HEALTH AND HEALTH CARE FOR
ASIAN AND PACIFIC ISLANDER AMERICAN ELDERS
Patricia Lanoie Blanchette,
Chair, Asian and Pacific Islander Modules
Department of Geriatric Medicine and Pacific Islands Geriatric Education Center
John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
The term "Asian/Pacific Islander" (API) is used in this curriculum to correspond to the federal grouping for the U.S. census and other data. However, this is an exceedingly diverse group, some with historical interrelationships. The group includes residents of the U.S. from Chinese, Japanese, Asian Indian, Pakistani, Korean, Vietnamese, Hmong, Laotian, Thai, Filipino, Samoan, Hawaiian and other Pacific Islander, and other backgrounds.
For the most part, this section discusses API's living in the 50 U.S. states. However, because of the ongoing relationship of the U.S. and many Pacific Islands, such as for health care, and the relative paucity of this information elsewhere, the Pacific Islander section is more detailed with regard to history and demography and current health status in those islands. It is intended to be useful both for classroom instruction and for health care workers preparing themselves to provide direct care in the islands.
According to the 2000 U.S. Census, API's make up 4.5% of the U.S. population if people who identify themselves as having more than one racial background are included. That includes 12.8 million people. If the total is limited to individuals who said they have only one racial identity, the size of the API population is 10.6 million, 3.7% of the U.S population. People of Asian descent comprise a 96% API total, while Pacific Islanders comprise approximately 4%.
The majority of API's live in the Western U.S., with the majority in California, Washington, Oregon, Hawaii and other Pacific Islands, but also in New York, Texas, New Jersey, Illinois, Florida, Virginia, and Massachusetts. For the most current data, refer to the U.S. census internet site at: www.census.gov
In 1990 approximately 6% of Asian/Pacific Islanders in the U.S. were aged 65 and older. For a summary of some of the characteristics of those elders by ethnic group, see Table 3.
Certain cultural influences are common to several of the groups. Confucianism, for example, has its origins in China, but was brought to Japan in the seventh century and has been passed down through the ages to many of the countries of origin of API elders. In Confucian thought, filial piety was felt to be of utmost importance. Children were expected to obey and respect their parents, bring honor to their parents by succeeding in work, and support and care for parents in their old age. Filial piety has shaped the experiences and expectations of those who immigrated to the U.S. as well as succeeding generations, many of whom experience stress as they become acculturated to American way of life and have difficulty fulfilling the expectations of their parents generation.
The degree to which any older adult or family member holds to the traditional beliefs and values of their heritage depends on a number of factors. These may include the degree to which the traditional values have been held in the family, and personal, educational, and work experiences. Another significant factor is intermarriage and mixed heritage. While recent immigrants might be expected to hold more tightly to traditional values, some might have left their native countries because they were in conflict with those values.
As with other aspects of health care, assessing the individual is of primary importance. Having an understanding of cultural values and beliefs traditional to a group is helpful background, but it is of great importance to understand that any one individual may not hold to traditional beliefs. In some instances, it will be important for a health care provider to assist an individual seeking to make personal choices that are in conflict with the values and beliefs of their family.
It is hoped that these modules will assist faculty who aspire to increase the cultural competence of their students in geriatric health care by providing resources to make increased emphasis on API elders easier to include in the curriculum. Because the cultural traditions in the countries of origin of API elders are so diverse, the editors and authors of the Curriculum in Ethnogeriatrics felt is was very important not to lump them together in one Asian or Asian/Pacific Islander module. Therefore we are presenting eight different modules in this section that can be taught individually or together, covering the major populations in the U.S. for which there is any information. Because each set of authors has its own perspective and interests, and because the literature available on different populations varies greatly in size and depth, the modules differ in style and emphasis.
*The 1990 census is quoted because as of this writing, relevant tables from the 2000 census that show age by race/ethnicity were not yet posted.
Adapted from Young, J.J. & Gu, N. (1995). Demographic and Socio-economic Characteristics of Elderly Asian and Pacific Island Americans. Seattle: National Asian Pacific Center on Aging.
From: Yeo, G. & Hikoyeda, N. (2000) Asian and Pacific Island American Elders. In Maddox, G. (Ed.) Encyclopedia of Aging, 3rd Ed. New York: Springer Publishing Co., Inc., NY, 10012. Adapted with permission.