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.
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| Screenshot of the Hmong American Module |
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
Comments
I would also love to see information for caring for aging adults from the LGBTQ population and for aging adults with developmental disabilities.
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
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.
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 Torkildson, RN, PHN, MSN
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.
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)
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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.
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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
This tool is going to inform my geriatrics practice.
--A Geriatrician
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!
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.