Laurie Brummett, RN & Susan Goo, RN

1. Explore the Role of Culturally Competent Care in Reducing Health Disparities and Promoting Optimal Health in the Elderly Laurie Brummett, RN & Susan Goo, RN

2. Nurses Improving Care for Healthsystem Elders (NICHE) • Developed by the Hartford Institute for Geriatric Nursing • More than 225 hospitals in both the U.S. and Canada are participating • NICHE has ways to improve elderly care (Wood, 2009)

3. Geriatric Institutional Assessment Profile • Skin care • Restraint use • Incontinence • Sleep issues • Attitudes and perceptions about caring for elderly patients (Wood, 2009)

4. What the NICHE Program Entails • Training program about sensory changes r/t advancing age • Plans to differentiate delirium and dementia • Programs to assess fall risks • Programs on best practices for relating to older adults. (Wood, 2009)

5. John Muir Health is Utilizing NICHE • Coordinate with existing outpatient geriatric program • Biannual geriatric interdisciplinary professional development • Geriatric nurse resource program • Specialized Med/Surg unit focused on needs of the elderly (Wood, 2009)

6. Stereotype of Minorities Taking Care of Their Elders • Commonly held belief that minority families need less assistance with elders • Research does show • Unmarried elderly African Americans are 2x as likely as Caucasians to live with family • Hispanic and Asian American elders are 3x as likely • ½ of urban Native American elders live with family (____, 2001)

7. Caring for Elderly Family Members • Research shows taking care of elder family members can be overwhelming. • Does living with extended family mean minority elders do not need formal support services? • (______, 2001)

8. Adult Day Health Care (ADHC) Activity program Dietary services Meals Medication management Occupational therapy Physical therapy Physician services Psychology/Psychiatry Skilled nursing Social Work/Services Speech therapy Transportation (Santa Barbara County, n.d) Wisdom Center, in Santa Maria, CA

9. Wisdom Center • Adult Day Program (ADP) • Activity program • Care and supervision • Meals • Social Services • Transportation (Santa Barbara County, n.d)

10. Payments accepted Medi-cal Veteran’s benefits Private insurance Private pay (Santa Barbara County, n.d.) Languages spoken English Spanish Tagalog Who does the Wisdom Center serve?

11. Elderly people may have a different definition of health than the younger population Objectives may be related to maintaining functional status, instead of preventing or eliminating disease (Miller & Iris, 2002) Emic Perspective of the Elderly on Health

12. Being healthy has been defined by the elderly as: • Functional independence • Self-care management of illness • Positive outlook • Personal growth • Social contribution (Miller & Iris, 2002)

13. Emic Definition of Health • Being healthy = actively pursuing a healthy lifestyle • Strategies to stay healthy include participating in healthy activities and engagement • Motivators include social support, challenge, past activities and getting better (Miller & Iris, 2002)

14. “When you get into your 80’s, little pieces of you kind of break off and fall astray…most of us have some little thing going on.” • There is a connection between mental attitude and physical health (Miller & Iris, 2002, p. 255)

15. Physical Physical activity and exercise Change unhealthy eating and alcohol habits Participate in tx and management of illness and disability Use of assistive devices to maintain mobility Cognitive Learn new things Take classes Stay up on current events Participate in activities and in the community (Miller & Iris, 2002) Strategies Older Adults Use to Promote Health

16. Psychosocial Positive attitude Set priorities Avoid dwelling on problems Capitalize on previous successes Participate in activities based on interest, needs and limitations Express feelings Have fun Interpersonal Volunteer Join activities Share experiences Remain connected with family & friends Make new friends and acquaintances (Miller & Iris, 2002) Strategies Elderly Use to Maintain Health

17. Emeritus Programs • Adult fitness • Computers • Literature by local authors • Music arts • Pastel drawing & painting • Yoga • Nutrition and health • Exploring cultural and natural wonders • Reminiscing for frail older adults (Cuesta College, 2009)

18. What do you see nurses? . . What do you see?What are you thinking . . . . when you're looking at me?A crabby old man, . . not very wise,Uncertain of habit . . . . . with faraway eyes?Who dribbles his food . . . . . . and makes no replyWhen you say in a loud voice . . 'I do wish you'd try!'Who seems not to notice . . . the things that you do.And forever is losing . . . . . . . A sock or shoe? Who, resisting or not . . . . . . . . . lets you do as you will,With bathing and feeding . . . . . . The long day to fill?Is that what you're thinking? . . . Is that what you see?Then open your eyes, nurse . . . . you're not looking at me.I'll tell you who I am, . . .. . .. as I sit here so still,As I do at your bidding, . . . . as I eat at your willI'm a small child of Ten . . . . with a father and mother,Brothers and sisters . . . . . . . who love one another Crabby Old Man

19. A young boy of Sixteen . . with wings on his feetDreaming that soon now . . . . a lover he'll meet.A groom soon at Twenty. . . . . .My heart gives a leap.Remembering the vows . . . . . that I promised to keep.At Twenty-Five, now . . . . . . . I have young of my own.Who need me to guide . .. . And a secure happy home.A man of Thirty . . . . . . My young now grown fast,Bound to each other . . . . . . With ties that should last. At Forty, my young sons . . have grown and are gone,But my woman's beside me . . .. . . . to see I don't mourn.At Fifty, once more, . Babies play 'round my knee,Again, we know children . . . . . . My loved one and me .Dark days are upon me . . My wife is now dead.I look at the future . . . . . . . . .. . I shudder with dread.For my young are all rearing . . . . . . young of their own.And I think of the years . . And the love that I've known. Crabby Old Man

20. I'm now an old man . . . . . and nature is cruel.Tis jest to make old age. . . . . look like a fool..The body, it crumbles . . . . . . . . . . grace and vigor depart.There is now a stone . . . . . . where I once had a heart.But inside this old carcass . . A young guy still dwells,And now and again . . . .. . my battered heart swellsI remember the joys . . . . . . . . . . I remember the pain.And I'm loving and living . . . . . . . . . . .. life over again. I think of the years . all too few . . . . . gone too fast.And accept the stark fact . . . . . . . that nothing can last..So open your eyes, people . . . . . open and see..Not a crabby old man Look closer . . see . . . . ME!! Crabby Old Man (Anonymous, n.d.)