Giving Culturally Sensitive Care
September 21, 2007
SAN JOSE — Attendees gathered in Japantown last Saturday for a multicultural caregivers conference on Alzheimer’s disease. Sponsored by Yu-Ai Kai, a Japanese American community senior services center, the conference focused on Alzheimer’s, end-of-life issues, and concerns faced by caregivers who must care for family or friends with debilitating conditions.
More than 75 percent of caregivers become depressed at one time or another, said Wesley Mukoyama, executive director of Yu-Ai Kai.
Culturally and linguistically sensitive care was a central theme:
1. With Alzheimer’s, any second language learned may be the first to go. Caregivers should understand the shame and embarrassment this may cause — a person may be reluctant to socialize with the same group of friends because their language abilities are diminished.
It may be helpful for the person suffering from Alzheimer’s to be in a community or group that speaks the same native language to combat any shame or withdrawal from social activities.
2. Filial piety and family obligation, both of which are usually strong in Asian American families, brings difficulties in making decisions regarding end-of-life care.
There may be a breakdown in power dynamics within the family; for example, if a son must take on the caregiver roll for his mother, the son may feel obligated to be respectful of his mother’s wishes. But his mother may not have the competency to make the best decisions regarding her health. The mother may feel that her personal boundaries that are usually respected are now being violated. Talking about possible situations like this can make it easier on the entire family in the event that a family member does become chronically ill.
3. At any age, writing up an advanced health care directive is a good idea. Advanced health care directives serve as a sort of emergency form for the “what ifs” in life. If a close family member gets into a car accident and is incapacitated without a directive, family members may not know how to act in the best interest of the incapacitated individual.
Especially in Asian cultures, where it may be religiously or culturally important to preserve the body and not perform invasive surgeries, a directive outlines exactly what types of medical procedures a patient is willing to endure before passing—like CPR, being hooked up to a ventilator and having a feeding tube inserted.
The recent Terri Schiavo case serves as an especially relevant example of the importance of having a directive ready.
Directive forms should be available at your health provider. A copy of the directive should be given to your health provider, family members, and anyone who you could foresee taking action on your behalf if you are in critical care.
4. How to avoid the unpleasant “D” word: in some cultures, it may be uncomfortable to discuss death. Posing “what if” situations to family members and friends may be a more comfortable way to ease into such discussions, especially in writing up a will.
What if you got in a car accident? What would you do? Another way is to use media references — everyday stories that may not directly affect you but give you a way to talk about end-of-life decision-making. Throwing in some Grey’s Anatomy or ER may just do the trick.
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