Monday, October 11, 2010

A New Tool for Delivering Culturally-Competent Geriatric Care

By the middle of this century, one out of every three older Americans will be from a diverse group of minority populations. How can we provide culturally effective care for this growing heterogeneous population? VJ Periyakoil, fellow GeriPal contributor and director of palliative care education and training at Stanford, just came out with one way - the eCampus geriatrics portal.  eCampus Geriatrics is an educational website that offers a range of tools and resources to help health-care professionals provide culturally-competent geriatric care.

The site is currently split among three main components. The first is “Culture Med” – a collection of five ethnogeriatrics modules that include instructional strategies and a student evaluation guide. Topics include an introduction, an overview of patterns of health risks and mortality The second is “Ethno Med”, where one can find detailed information on specific ethnicities, as well as instructional and student evaluation strategies. The third section, "Tools and Resources", offers video teaching tools and slide show presentations.

The ethnogeriatrics overview is split into 5 modules. These include an introduction to ethnogeriatrics, an overview on the health and mortality risk among elders from diverse ethnic backgrounds, a summary of major systems of health beliefs, a module on culturally-competent geriatric assessment, and a module on culturally-competent delivery of care.

Screenshot of the Hmong
American Module
The Ethno Med section stands out for its depth and breadth of content. It includes 13 ethnic-specific modules on the health and health care of multi-cultural older adults. The major ethnic groups covered include African Americans, Alaska Natives, American Indians, Asian Indian Americans, Chinese Americans, Filipino Americans, Hawaiian and Pacific Islanders, Hispanic/Latino Americans, Hmong Americans, Japanese Americans, Korean Americans, Pakistani Americans, and Vietnamese Americans.

I spent a good deal of time on the site this weekend and enjoyed the interface and the content. The only feedback is that I wished there was a “next” button that moved me along the modules. Otherwise, VJ and her colleagues did an outstanding job in setting up this resource.

Please check it out and comment below.

by: Eric Widera

23 comments:

Nate said...

this resource is brilliant. I am a member of the Cultural Diversity Committee for the hospice where I work. I am excited to share this information with the committee and see how it can be best utilized in our agency.
I would also love to see information for caring for aging adults from the LGBTQ population and for aging adults with developmental disabilities.

Anonymous said...

I think it a huge mistake group Latinos as one.. Each culture within the islands and central and south america is different. I hope there will be others who recognize and seek to correct this overgeneralization.

Evelyn said...

This looks like a great resource, I am a social worker who does health education for both patients and providers. I watched the video of the MD telling the Korean man and his sister that he had 2 months to live. Very powerful stuff.

I know how hard it is to convey any meaningful information about a large group of people without pigeon-holing, but some information is better than none

Anonymous said...

Excellent resource. Very timely. I am currently involved in a Disparities Project with Mass General. This will be very helpful.

Terry said...

The EthnoMed section provides the most comprehensive ethnic-specific information relevant to health care that I have encountered. I think this site will inform the practice of many of those with whom I work.

SusanAlameda said...

Thank you! I train volunteers for a local hospice program, and this information is so helpful.

I second the need for accurate information about the needs of the GLBT community as well as those with developmental delay...we've been seeing more folks in our hospice program who are developmentally delayed, and knowing what to say, how to present end of life issues, is challenging...

Thank you for a great resource.

Anonymous said...

I run a certificate program in gerontology and this will be an excellent resource across the curriculum. Thanks for sharing it.

Anonymous said...

This is a great resource. Thanks for doing this. There is a great need for resources to provide better care for Americans of varying cultures.

Carol said...

Two comments - it can be problemmatic to assume the approach of generalization about various cultures. I did not see an explanation regarding this concern nor how we tend to sterotype. However, and secondly, I am waiting for someone to write about White/Caucasian Americans - many ethnic groups are interested in this group!

Travis said...

This looks like a great resource. I work with caregivers of people with brain-related disorders. I'm excited to incorporate this information into my work.

Sphen said...

This appears to be a great resource. I plan to explore it more and then integrate into our geriatrics and possibly hospice fellowships and also family medicine residency teaching time. Thanks so much for publicizing this!!

Eric Widera said...

Although not an ethnic minority I do like the idea about the LGBTQ population - its something that I don't see much in the palliative care or geriatrics literature.

In regards to Caucasian Americans- its a good question - I'm not sure how they "identified the major ethnic groups of older adults" - I'm guessing they meant to say "minority ethnic groups". That being said I would find it helpful for some discussion on populations with European, the Middle Eastern, or North African descent (all lumped as white in census data). For instance, Russian Americansaccount for a sizable portion of adults >65. Maybe VJ can address this.

In regards to lumping and over-generalizations - VJ and her colleagues do state in the Ethno Med section:

"While we have strived to describe the commonalities for each ethnic group described, it is to be noted that there is tremendous heterogeneity in the populations of older adults described in each module."

Christy said...

This is a wonderful resource and I will be able to integrate it into all my curriculum's however, I do have one bias and question. Although I appreciate the explanation of the definition for Spanish, Hispanic, Latinos; I think a further sub-categorization may be helpful as there are such differences in terminology, cultural beliefs, practices within this very broad category.Heritage from a Spanish speaking country does not equate across all borders. I also question the very low number of Hispanics in the state of Florida - it certainly does not correlate with my findings or personal experience. Thank you, this is a wonderful resource despite my personal bias!
Christy Torkildson, RN, PHN, MSN

Kate said...

I just looked through this resource and it looks really good. As the program director for a masters of science in chronic care management I can have my students go to this website and complete the modules as part of their coursework. This website focus on some important aspects of chronic care management, namely, aging, cultural diversity, chronic illness and health promotion....many of the issues being addressed in health care reform.
I read the other posts and this resource may not be perfect...but it is the most comprehensive website I have seen to date about culturally competent care for older adults.

Anonymous said...

Thank you so much for this awesome resource. I will be integrating some of the cases into my teaching this week! I appreciate the thoughtfulness and humility in which the site information is delivered…we will explore ways to integrate website exploration into our geriatrics curriculum here at the family medicine residency program.

Anonymous said...

Thank you so much for this awesome resource. I will be integrating some of the cases into my teaching this week! I appreciate the thoughtfulness and humility in which the site information is delivered…we will explore ways to integrate website exploration into our geriatrics curriculum here at the family medicine residency program.

VJ Periyakoil said...

Thanks for the comments- it is gratifying to see that so many clinicians care deeply about the care of multi-cultural older adults.
I wanted to address some of the issues raised to the extent I can:

1. Module selection: The ethnomed section has 13 modules now (we hope to add more content on an ongoing basis). We had a long and active debate about what to include and how to avoid overgeneralizations while attempting to address some common issues specific for each group. Here are some organizing principles in our planning:
a. Use the census classification to the extent we could to identify: The 2010 census does not include Hispanic under race. In addition, they use the terminology of race and not ethnicity. The issue is infinitely complicated and so we decided to use a simple clinical approach based on how our trainees report on their patients (e.g. Mr. X is a 67 year old Hispanic male…) as this resource is intended to help clinicians by giving them information pertaining to the health related issues of multi-cultural patients.

b. Identifying expert authors: Once we identified the module topics, the next was to identify expert authors who could speak from clinical experiences on geriatrics/gerontology issues as well as have "lived experience" in the ethnic group under consideration. At least one author in most modules belongs to the particular ethnicity. We also wanted to have card-carrying gerontologists/geriatricians who were in clinical practice to author modules so that they could speak from experience. Finally, we wanted to have doctors, nurses, social workers and other allied health experts co-author the modules collaboratively ( This is admittedly my bias as I felt that this would add to the depth and breadth of the content). Once the module was written, it was peer reviewed and the authors revised it until the reviewers were satisfied. The time commitment towards writing a module was similar to writing a journal article. This complex and rigorous process is why we are currently limited to 13 modules. I would personally love to do many more modules (I can hear my team members groaning and growling :-), if we have the expert author teams who are up for the challenge.

(Rest in the next comment)

VJ Periyakoil said...

(continued from pervious comment):

***********************************
2. Heterogeneity: lumping vs. splitting approach: The point about not stereotyping is well taken. In our defense, if we had to get this project done in a timely fashion, we had to do some lumping of topics with the awareness that were losing out on specificity. It is true that the term "Hispanic" is used for Spanish speaking Americans from numerous parts in the world.
When it comes to heterogeneity, Asian Indians are no slouch either- the language dialect and the culture changes every 200 miles in India. I suspect that this is true of all ethnicities. Having said that, I would love to have taken more of a "splitting approach" and give each unique group the attention it deserves.
***********************************
3. Culture vs. ethnicity: I agree that the issues faced by special cohorts of older adults need more attention. Sexuality and sexual orientation in older adults is definitely an important topic. Other cohorts with specific health needs include older Veterans, homeless older adults, developmentally disabled older adults, rural older adults to name a few. The Stanford e-Campus geriatrics portal is currently limited to addressing 13 large ethnicities. Once again, please note that we will be happy to consider adding modules to the site and the steps for this are as follows:

• Step 1: Identify a cohort of older adults you would like to write about.
• Step 2: Identify two co-authors (preferably inter-disciplinary experts).
• Step 3: Send an email to geriatrics@lists.stanford.edu with your idea and we will be delighted to guide you thru the writing process

Thank you again to Eric Widera for featuring the Stanford eCampus Geriatrics portal on Geripal. Thanks to the Geripal community for your very perceptive comments.

VJ Periyakoil, Stanford University School of Medicine

Anonymous said...

This is a great way to learn about how other cultures' health issues. Thanks to Stanford for sharing such a great tool free full text.
This tool is going to inform my geriatrics practice.

--A Geriatrician

CyndiC, RN said...

What a wonderful resource--thank you!!!

I teach Cultural Considerations in the ELNEC program and find that you have to be very careful to keep stressing not to stereotype--people can be easily offended if it looks like you are trying to pigeon hole them. But, healthcare workers are frustrated if they don't have at least some general guidelines. People really don't mean to offend--they often just don't know better...

I always, near the end, put in a slide of an "Asian looking" woman and ask them: "What would you expect from this woman culturally?"
The answer is: You can't tell just by looking--you have to talk to her and ASK HER...

It is amazing to find so much information in one location--you did a tremendous job!

Lisa said...

This is really a fantastic resource. I'm very impressed, and will utilize and tell others about this site regularly, I'm sure.

Both LGBTQ and intellectual disability are specialty issues of mine, and it would be great to include them here. Of course, members of these groups are also members of ethnic and racial groups, and it is often at the intersection of these experiences--those of their parents & families of origin with those of other cultural groups (intellectual & developmental disabilities, and/or LGBTQ) that many of the challenges arise.

Anonymous said...

Great job! I feel lucky to have received this in my inbox.

Anonymous said...

Thank you for the resource. We can definitely use this material here in our institution.