5.4Multicultural Health Care and Rehabilitation of Older People
The ageing process brings with it problems to all, but particularly so to the ethnic minority living within the larger community. The current trend is for the proportion of aged persons to increase, but the proportion of ethnic aged is increasing at a particularly alarming rate.
Moreover, as Prof. Shah Ebrahim says in the Forward to a book with the above title (Squires 1991): " we have too little information and know too little about the impact of what we as practitioners do for ethnic minorities to see the way forward with any clarity...... Although there is a wealth of literature about ethnic minorities there has been remarkably little systematic study of the impact of ageing on the psyche, on social networks, and on physical health, and virtually no research making comparisons with the experience of the host community".
Official recognition that Britain has become a multicultural society was acknowledged by the Race Relations Act (1976) and the NHS and Community Care Act (1990) which state that: "people from different cultural backgrounds may have particular care needs and problems." The 1989 White Paper 'Caring for People', likewise recognises that "people from different cultural backgrounds may have particular care needs and problems".
In the United Kingdom there are over 3.3 million, or 6.3 % of the population of Great Britain who were born outside the UK. The major group (31%) comes from the Indian subcontinent, with another 17% coming from Pakistan. Other substantial groups come from the West Indies (19%), China (5%), Africa (4%), Arab countries (3%), or mixed background (11%). Another 0.6 million (18.1%) come from Ireland. The specific disease prevalence varies quite considerably with ethnic background. Increased mortality and morbidity may be found in higher proportions than the national average in certain groups, e.g. alcoholism (Irish, Sikh men), (Irish), diabetes and coronary heart disease (SE Asians), hypertension (Afro-Caribbeans). Decreased rates for cancer are found in several groups (SE Asians, Afro-Carribbeans)
Pam Schweitzer descibes the key issues affecting the older migrant which include:
- Loneliness (Caribbean man: "Sometimes I sit in the park and think about the thing that I dread most and that is loneliness")
- Language barriers: (Indian man: "If someone swears I know straight away")
- A longing for home - memories of home become particularly sharp in the later years.
- Rejection of change in the homeland: elders are often shocked to learn that in their homeland there are many of the same problems of social disintegration as in contemporary Britain.
- Alienation from children and grandchildren: (Indian man: "My children.... Have betrayed me since coming here").
- A need to be with compatriots.
The role of the general practitioner, physician, nurse, physiotherapist, occupational therapist, speech therapist, chiropodist, nutritionist, pharmacist and social worker are all critical for the welfare of migrants.
One obvious problem is the difficulty in communication. In a survey carried out at the London Hospital for instance, 12% of all patients did not have a good command of English, and most of these did not bring with them an interpreter. In another survey, it was found that "Approximately one third of Asian patients are unable to read, a further third are able to read an Asian language".
The difficulties of communication are particularly obvious in speech therapy. Deidre Duncan comments : "In many instances they function linguistically, communicatively and socio-culturally as monolinguals in their home/community language" .
The difficulties of assessing the degree of pathological defect are also evident because testing has been devised primarily for English speaking patients. "There are very few formal assessments of aphasia in languages other than English...The strategies which are employed by clinicians in therapy at different levels of language breakdown - phonology, syntax, semantics - are based on the structure and function of English."(Ibid.)
Another issue that could cause acute embarrassment is the male/female relationship: " a sensitive awareness of this is required. In some cultures, a man may not discuss personal topics with a female therapist or vice versa." (Cellophane A. Hume on "Occupational therapy with ethnic minority elders").
The taking of medicinals by older persons presents problems of its own. Firstly there is the obvious fact that older people in general are more likely to be using drugs of one kind or another (about 3 fold more frequently than the national average.) More specifically, differences in language and culture may lead to reduced compliance with prescribed medication. During Ramadan, for instance, as many as three quarters of Moslem patients may not take their medications as prescribed. Alcohol, a constituent of many oral medicines, is forbidden in four religions - Islam, Hinduism, Sikhism and Buddhism. Gelatine capsules are made from the bones and hide of animals (cows and pigs), that would be unacceptable to Hindu, Sikh, Moslem, Jews or vegetarians.
Providing a uni-cultural service to a multicultural clientele is just not adequate. Health care delivery, as Margaret Heatley and Amanda Squires comment, "is dependent on co-operation which is elicited by understanding, empathy, respect, explanation, realistic assessment, joint goal setting, encouragement and feedback. With elderly people, social attitudes and health beliefs held by any culture must be understood to make the rehabilitation process work."
While there are obvious differences in the difficulties encountered by the various ethnic groups, there are obvious similarities also. Many of the problems highlighted by this report are faced daily by aged Maltese migrants also.
Squires Amanda J. (ed.) Multicultural Health Care and Rehabilitation of Older People, Edward Arnold, London, 1991.
[From: Bold 1993]
Source: Maurice N.Cauchi - The Maltese Migrant Experience, Malta 1999