Older Adults and Cultural Competency
Dr. Jose Leon, MD, MPH
Overview: Understanding what it means to practice in a culturally competent manner is vital in today’s diverse society. Healthcare professionals in particular must understand the effects of a patient’s culture and beliefs on their interaction with the health care system. The needs of older adults and specifically, the needs of ethnic older adults must be addressed in a culturally competent and sensitive manner. If practitioners fail to understand cultural influences, many older adults will suffer unintended negative health outcomes.
The United States has experienced exceptional growth in the number and proportion of older adults. Two factors—longer life spans and aging baby boomers—will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population.[i]
Along with the dramatic aging of the U.S. population, during the next several decades will be significant increases in racial and ethnic diversity. In 2010, 80% of adults aged 65 years or older in the United States were non-Hispanic white. By 2030, that percentage will have declined, and older non-Hispanic white adults will make up 71.2% of the population, whereas Hispanics will make up 12%, non-Hispanic blacks nearly 10.3%, and Asians 5.4%.[ii]
Cultural competency is a key component of closing the disparities gap in health care. Healthcare professionals must focus on health care services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients, which can help bring about positive health outcomes.[iii]
Why is Culture and Linguistic Competence so Important in this Age Group?[iv]
- Patients are at higher risk of receiving poor quality care and experiencing negative health consequences when healthcare professionals, medical institutions and systems do not promote and provide culturally competent care.
- The aging population is diverse in terms of race and ethnicity, gender, sexual identity, language, education, etc. With this growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patient’s needs. Provision of culturally competent care can increase quality and effectiveness, increase patient satisfaction, improve patient compliance, and reduce racial and ethnic health disparities.
- Racial and ethnic minorities have higher morbidity and mortality rates from chronic conditions than their white counterparts. The rates of asthma, cancer, heart diseases, diabetes, obesity, and depression are higher among racial minorities.
- Higher proportions of minorities do not have a regular source of care or health insurance.
Benefits of Cultural and Linguistic Competence[v]
There are numerous benefits for health center programs to engage in cultural and linguistic competence services. Such benefits include but are not limited to:
- Expand quality and effectiveness of care: With the growing aging population of the U.S., healthcare providers are increasingly called on to address their patient’s unique social and cultural experience and language needs.
- Improve health outcomes and well-being: Culturally competent care ensures individual needs are identified and that appropriate support is in place.
- Increase the effectiveness of the older patient-provider communications: Older patients who have difficulty communicating, for whatever reason, will continue to experience unnecessary pain, consequential medication errors, and dissatisfaction.
- Expand provider knowledge and skills: The understanding of beliefs, culture, and social values offer the knowledge and skills necessary for providing quality care to a diverse population.
- Foster mutual respect and shared-decision making: Providers work with patients to select treatments that take into account patients’ health-related values, weighing available treatment options and patient preferences.
- Strengthen Patient and Provider Satisfactions: Providing culturally competent services has the potential to improve health outcomes, increase the efﬁciency of clinical and support staff, and result in greater client satisfaction.
Conclusion: Cultural competency is not an isolated aspect of health care, but a vital component of overall quality in health care delivery. Issues of health care quality and satisfaction are of particular concern for people with chronic conditions who frequently come into contact with the health care system. Efforts to improve cultural competence among health care professionals and organizations would contribute to improving the quality of health care for older adults.
[i] The State of Aging and Health in America http://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf
[ii] Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent
obesity in the United States. MMWR Morb Mortal Wkly Rep. 2009;58:1-26.
[iii] Office of Minority Health. Cultural Competency http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11
[iv] Cultural Competency and Older Adults http://www.cehd.umn.edu/ssw/ContinuingEd/Documents/Module3/CulturalCompetency_slides.pdf
[v] T. D. Goode, M. C. Dunne, and S. M. Bronheim, The Evidence Base for Cultural and Linguistic Competency in Health Care, The Commonwealth Fund, October 2006