Hmong Older Adults’ End-of-Life Care Preferences: Physical, Psychosocial, Cultural, Religious, and Spiritual

As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

Toward Understanding Everyday Lives of Older Adults: A Methodological Exploration

BACKGROUND AND OBJECTIVES

Emerging trends in aging-in-place and increasing needs for home health care highlight the importance of researching older adults' daily lives as they unfold within their residential environments. However, studies that examine how older adults interact with their home environments are scarce as homes are fluid and private spaces, and do not render themselves easily to the researcher's eyes. This article explores a new investigational method combining 3D-scanning and biomarker tracking technology with in-depth qualitative interviews in-situ to explore older adults' daily interactions with their home environments.

RESEARCH DESIGN AND METHODS

We employed a unique approach that combined spatial, locational, and physiological tracking technology with in-depth qualitative in-home interviews with older adults aged 62 to 89 who received home modifications as a means to successfully age in place. We explored multiple datasets both individually and collectively, using various data analysis, visualization, and integration methods to test the feasibility and utility of our approach.

RESULTS

Review of individual datasets allowed unique insights into different aspects of the daily lives of this sample of older adults. When combined, the datasets and subsequent analysis allowed in-depth understanding of participants' wellbeing and adaptive behaviors.

DISCUSSION AND IMPLICATIONS

This study provides a strong methodology for studying the home environment and its impact on the participants' health and wellbeing. Insights obtained through this method can inform research, policy, and practice at all levels for professionals to continue exploring ways to support older adults aged 65+ aging at home.

Walking in Two Worlds: Hmong End of Life Beliefs & Rituals

For over 40 years, the Hmong have sought refuge in the United States; however, many Hmong elders continue to honor healthcare and end-of-life beliefs and rituals that they practiced in their home country. With little knowledge by the general public and healthcare systems about these beliefs and rituals, healthcare professionals may struggle to provide the Hmong community with culturally-sensitive care. This study sought to address this gap by conducting in-depth face-to-face interviews with 12 Animist and 8Christian Hmong elders born in Southeast Asia, who now reside in the United States. Results provided insights regarding the heterogeneity among these Hmong elders concerning their end-of-life beliefs and rituals. Both Animist and Christian respondents believed family should provide care at end of life. Animist Hmong elders reported the importance of Shamanistic rituals such as soul calling or spiritual offering while Christian Hmong elders believed in the power of prayers. Healthcare providers need to assess Hmong elders' preferences for care at end of life, be open to the inclusion of traditional healers in their care and/or decision-making, and understand preferences of family and community members' involvement in care at the end of life.