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EDUCATE, LEARN & GROW

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Cross-Cultural Differences in Elderly Care



Introduction 

In Canada, a nation marked by its multicultural identity, almost a quarter of adults identify as immigrants, with 15% of those aged over 65, predominantly from culturally diverse backgrounds since the 1990s, especially from Asia, the Pacific region, and South and Central America (Andruske and O’Connor, 2020). Many older immigrants have arrived through family reunification policies, often living with or receiving support from family for a decade or more post-arrival (Andruske and O’Connor, 2020). Recognizing the impact of cultural diversity on aging and family care has emerged as a crucial area of study. 


In this blog post, we’ll explore how culture significantly shapes the caregiving experience in immigrant and ethnic communities, necessitating a deeper understanding of its role. Although gerontological research has extensively examined family care through a stress and burden perspective, especially in ethnically diverse contexts, it has often overlooked the broader family dynamics and the influence of immigration and acculturation on care practices. This oversight highlights the need for a more nuanced approach to understanding family care within a culturally diverse and globalized migratory context. 


Cultural Attitudes Toward Aging 

In their comparative analysis of attitudes toward aging among young adults from the United States and Germany, McConatha et al. (2003) explore how cultural perceptions and respect for the elderly can significantly vary. The study highlights that German participants generally viewed aging more negatively compared to their American counterparts. This difference may stem from cultural and societal norms that shape attitudes towards aging and the elderly. In Germany, aging is often associated with anxiety over physical appearance changes and fear is losing independence, reflecting a societal emphasis on youth and physical vitality (McConatha, 2003). Conversely, in the United States, although aging is also met with some degree of negativity, there is a slightly more positive reception, potentially influenced by a cultural narrative that values the wisdom and experience of older adults(McConatha, 2003). 


Traditionally, Eastern cultures are believed to respect and value the elderly more than Western cultures, due to principles like filial piety in Confucianism (North and Fiske, 2015). However, modern research challenges this notion, indicating that rapid social changes, including industrialization and urbanization, have altered these traditional values. North and Fiske (2015) found that attitudes toward older adults are often more negative in Eastern countries compared to Western ones, a surprising revelation given the cultural expectations. In particular, as societies industrialize, the roles that older adults traditionally held (e.g. as knowledge keepers) become less significant, which may contribute to less positive attitudes towards this demographic. The economic pressures of supporting a growing older population can also exacerbate negative perceptions, especially in places where rapid aging coincides with economic stagnation (World Health Organization, 2011). 


Family Reunification and Its Impact on Elder Care 

Family reunification remains a cornerstone of Canada’s immigration policy. It aims to allow Canadian citizens and permanent residents to sponsor their family members, including parents and grandparents, to immigrate to Canada. This has led to a noticeable increase in multigenerational households where older adults live with their children and grandchildren. Such arrangements often provide emotional and financial support to the elderly but can also introduce complex family dynamics and caregiving responsibilities. For instance, older immigrants, particularly from Asian and Latin American backgrounds, often arrive in Canada through these reunification programs and find themselves living in extended  family settings (Andruske and O’Connor, 2020). This living arrangement can offer them a supportive environment that aligns with the cultural expectation of filial piety and respect for elders, which is prevalent in many non-Western cultures. However, these setups can also lead to strained resources and space, sometimes heightening tensions within the household due to differing cultural expectations about independence and caregiving (Andruske and O’Connor, 2020).


The role of technology in facilitating care for older immigrants in Canada has evolved, becoming crucial in maintaining the continuity of family connections and managing the practical aspects of care across distances. With the widespread adoption of digital communication tools such as Facebook, WhatsApp, and other social media platforms, families are able to offer support and maintain emotional connections despite geographical separations (Andruske and O’Connor, 2020). For instance, a family from Vancouver might use video calls to stay in touch with a parent who remains in the Philippines, providing not only social interaction but also enabling them to monitor their health and well-being from afar. This technological shift has allowed for a form of “virtual co-presence” where family members can participate in the daily lives of their elderly relatives, celebrating milestone or providing comfort during tough times without being physically present (Andruske and O’Connor, 2020)


Integrating Cultural Competence 

In her work on Ethnocentric: Cross-Cultural Care of Older Adults, Gwen Yeo emphasizes the importance of cultural competence among geriatric care providers. This is increasingly significant in light of demographic shifts where a substantial number of elders come from diverse cultural backgrounds. Yeo discusses how elders from ethnic minorities and immigrant communities are growing faster than the majority elder population in North America, a trend that presents unique challenges in geriatric healthcare provision. 


This diversity introduces complex challenges in geriatric care, primarily because these populations often carry unique health risk profiles and adhere to various traditional practices that influence their health behaviours and interactions with healthcare systems. For example, many elderly patients from Asian backgrounds might use traditional medicine practices, such as herbal treatments or acupuncture, which they may prefer over to use alongside Western medical treatments (Yeo, 2015). These cultural nuances in health practices necessitate a healthcare approach that acknowledges and integrates diverse cultural beliefs into the care process, aiming to deliver care that is not only medically competent but also culturally sensitive. 


Furthermore, Yeo (2015) discusses the critical role of understanding family dynamics and expectations surrounding elder care within different cultural contexts. Many cultures have strong expectations regarding family involvement in caregiving, which can influence decisions related to independent living, medical interventions, and end-of-life care. For instance, in many Hispanic and Asian communities, there is a significant expectation that the family will provide for the elder’s care, which can impact the utilization of nursing homes or other long-term care facilities (Yeo, 2015). This cultural perspective on family caregiving underscores the necessity for healthcare providers to engage with both patients and their families in a manner that respects these cultural values while also providing appropriate medical advice and support. By embracing a culturally competent approach in geriatric care, healthcare providers can ensure that they are effectively meeting the needs of an increasingly diverse aging population, thereby improving overall care outcomes and patient satisfaction (Yeo, 2015). 


Conclusion

To conclude, the evolving demographic of Canada’s elderly population characterized by a significant number of older immigrants, necessitates a culturally competent approach to geriatric care. Studies showcased in this blog post underscore the diversity in cultural attitudes towards aging and the corresponding impact on caregiving practices. As these insights suggest, incorporating cultural competence into geriatric care is essential for addressing the unique needs of this growing demographic. Healthcare providers and policymakers must therefore work collaboratively to ensure that care strategies are inclusive and respectful of cultural differences, enhancing the quality of life for all elderly Canadians. 


References

Andruske, C. L. (2020). Family care across diverse cultures: Re-envisioning using a transnational lens. Journal of Aging Studies, 55, 100892. https://doi.org/10.1016/j.jaging.2020.100892


McConatha JT, Schnell F, Volkwein K, Riley L, Leach E. Attitudes toward Aging: A Comparative Analysis of Young Adults from the United States and Germany. The International Journal of Aging and Human Development. 2003;57(3):203-215. doi:10.2190/K8Q8-5549-0Y4K-UGG0


North, M. S., & Fiske, S. T. (2015). Modern attitudes toward older adults in the aging world: A cross-cultural meta-analysis. Psychological Bulletin, 141(5), 993-1021. doi:https://doi.org/10.1037/a003946


YEO, G. (2015). ETHNOGERIATRICS: CROSS-CULTURAL CARE OF OLDER ADULTS. Generations: Journal of the American Society on Aging, 20(4), 72–77. http://www.jstor.org/stable/44877910




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