Gerontological Nursing & Healthy Aging: Chapter 4

Culture, Ethnicity, Diversity, and Aging

The Gerontological Explosion and Multiculturalism in Canada
Canada is becoming increasingly diverse, with multiculturalism a core part of its identity.
- Officially recognized as a multicultural society since 1971.
Older immigrants, particularly those aged 65 and older, make up 30% of the population in this
age group. Although ethnocultural minorities are not as prevalent among those 65 and older,
their numbers are steadily increasing, especially in the younger senior age group (45-64 years).
- This shift is becoming more relevant in gerontological nursing, which is increasingly
addressing the needs of this diverse aging population.
Health Disparities in Canada
Health disparities in Canada have been a longstanding concern, impacting vulnerable populations
based on factors such as Indigenous identity, low socioeconomic status, sexual and gender
minority status, racism, immigrant status, and functional limitations.
- Other groups affected by health disparities include those with lower education levels,
those living in poverty, and those in rural or remote areas.
Indigenous Peoples
Indigenous peoples experience significant health disparities, including higher rates of chronic
conditions, disability, and death from injury, along with lower life expectancy compared to non-
Indigenous Canadians.
- These disparities are rooted in historical factors such as colonialism, assimilation
policies, and systemic racism.
Indigenous populations often face difficulties accessing healthcare and experience poorer living
conditions, such as inadequate housing and lack of access to safe drinking water.
- Older Indigenous adults, especially residential school survivors, continue to face lasting
health effects, including chronic conditions and mental health challenges.
Health Disparities Among Visible Minorities and Immigrants
Visible minorities and immigrants in Canada also face health disparities and tend to have worse
health outcomes and higher poverty rates.
While most older immigrants have lived in Canada for decades, they often experience poorer
health than their Canadian-born counterparts, particularly long-term immigrants.
- A phenomenon known as the “healthy migrant effect” suggests that recent immigrants
may have better health than older immigrants, but this gap diminishes over time.
- Barriers to healthcare, such as language, cultural differences, and racism, further
exacerbate health disparities in these groups.
Reducing Health Disparities
Addressing health disparities requires more than improving healthcare access, it requires tackling
the root causes, including the social determinants of health and intersectionality.
- This means recognizing how multiple identities interact to create compounded inequities.
Policies aimed at improving socioeconomic status, like income protection and pension policies,
have reduced poverty rates among older Canadians but have not equally benefited all groups.
- Visible minorities, those living alone, and LGBTQ individuals face higher poverty rates.
An intersectional approach is necessary to effectively address these disparities, ensuring that
policies and practices are inclusive and address the diverse needs of all older adults.
Cultural Competence vs. Cultural Safety
Cultural competence involves nurses acquiring the skills to use cultural knowledge in
assessments, communication, and interventions.
- This includes recognizing personal biases and learning to assess and support older adults’
cultural needs without hindering wellness practices.
Cultural safety goes beyond cultural competence. It addresses power imbalances and biases
within healthcare systems, striving to ensure equity in care.
- This is particularly important for marginalized groups, such as Indigenous peoples,
whose health disparities are tied to the impacts of colonization.
Key Elements of Culturally Safe Health Initiatives:
1. Collaboration and partnerships with communities to build trust and respect.
2. Power-sharing, empowering patients to define their experience of cultural safety.
3. Addressing the broader context of a patient's life, including the trauma of colonialism.
4. Creating safe environments, both emotionally and physically.
5. Self-reflection on power dynamics and biases at both organizational and individual
levels.
6. Ongoing training for healthcare providers to promote cultural safety.
Cultural Awareness
Cultural awareness involves self-reflection and understanding how societal privileges, such as
race, impact interactions with older adults from different ethnic or cultural backgrounds.
- Awareness of isms (racism, ageism) is essential, as these issues can affect the quality of
care and access to services for older adults.
Cultural Knowledge
Nurses should gain knowledge about different cultures to provide effective care.
- This includes learning about practices such as folk medicine, caregiving traditions, and
end-of-life rituals, which may vary significantly across cultures.
- However, it’s important to avoid stereotyping and to treat each individual as unique.
 Different Health Belief Systems
- Western/biomedical: Views illness as the result of biological abnormalities.
- Personalistic/magico-religious: Believes illness is caused by supernatural forces or
punishment from deities (i.e. god).
- Naturalistic/holistic:– Focuses on maintaining balance and harmony in the body and
environment to prevent illness.
Cultural Skills
Cross-cultural nursing requires skills such as active listening, interpreting nonverbal cues, and
negotiating treatment plans that incorporate both the nurse's and the patient’s perspectives.
Working with Interpreters
Effective communication with older adults who have limited English proficiency often requires
the use of an interpreter. Nurses should ensure interpreters are well-prepared and ideally match
the patient’s age, gender, and social status.
- Clear communication practices include speaking directly to the patient, using simple
language, and ensuring that the interpreter accurately conveys the patient’s words without
personal judgment.
Implications for Gerontological Nursing and Healthy Aging
Culturally Sensitive Assessment and Communication
The role of gerontological nurses often begins with an initial assessment that focuses on
understanding the older adult's unique health and cultural perspectives.
- Listening carefully to their story and assessing their cultural background helps build
rapport and trust. A thorough assessment, although sometimes done gradually, should
aim to be culturally sensitive.
Tools for Culturally Competent Care
Explanatory Model: This model is designed to gather insights into a patient’s understanding of
their health condition. It asks questions about the nature of the problem, its perceived causes, and
its impact, helping nurses assess the cultural aspects that influence care.
- This tool enables nurses to align their care approach with the patient's beliefs, enhancing
communication and treatment effectiveness.
LEARN Model: This framework guides nurses through a process of listening attentively to the
patient, explaining their own perception of the situation, acknowledging differences in
understanding, and negotiating a care plan that incorporates both perspectives.
- By using this model, nurses can become more culturally sensitive and reduce health
disparities.
Respecting Health Beliefs
Understanding and respecting an older adult’s health beliefs, which may combine biomedical
and traditional or spiritual practices, is essential for effective care.
 - Nurses should be aware that patients may refuse certain biomedical treatments based on
cultural or religious views, and it’s important for the nurse to navigate these situations
without trying to change the patient’s beliefs.
Instead, nurses can:
Negotiate care: Offer treatment options that consider the patient’s cultural beliefs.
Accommodate beliefs: Find ways to integrate beneficial cultural practices into the treatment.
Guide patients on harmful practices: Gently explain the potential harm of certain practices and
suggest safer alternatives.
Promoting Healthy Aging and Collaboration
For healthy aging to be promoted, nurses need to work collaboratively with the patient’s family,
especially in cases where there is cultural or generational conflict about caregiving.
- Nurses can help families understand different caregiving practices and expectations,
providing strategies to manage caregiving responsibilities and resolve conflicts.
Additionally, nurses should ensure the older adult has access to necessary services, considering
factors like affordability, availability, and satisfaction with healthcare options.