not obtaining health care services as readily as whites. After briefly reviewing the literature on barriers to service utilization, the authors provide a three-tiered framework for understanding the factors that affect service utilization by an increasingly diverse older population. Although this chapter neither extensively reviews nor adds to existing literature, the authors do provide a useful structure in which to examine this pressing problem. A more detailed analysis of some of the important points raised in this chapter would have been helpful.
In Chapter 4, Waite, Harker and Messerman discuss the problems with diversity training programs, citing specifically the lack of theoretical frameworks on which to base the training; a failure to address the needs of the team members being trained; and an absence of a systematic evaluation format. The authors identify the many cultural factors which may affect communication in team meetings and adapt several assumptions about team meetings in educational settings in order to provide a framework for planning and evaluating training programs for multicultural interdisciplinary health care teams. The chapter would have been more relevant to the others in the book if the issues concerned with team members relating to families of different cultures alluded to in the conclusion had been discussed in greater depth.
In Chapter 5, Alien described a multidisciplinary fellowship program that incorporated cultural content into geriatric clinical education and training. Examples demonstrated how interaction with fellows from medical sociology or anthropology could assist clinicians in understanding a patient's culture and its impact on his illness and health behavior. The author provides several useful recommendations to assist clinical faculty in taking advantage of existing opportunities that lend themselves to teaching about cultural diversity. A more in-depth discussion of these recommendations would have enhanced the contribution of this chapter to the overall volume.
In Chapter 6, Hasselkus presents a trajectory in which the locus of decision-making and responsibility fluctuates between profession and family caregivers during various stages in the rehabilitation process. Problems arise on this trajectory when professionals fail to facilitate the patient's resumption of normal routines. This chapter presents s cogent analysis of the relationship between professional and family caregivers but the impact of the family's cultural background on this relationship is not addressed.
In Chapter 7, KagawaSinger presents a paradigm for reintegrating the process of dying into the context of living. The author briefly discusses the functions of rituals of several world religions. This author identifies differences between American practices and those of other cultures and discusses the need for viewing dying and grieving rituals in the context of the overall culture. This is a thought-provoking article about the need to restructure hospital practices to provide culturally acceptable care to dying patients and their families. The chapter concludes with suggested strategies to assist health professionals in accomplishing this task.
This book provides a helpful and well-written overview of the issues related to cultural diversity and geriatric care. While not adding anything new to the literature on this topic, it provides useful insights into the cultural influences on aging and health care. The book would have benefited by further development of these insights. Chapters 4, 5 and 6 added little to the discussion on cultural diversity.