Alzheimer's Disease Health Promotion Case Study
Part 2: Gender, Culture, and Developmental Stages
Gender, Culture, and Developmental Stages
This section will discuss the impact of Alzheimer's disease on racial, cultural, and gender variables, with the focus being on the various approaches to care of the disease. Developmental stages and tasks will be discussed for both the client and the caregiver. Gender and Culture
Alzheimer's disease and related dementias affect all races, ethnicities and cultures equally. (Anonymous, 1998) Of people over 65 an estimated 6-10% will be affected by some form of dementia. (Hendrie, 1998) It is only in gender where we see slightly more women than men who are affected by this destructive illness. (Lautenschlager et al., 1996) The only controllable risk factor that is known at this point is cigarette smoking. In a large study in Germany smoking cigarettes doubled the risk of dementia in the older population. (Ott et al., 1998)
Alzheimer's disease patients can survive for 3-20 or more years. It is not the AD that kills the patient, rather it is diseases of aging and/or inactivity, with pneumonia being the leading cause at 70%. This is followed by heart disease, stroke, and cancer. (Thomas, Starr, & Whalley, 1997) Cultural Differences
Race, culture, religion and ethnicity all play a part in how we care for our elderly. Each family makes decisions based on background, experience, expectations, knowledge base, and economics. Most people would like to be able to care for their aging parent or spouse with as little disruption to lifestyle as possible. Alzheimer's Disease, however, is a full time commitment, not just eight hours a day, but "24/7", as the current idiom implies, the patient needs continuous care. Sleep habits are disturbed, wandering is common, medications must be carefully controlled, safety is always important. Home care soon becomes frustrating and exhausting if left to one or two caregivers. When the primary caregiver has his/her own medical needs to see to, is also aged, or is the parent of young children as well, the burden can become overwhelming. In-home care is a possibility as is placement in a live-in facility, but both are expensive alternatives.
In California ethnic minorities make up a large part of our population. In the book Culture and Nursing Care: A Pocket Guide, there are characteristics of these groups and generalizations are made about how they care for their elderly. (Lipson, 1996) The following table highlights some of these groups that are represented in the Bay Area.
American IndianStatus of "elder" begins in middle age. Great respect and veneration of elders. Extended family cares for elders.
Prefer home care. (Only 10 SNFs on all US reservations.)
African AmericanPrefer to keep at home. May want patient to die in hospital since death in a home brings bad luck to the home.
ArabExtended family cares for patient. Will seek hospitalization to prevent death.
CambodianExtended family performs home care. May attribute memory loss and depression to Khmer Rouge War atrocities.
Central AmericansPrefer home care by extended family. Reluctant to place in SNF. May attribute dementia to supernatural or significant life event e.g. death of child or spouse.
ChineseExpect home care by extended family.
FilipinoExpect home care by extended family. Religion a large part of daily life.
HmongHome care by female family members expected. Evil spirits can cause harm, so illness is not spoken of.
JapaneseHome care expected by family. Shame associated with mental deterioration.
MexicanHome care by extended family. Mental deterioration a sign of weakness.
Southeast AsianHome care preferred. Want to die at home with family attending.
RussianPrefer home care, but SNF OK if near home and family...