Developing a culturally responsive dementia storybook with Native Hawaiian youth

Similar to the nation's majority and racial/ethnic minority populations, Native Hawaiian families provide the bulk of care to loved ones with dementia. Limited research has focused on youth caregivers, who are largely invisible to the eldercare service system. This knowledge gap is especially critical for Native Hawaiians who place a high value on eldercare, often provided in multigenerational homes. To address this gap, we describe the process by which a university-community center developed a culturally responsive storybook on dementia targeted to Native Hawaiian youth. The development process honored community-based participatory research principles grounded in the cultural values and practices of Native Hawaiians, active collaboration of an advisory council, and face-to-face engagement with Native Hawaiian youth. Future directions are shared about culture-based programming and evaluation in dementia care that may be useful in work with other racial/ethnic youth and families.

Global Gender Inequality, Older Women, and the Call for Change in the United States

Gender inequality that persists through much of their lives, from birth through adulthood, impacts women and their quality of life in their later years. With some variation this holds true in every nation in the global community. In older adults, the most apparent indication of gender inequality-and a linchpin-is the disproportionate impoverishment of older women compared to older men. We take stock of global policy directions toward equality for girls and women, focusing specifically on derived avenues for furthering and protecting the economic well-being of older women in the United States, cognizant that these directions can rebound with implications for nations worldwide.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

Women's employment, work-life balance policies, and inequality across the life course: a comparative analysis of Japan, Sweden and the United States

We draw from a number of theoretical perspectives and frameworks on the life course, age and gender scholarship to argue their value in furthering critical discussions on work-life balance policies and their contributions to women's employment and economic security in later life. Using OECD and other big data sets, we examine the patterns of women's employment over the life course in Japan, Sweden and the United States, as three illustrated cases of welfare states with different nation's work-life balance policies. We summarize findings before offering concluding thoughts to advocate for women's security in later life.

Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach

Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kūpuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kūpuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kūpuna health and service use.

United States Indigenous Populations and Dementia: Is There a Case for Culture-based Psychosocial Interventions?

Dementia is an issue of increasing importance in indigenous populations in the United States. We begin by discussing what is known about dementia prevalence and elder family caregiving in American Indian, Alaska Native, and Native Hawaiian populations. We briefly highlight examples of culture-based programming developed to address a number of chronic diseases and conditions that disproportionately affect these communities. These programs have produced positive health outcomes in American Indian, Alaska Native, and Native Hawaiian populations and may have implications for research and practice in the dementia context of culture-based interventions. Evidence-based and culture-based psychosocial programming in dementia care for indigenous populations in the United States designed by the communities they intend to serve may offer elders and families the best potential for care that is accessible, respectful, and utilized.

When a Case Management Program Closes: Impact as Perceived by Frail Elders and Their Family Caregivers

Geriatric case management programs benefit elders and their caregivers by providing technical and emotional support and linkages to services and financial assistance. This study used qualitative and quantitative data to document the perceived impact felt by clients and their families when this assistance is withdrawn. Attempts were made to contact all 205 former clients of a case management program in Honolulu 6 months after program closure. Of these, 118 were still living at home, 20 had entered nursing homes, 28 had died, and 39 were lost to follow-up. Compared to a previous 6-month period, the percentage who entered nursing homes was similar, whereas the percentage that died was higher. Half of responding caregivers reported a deterioration of their own health and increased emotional fatigue. Data suggest that the program was perceived by elders and their caregivers to be a critical component in providing support and maintaining the safety of frail elders in home settings.

Native Hawaiian and Pacific Islander Elders: What Gerontologists Should Know

Native Hawaiian and other Pacific Islanders (NHOPI) experience significant health disparities compared with other racial groups in the United States. Lower life expectancy has resulted in small proportions of elders in the population distribution of NHOPI, yet the number of NHOPI elders is growing. This article presents data on NHOPI elders and discusses possible reasons for continuing health disparities, including historical trauma, discrimination, changing lifestyle, and cultural values. We outline promising interventions with NHOPI and make suggestions for future research.

Research on indigenous elders: from positivistic to decolonizing methodologies

Although indigenous peoples have lower life expectancies than the social majority populations in their countries, increasing numbers of indigenous people are living into old age. Research on indigenous elders is informed by a number of research traditions. Researchers have mined existing data sets to compare characteristics of indigenous populations with non-indigenous groups, and these findings have revealed significant disparities experienced by indigenous elders. Some investigators have attempted to validate standardized research tools for use in indigenous populations. Findings from these studies have furthered our knowledge about indigenous elders and have highlighted the ways in which tools may need to be adapted to better fit indigenous views of the constructs being measured. Qualitative approaches are popular, as they allow indigenous elders to tell their stories and challenge non-indigenous investigators to acknowledge values and worldviews different from their own. Recently, efforts have extended to participatory and decolonizing research methods, which aim to empower indigenous elders as researchers. Research approaches are discussed in light of the negative experiences many indigenous peoples have had with Eurocentric research. Acknowledgment of historical trauma, life-course perspectives, phenomenology, and critical gerontology should frame future research with, rather than on, indigenous elders.

Why Are Native Hawaiians Underrepresented in Hawai'i's Older Adult Population? Exploring Social and Behavioral Factors of Longevity

Native Hawaiians comprise 24.3% of Hawai‘i's population, but only 12.6% of the state's older adults. Few published studies have compared health indicators across ethnicities for the state's older adult population or focused on disparities of Native Hawaiian elders. The current study examines data from two state surveillance programs, with attention to cause of death and social-behavioral factors relevant to elders. Findings reveal that Native Hawaiians have the largest years of productive life lost and the lowest life expectancy, when compared to the state's other major ethnic groups. Heart disease and cancer are leading causes of premature mortality. Native Hawaiian elders are more likely to report behavioral health risks such as smoking and obesity, live within/below 100–199% of the poverty level, and find cost a barrier to seeking care. Indicated is the need for affordable care across the lifespan and health services continuum. Future research might explain behavioral factors as influenced by social determinants, including historical trauma on Native Hawaiian longevity.

Eldercare in a Filipino community: older women's attitudes toward caregiving and service use

Focus group research on elderly Filipino women living in the United States yields preliminary findings regarding their attitudes toward caregiving and formal service use. Filipino cultural values and the economic challenges attributed to their immigration status were perceived to be the greatest strengths and challenges in caring for the aged. Results identify generally positive attitudes toward formal service use and governmental assistance. Together, these findings shed light on Filipinos' acceptance and use of formal services. Further research to confirm and explore these findings can guide the design of the nation's practice and policy interventions for an increasingly ethnic and cultural diverse older population.

Adversity and resiliency in the lives of Native Hawaiian elders

Native Hawaiians constitute 401,000 or 0.1 percent of the total U.S. population, with approximately 60 percent residing in the state of Hawai'i. In Hawai'i, Native Hawaiian elders (na kapuna) face a number of social and health disparities when compared with their non-Native Hawaiian counterparts: higher rates of poverty, greater disability rates, higher rates of specific life-threatening diseases, shorter life expectancies, and lower utilization rates of some services. Integrating life course literature and resiliency theory, the authors propose a model that provides a context from which to analyze and understand social and health disparities found among older Native Hawaiians. The authors introduce a historical timeline that identifies key cultural and historical markers in the lives of na kapuna and then link this timeline to health and social-health delivery strategies. This model offers a rationale for the development and implementation of culturally based solutions for na kapuna and underscores the need for social workers to intervene at the micro, meso, and macro levels to affect the well-being for this and other ethnic populations.

Using a community-based participatory approach to create a resource center for Native Hawaiian elders

CONTEXT

Historically, Native Hawaiian elders have been recognized as the major sources of wisdom and transmitters of knowledge and training to younger generations. Yet, concerns exist today for these elders who experience shorter life expectancies, poorer health and greater disability than elders in other ethnic groups in Hawai;i.

OBJECTIVE

We describe Hā Kūpuna: National Resource Center for Native Hawaiian Elders, established at the University of Hawaii to address disparate health and improve the access and delivery of services to these elders.

METHOD

Hā Kūpuna is described in accordance with the principles of community-based participatory (CBP) research with its unique emphasis on culturally competent practice.

RESULTS

Application of the CBP approach is illustrated in the following steps: community engagement; development of an infrastructure; implementation and dissemination of research and technical assistance projects; and evaluation.

DISCUSSION

The CBP approach is highly relevant for Native Hawaiians because of its alignment with cultural values, the mobilization of the community and the emphasis on reducing health inequities through social change. In adhering to a CBP approach to improve the health of elders, Hā Kūpuna seeks to perpetuate the culture through the transmission of hā (breath) from older to younger generations.

The initiation of coronary angioplasty and stenting in a single outpatient centre in Barbados

Percutaneous transluminal coronary angioplasty (PTCA) is a novel procedure to Barbadian healthcare. Only one centre in Barbados provides PTCA and stenting. This is a retrospective study aimed at describing the initial results of coronary angioplasty and stenting in the first 48 patients at the Carib-American Heart Centre and exploring the feasibility and safety of coronary angioplasty and stenting in Barbados. Forty-eight patients underwent PTCA during the period March 2002 to June 2004 inclusive, with or without intracoronary stenting. Most (64.6%) of the patients were male and 43.7% were diabetic. The most common vessels involved were the left anterior descending coronary artery (LAD) and the right coronary artery (RCA). In one patient, attempted stenting was unsuccessful but PTCA reduced stenosis. One patient had previous PTCA and stenting of the LAD and two patients had coronary artery bypass grafting (CABG) prior to the procedure. Twventy-one per cent of the patients treated had severe triple vessel disease. There were no cases of re-stenosis or acute vessel closure, during or immediately following the procedure that required emergency PTCA or CABG All patients were discharged within 24 hours of the procedure. Procedural success was 100%. In conclusion, outpatient PTCA and stenting is safe and feasible in the Barbadian population. Coronary artery bypass grafting is still the procedure of choice for treating coronary artery disease (CAD) involving the left main coronary artery but PTCA is indicated in some cases of severe triple vessel disease.

Immigration and the direct long-term care workforce: implications for education and policy

The escalating demand for trained direct long-term care (DLTC) workers, those individuals with the most sustained direct contact with vulnerable older adults in homes and facilities, is a consequence of our rapidly aging population. Research documents the present and projected shortages of DLTC workers, and developed nations are increasingly turning to immigrant women to fulfill these workforce needs. The authors identify international trends that influence the availability of these workers. Following a broad overview of the DLTC workforce, they turn to a specific examination of immigrants working in long-term care settings in the United States. The authors raise a number of questions about this changing workforce profile. They outline four ways that institutes of higher education can help improve the DLTC workforce in the United States and suggest that colleges and universities work in partnership with policy makers and the long-term care industry to this end.

Filipinas as residential long-term care providers: influence of cultural values, structural inequity, and immigrant status on choosing this work

This exploratory study investigated reasons why Filipinas in Hawai'i have become the primary caregivers of elders in residential care homes and if they thought their children would follow them in this profession. A random sample of 173 Filipina care home operators (CHO), of which 95% were first-generation immigrants, was interviewed using telephone survey methods. Data were collected: to profile caregivers; to identify motivations for becoming a care home operator; and to gauge if they or their children would continue in this line of work. The sample was composed of middle-aged Filipina CHO with training and experience in elder care who concurred that the job fit their cultural values. About a third also felt that this job was open to immigrants and helped them buy a house. Twenty percent or less felt discriminated against because of this work. Although half the sample felt that women were better caregivers than men, only 38% felt that caregiving was primarily the responsibility of women. Almost 90% planned to continue with this work, but only 12% said it was likely that their children or grandchildren would become CHO, supporting the notion that choosing this profession had less to do with cultural values and gender expectations than with economic opportunities available to the current cohort of CHO. Given these findings, Hawai'i's capacity to meet future residential long-term care needs is discussed.

Developing a multisite project in geriatric and/or gerontological education with emphases in interdisciplinary practice and cultural competence

PURPOSE

This 2-year, multisite, curriculum-development project aimed to increase the pool of professionals trained in geriatric and/or gerontological social work.

DESIGN AND METHODS

Our methods included (a) providing advanced training in aging, cultural competence, and interdisciplinary practice to social work professionals and masters degree students, (b) developing, implementing, and testing an innovative student curriculum based on standardized learning competencies identified by project participants, (c) revising the university curriculum to support such competencies, and (d) producing a practicum handbook.

RESULTS

The project achieved its out-comes.

IMPLICATIONS

Project conceptualization, implementation, and evaluation are discussed together with approaches for its replication.

Perceptions of dementia, caregiving, and help seeking among Asian and Pacific Islander Americans

The United States is becoming more ethnically diverse, and Asian and Pacific Islanders (APIs) are one of the most rapidly growing ethnic minority groups. Of interest to social workers is how the traditional values and practices of these cultures affect their perceptions of disease and use of health services. This article presents information on perceptions of dementia, caregiving, and help seeking for the API group as a whole, with additional information on five of the major API subgroups--Chinese, Japanese, Filipino, Vietnamese, and Hawaiian. Implications for practice, policy, and research are discussed.

Advancing social work practice in health care settings: a collaborative partnership for continuing education

This article describes a model for social work education and research established by a school of social work and the social work department of a metropolitan medical center. Social workers in the health care setting were surveyed on the knowledge and skills they needed to help them respond to new directions for the department. Results of the study identified a number of themes for staff development and research. Implications of the study, together with a description of the education and research programs developed to respond to these themes, are presented.

Empowerment in social work practice with older women

Literature describing the interface of ageism and sexism on older women, the majority of the nation's elderly population, has resulted in the knowledge that they are a population at risk. Empowerment is a social work process and intervention that has been recommended for work with oppressed populations and with women. An analysis of traditional, feminist, and social work conceptualizations of empowerment, however, identifies issues that are problematic for social workers. This article suggests reasons for broadening the definition and concept of empowerment to allow social welfare professionals to better speak to the multiple needs of women in their later years.