for Vietnamese American Elderly Chinh Duy Le MD UCI Senior Health Center 1 Objectives 1 To raise awareness of cultural affects in health care for Vietnamese American seniors 2 To emphasize the importance of culturalappropriate approach for health care in diverse society ID: 677787
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Cultural Aspect in Health Care for Vietnamese American Elderly
Chinh Duy Le, MDUCI Senior Health Center
1Slide2
Objectives:
1. To raise awareness of cultural affects in health care for Vietnamese American seniors.2. To emphasize the importance of cultural-appropriate approach for health care in diverse society.
2Slide3
VN American Elderly: Demographic Data
U.S. Census Bureau, 2004 American Community Survey
3Slide4
Vietnam: A Snapshot
4
Strongly influenced by Chinese and French culture due to prolonged colonization by these governments in history
ASDFGHJ. (2009). Location Vietnam ASEAN [vector graphics], Retrieved May 5, 2011, from: http://en.wikipedia.org/wiki/File:Location_Vietnam_ASEAN.svg.Slide5
Mr. Nguyen…
Mr. Nguyen is 75 y.o. Vietnamese male, walk-in for an assessment for weight loss. He was doing fairly well until 3 months ago when he started losing his appetite and weight (~15 lbs/3 months).
Denies any symptom and depressed mood.
5Slide6
Mr. Nguyen…
PMHx: Lung TB diagnosed and treated in 1990 in VN Chronic hepatitis B
How Mr. Nguyen’s
PMHx
information would affect your clinical management for Vietnamese seniors?
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Vietnamese American: Infectious Diseases
TB in Orange County of 3 million people
300,000 persons with TB infection (latent TB).
200 active TB cases/ year, ~6.2 cases/ 100,000 residents (3.8/100,000 in States)
87.2% were among foreign-born; Vietnamese: 34%; Mexican: 25%; Philippines: 19%; Korean 6%
Chronic
Hep
B and liver cancer.
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Mr. Nguyen,… Social
Hx, English, EducationSocial history: Finished
high school
in VN; joined the army until 1975; spent
8 years in communist re-education camp
;
speaks primarily Vietnamese
at home; unable to complete your health screening form in English.
Would Mr
. Nguyen’s social history
give
you any information that may affect your health care for Vietnamese seniors?
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Vietnamese American:Immigration Waves
First wave
: April 1975.
Speak more English. More acculturated to American culture.
Second wave:
1978 – 1990.
May have trauma from a dangerous journey
Third wave:
1990 – 2000.
May represent majority of VN American elderly. Most have trauma from war or re-education camp.
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PH2 Phil
Eggman
. (1984). 35 Vietnamese Boat People 2 [photograph], Retrieved May 6, 2011, from: http://en.wikipedia.org/wiki/File:35_Vietnamese_boat_people_2.JPEG.Slide10
Long-term Effect of Psychological Trauma on The Mental Health of Vietnamese Refugees in Australia.
Zachary Steel et al., Lancet, Oct 5, 2002
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Long-term Effect of Psychological Trauma on The Mental Health of Vietnamese Refugees in Australia.
Zachary Steel et al., Lancet, Oct 5, 2002
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Traumatic Head Injury _ Brain Structural Abnormalities and Mental Health Sequelae
Richard F. Mollica, MD_ Arch Gen Psychiatry. 2009;66(11):1221-1232
Identify structural brain alterations associated with THI and investigate association with posttraumatic stress disorder and depression
.
Mean cortical thickness in some areas significantly thinner in ex-political detainees with THI compared to those without.
More depression and PTSD in ex-political detainees with THI compared to those without.
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Mr. Nguyen,… Social
Hx, English, Education
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Non-English at home,
English spoken
less than "very well"
Non-English at home
English spoken
"very well"
Only English at homeSlide14
VN American Elderly: Demographic Data
U.S. Census Bureau, 2004 American Community Survey
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Effects of Limited English Proficiency on Health Care Comprehension Wilson, E. et al.
J GEN INTER N MED 2005; 20:800
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Mr. Nguyen… Traditional Practices
On physical exam you find lines of red bruises along ribs and midline in his back…. You probably would….
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Coin rubbing
1
Cupping therapy
2
Jugana
Loder
. (2008).
Gua
Sha
[photograph], Retrieved May 6, 2011, from:
http://en.wikipedia.org/wiki/File:Gua_Sha.jpg
.
Alanna
Ralph. (2004). Fire cupping [photograph]. Retrieved May 6, 2011 from: http://en.wikipedia.org/wiki/File:Fire_Cupping.jpg.
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Mr. Nguyen…
What are common cancers in VNese American seniors? White Men White Women VN Men VN Women
All Cancer* 1432.0 1.00 907.8 1.00 883.7 0.66 534.7 0.63
Stomach 37.1 1.00 19.8 1.00 88.0 2.54 51.3 2.92
Liver 28.2 1.00 14.6 1.00 141.8 5.24 61.9 4.55
Cervix 7.7 1.00 13.7 1.74
Breast 129.3 1.00 23.5 0.19
Lung 454.3 1.00 206.8 1.00 285.5 0.64 114.2 0.56
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*Death rate/100,000. Cancer Causes Control (2008) 19:135–
Cancer death rates for older Asian-Americans_
Lauderdale, D.; Huo, D
.Slide18
Mr. Nguyen…
After evaluation, you think Mr. Nguyen probably has depression and needs antidepressant treatment. .. What could be cultural barriers in diagnosis and treatment of mental health issues in VNese elderly?
Social stigma.
Traditional health beliefs:
Hot/cold (Yin – Yang)
Herbal medicine (“northern medicine”, “southern medicine”)
Acupuncture.
3.
Lack of sensitive and specific testing instruments
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Mr. Nguyen…
General Issues in Health CareOther cultural barriers in health care1. Advanced directive
2. Responsible party
3. Death and dying truth telling
4. Care-giver burden
5. Attitude toward health maintenance
19Slide20
Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey, 2001–2002
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MMWR, August 27, 2004Slide21
Cultural Aspect of Health Care in Vietnamese American Elderly_ Summary
1. Vietnamese American seniors do have difference in their medical profiles.2. Culture and traditional health beliefs have strong impact on health care for VNese seniors.
3. A culturally appropriate approach is important in medical care for
VNese
elderly to improve our patient care.
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