APPENDIX A

EXPLANATIONS OF SIGNIFICANT CONCEPTS IN ETHNOGERIATRICS
NOTE: The following explanations are composites of: traditional definitions of the terms used in the social science literature; comments from the literature in ethnogerontology; and insights provided by the team of authors who are members of the Collaborative on Ethnogeriatric Education. Published sources used are referenced.

Culture: the way of life of a population, including shared knowledge, beliefs, values, attitudes, rules of behavior, language, skills, and world view among members of a given society. It shapes human behavior because it is the foundation of conscious and unconscious beliefs about "proper" ways to live. Cultures change constantly. Different members of a society internalize and express different parts of their culture. Subcultures can also reflect differences by geographic region or other subgroups within a larger society (Andrews & Boyle, 1995; Henderson, 1990: Klein, 1995).

Cultural Competence in Geriatrics: Ability to give health care in ways that are acceptable and useful to elders because it is congruent with their cultural background and expectations. At the provider level, it has been described as including the demonstrated integration of:

A) awareness of one’s personal biases and their impact on professional behavior;
B) knowledge of
1) population-specific health-related cultural values, beliefs, and behaviors;
2) disease incidence, prevalence or mortality rates; and
3) population-specific treatment outcomes; and
C) skills in working with culturally diverse populations.

At the institutional level, it can be viewed as those systems of care that acknowledge the importance of culture, assess cross-cultural relations, are alert to cultural differences and their repercussions and adapt services to meet cultural needs. Health care settings may be placed on a continuum of cultural competence that have been described as including stages of: monocultural, nondiscriminatory, and multicultural; or destructiveness, incapacity, blindness, competence, and proficiency (Cross, Bazron, Dennis, & Isaacs, 1989; Foster, Jackson, Cross, Jackson, & Hardiman, 1988; Green & Leigh, 1989; Lavizzo-Mourey & Mackenzie, 1997, Tirado, 1998; Tripp-Reimer, 1999).

Cultural Guide or Cultural Broker: Consultants (health care, social service, senior service provider or respected leader) from the target ethnic population who can provide insight and information on health beliefs, culturally appropriate methods of showing respect to elders, and problem areas in health care interaction.

Emigration: movement of individuals or groups OUT of the country or region of their original residence to settle in another area.

Ethnic Group: originally defined by Gordon (1964) as a group of individuals with a shared sense of peoplehood based on race, religion, or national origin, it is now commonly used to refer to a group with a distinctive culture. Ethnicity is the active expression of culture. An ethnic group is a large group in which members self-identify. They internalize and share a heritage of, and commitment to, unique social characteristics, cultural symbols, and behavior patterns that are not fully understood or shared by outsiders. (Barresi & Stull, 1993; Gelfand, 1993; Markides, Liang, & Jackson, 1990; Valle, 1998).

Ethnocentrism: belief or attitude that ones own cultural view is the only correct view.

Ethnogeriatrics: health care for elders from diverse ethnic populations.

Ethnogerontology: The study of the causes, processes, and consequences of race, national origin, culture, minority group status, and ethnic group status on individual and population aging in the three broad areas of biological, psychological, and social aging (Jackson, 1985).

Geriatrics: health care for older adults.

Gerontology: the study of aging.

Immigration: movement of individuals or groups INTO a country or region to settle there.

Minority: subgroup within a population. In social science, it is used to identify a group that suffers subordination and discrimination within a society, usually because of their race, ethnicity or national origin. The term is used by the federal government to describe protected and/or disadvantaged ethnic or racial populations (Hooyman & Kiyak, 1999; Markides, 1993).

Race: socially constructed categories based on parentage and physical appearance. Although the term is now considered by many anthropologists to be obsolete because of difficulty classifying populations with widespread genetic diversity, it continues to be widely used. The term is used in official government documents, such as in the U.S. Census, in which individuals identify their own racial identity. It sometimes serves as a basis for discrimination and demarcation in conflicts over social resources (Fried & Mehrotra, 1998; U.S. Census, 1990). 

Spirituality: can be defined as whomever or whatever provides someone a transcendent meaning in life. It may be expressed as a relationship with ones god(s) or the creator, but can also refer to values such as: nature, energy force, belief in the goodness of all, or belief in the importance of family and community. Among some populations, it includes organized religion. It may or may not include belief in, and communication with, forces in the form of spirits (Puchalski, undated).

Transcultural: a term used widely in nursing to apply to people of diverse cultures. Transcultural nursing is sometimes described as a body of humanistic and scientific knowledge with concomitant skills essential to help nurses care for people of diverse cultures (Leininger, 1997).

 

REFERENCES FOR APPENDIX A

Andrews, M. & Boyle, J. (1995). Transcultural Concepts in Nursing Care (2nd Ed.). Philadelphia: J.P. Lippincott.

Barresi, C. & Stull, D. (1993). Ethnic Elderly & Long-Term Care. New York: Springer Publishing Co.

Cross, T.L., Bazron, B.J., Dennis, K.W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: Child and Adolescent Service System Program (CASSP), CASSP Technical Assistance Center, Georgetown University Child Development Center.

Foster, B. G., Jackson, G., Cross, W. E., Jackson, B., & Hardiman, R. (1988, April). Training and Development Journal, pp. 1-4.

Fried, S.B. & Mehrotra, C.M. (1998). Aging and Diversity: An Active Learning Experience. Washington, DC: Taylor and Francis.

Gelfand, D. (1995). Ethnicity. In Maddox, G. Atchley, R., Evans, J.G., Finch, C, Hultsch, D., Kane, R., Mezey, M., & Siegler (Eds.) The Encyclopedia of Aging, 2nd Ed. New York: Springer Publishing Co.

Green, J.W., & Leigh, J.W. (1989). Teaching ethnographic methods to social service workers. Practicing Anthropology, 11:8-10.

Henderson, N., Alexander, L.G., & Mayka, M.G. (1990). Minority Alzheimers Caregivers: Removing Barriers to Community Services. Tampa, FL: Suncoast Gerontology Center, University of South Florida.

Hooyman, N. & Kiyak, H.A. (1999). Social Gerontology, 5th Ed. Boston: Allyn & Bacon.

Jackson, J. J. (1985). Race, national origin, ethnicity, and aging. In Binstock, R. and Shanas, E. (Eds.) Handbook of Aging and Social Sciences, New York: Van Nostrand Reinhold Company, 264-268. 

Klein, S. (Ed.) (1996). Ethnogeriatrics. In A National Agenda for Geriatric Education: White Papers. Washington, DC: Bureau of Health Professions, Health Resources and Services Administration.

Lavizzo-Mourey, R.J. & Mackenzie, E. (1995). Cultural competence--an essential hybrid for delivering high quality care in the 1990s and beyond. Transactions of the American Clinical and Climatological Association, 107, 226-237.

Leininger, M. (1997). Overview and reflection of the theory of culture care and the ethnonursing research method. Journal of Transcultural Nursing, 8, 32-52.

Markides, K.S. (1995). Minorities and Aging. In Maddox, G. Atchley, R., Evans, J.G., Finch, C, Hultsch, D., Kane, R., Mezey, M., & Siegler (Eds.) The Encyclopedia of Aging, 2nd Ed. New York: Springer Publishing Co.

Markides, K., Liang, J., & Jackson, J. (1990) Race, Ethnicity, and Aging: Conceptual and Methodological Issues. In Binstock, R H. & George, L.K. Handbook of Aging and the Social Sciences, 3rd Ed. San Diego: Academy Press, Inc.

Puchalski, C. M. (Undated) A Spiritual History. Washington, DC: Center to Improve Care of the Dying, George Washington University.

Tirado, M.D. (1998). Monitoring the Managed Care of Culturally and Linguistically Diverse Populations. Report funded by the Health Resources and Services Administration Center for Managed Care.

U. S. Bureau of the Census & National Institute on Aging (1993). Racial and Ethnic Diversity of America's Elderly Population. Profiles of America's Elderly. Author.

Valle, R. (1998). Caregiving Across Cultures. Washington, DC: Taylor and Francis.