Cultural Aspect in Health Care for Vietnamese American Elderly

Chinh Duy Le, MDUCI Senior Health Center

• 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.

VN American Elderly:

Demographic DataU.S. Census Bureau, 2004 American Community Survey

Vietnam: A Snapshot

Strongly influenced by Chinese and French culture due to prolonged colonization by these governments in historyASDFGHJ. (2009). Location Vietnam ASEAN [vector graphics], Retrieved May 5, 2011, from: http://en.wikipedia.org/wiki/File:Location_Vietnam_ASEAN.svg.

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.

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?

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.

Mr. Nguyen,… Social Hx, English, Education

Social 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.

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.

Long-term Effect of Psychological Trauma on The Mental Health of Vietnamese Refugees in Australia.

Zachary Steel et al., Lancet, Oct 5, 2002

Long-term Effect of Psychological Trauma on The Mental Health of Vietnamese Refugees in

Australia.Zachary Steel et al., Lancet, Oct 5, 2002

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.

Mr. Nguyen,… Social Hx, English, Education

Non-English at home,English spoken less than "very well"

Non-English at home

English spoken "very well"Only English at home

VN American Elderly: Demographic Data

U.S. Census Bureau, 2004 American Community Survey

Effects of Limited English Proficiency on Health Care Comprehension Wilson, E. et al. J GEN INTER N MED 2005; 20:800

Mr. Nguyen… Traditional Practices

On physical exam you find lines of red bruises along ribs and midline in his back…. You probably would….

Coin rubbing1 Cupping therapy2

1. Jugana Loder. (2008). Gua Sha [photograph], Retrieved May 6, 2011, from: http://en.wikipedia.org/wiki/File:Gua_Sha.jpg.

2. Alanna Ralph. (2004). Fire cupping [photograph]. Retrieved May 6, 2011 from: http://en.wikipedia.org/wiki/File:Fire_Cupping.jpg.

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

*Death rate/100,000. Cancer Causes Control (2008) 19:135–

Cancer death rates for older Asian-Americans_ Lauderdale, D.; Huo, D.

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?

1. Social stigma. 2. Traditional health beliefs:

• Hot/cold (Yin – Yang)• Herbal medicine (“northern medicine”,

“southern medicine”)• Acupuncture.

3. Lack of sensitive and specific testing instruments

Mr. Nguyen…

General Issues in Health Care

Other cultural barriers in health care

1. Advanced directive

2. Responsible party

3. Death and dying truth telling

4. Care-giver burden

5. Attitude toward health maintenance

Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey, 2001–2002

MMWR, August 27, 2004

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.