Chapter 13: Cultural Differences in Aging Experiences of Ethnic and Sexual Minority Older Adults PDF

Chapter 13: Cultural Differences in Aging Experiences of Ethnic and Sexual Minority Older Adults Copyright © Springer Publishing Company, LLC. All Rights Reserved. Overview  Ethnic minority older adults ‒ Cohort effects ‒ Health...

Chapter 13: Cultural Differences in Aging Experiences of Ethnic and Sexual Minority Older Adults Copyright © Springer Publishing Company, LLC. All Rights Reserved. Overview  Ethnic minority older adults ‒ Cohort effects ‒ Health disparities and cultural stressors ‒ Factors contributing to resiliency and growth  Sexual and gender minority older adults ‒ Cohort effects ‒ Health disparities and cultural stressors ‒ Factors contributing to resiliency and growth  Intersectionality Copyright © Springer Publishing Company, LLC. All Rights Reserved. Ethnic Minority Older Adults  Class exercise: ‒ Consider your own personal experiences of being discriminated against for aspects of your identity beyond your control (e.g., age, gender, orientation, ethnicity) How did you feel during that moment? How did others seem to view and treat you? If you have not experienced this or did not have to think of this until now, why might that be? Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d) Figure 13.1 Percent aged 65 and older by single race and Hispanic origin for the United States. AIAN, American Indian and Alaska Native; NHPI, Native Hawaiian and Other Pacific Islander. Source: U.S. Census Bureau, 2012 Population Estimates and 2012 National Projections. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  The number of ethnic minority adults aged 65 years and older is expected to increase through 2050. ‒ Due to changes to immigration trends, increased life expectancies across groups, and the general increase in racial and ethnic minorities in the United States. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Cohort effects ‒ Cohorts are groups of people (not necessarily the same age) with shared cultural experiences and values. ‒ The experience of ethnic minority older adults is influenced by sociocultural views on aging. Negative ageist stereotypes increase the frequency of recalling more negative traits of aging than positive ones. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Cohort effects (cont’d) ‒ Sociocultural views on aging When working with older adults, individuals must be acutely aware of their own beliefs and values about aging and its intersection with race and ethnicity. Be aware of implicit bias and stereotype threat. Implicit bias refers to past experiences that affect attitudes and behaviors at a level below self-awareness. Stereotype threat refers to the confirmation of a group’s negative stereotype when receiving mild, sometimes subliminal, reminders of this stereotype. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Cohort effects (cont’d) ‒ Sociocultural views on aging (cont’d) When presented with positive or negative stereotypes of aging, the performance of older adults improves with positive stereotypes and decreases when presented with negative ones. Internalized ageism can affect older adults’ performance on tests of cognition and physical performance. Health care providers’ negative beliefs and attitudes about aging can result in delayed treatment, lowered expectations for improvement, and assumptions that older adults are too old to change. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Cohort effects (cont’d) ‒ Sociocultural views on aging (cont’d) Microaggressions Speaking to an older adult using infantalizing language (elderspeak) Often involves slowed rate of speech, simplified language, and fluctuating intonations Implies an exaggerated degree of dependency or inability to make basic choices that undermines the older adult’s autonomy Other examples of ageist microaggressions include speaking loudly and slowly to an older adult without evidence of hearing impairment or language difficulties Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors ‒ Health disparities are racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, or appropriateness of interventions. ‒ What contributes to health disparities? Socioeconomic status (SES) Access to health care Health literacy Ethnic minority status Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Racial and ethnic minority adults in general have premature morbidity rates across the life span. ‒ Due to differential access to resources and differential exposure to risk, may be beneficial to target the social context rather than the specific racial and ethnic group to improve inequities. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Example of targeting social context: Developing community gardens in lower income neighborhoods Increases access to organic, nutritious foods that might not otherwise be available or affordable Mitigates rates of multiple chronic health conditions Ride-share services through community organizations Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Legacy of institutionalized discrimination against certain groups continues to play a critical role in health disparities. For example, the mass incarceration of African Americans Legacies of systemic discrimination evolve and continue to oppress disenfranchised and marginalized groups Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Social reproduction Structures and activities that transmit social inequality from one generation to the next Social-stratification systems keep groups of people in the same class across generations Four forms of capital (financial, cultural, human, social) contribute to whether people remain in the same social-stratification system Capital refers to the resources one has to promote upward mobility Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Types of capital Financial capital: Wealth and access to purchase resources that represent their social class Cultural capital: Worldviews, values, knowledge, skills, and behaviors (e.g., traditions, language) adopted across generations Certain types of cultural capital may lend themselves to higher social status than others. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Types of capital (cont’d) Human capital: Knowledge base and skills one has that affects their social value Example: Educational systems (private schools, college, and so on) Social capital: Social networks and access to highly valued individuals or groups ‒ When working with older adults, consider the types of capital they currently have or have had throughout their lives Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Minority stress Increased prevalence of mental health disorders within minority groups Attributed to the chronic stressors commonly experienced by members of disenfranchised and stigmatized minority groups based on factors of their identity Ethnic minority older adults with secure capital may still experience minority stress Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Effects on health Ethnic minority adults, especially older adults, tend to have relatively more chronic health conditions than their non-Hispanic White counterparts. African American and Latino older adults less likely to initiate mental health care than their White counterparts. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Resiliency and growth ‒ Aldwin and Igarashi’s Ecological Model of Resilience in Late Life Sociocultural, contextual, and individual resources interact to create “generalized resistance resources” (GRR), which contributes to coping Sociocultural resources: Social and/or political policies, institutional practices, and historical events Contextual resources: Community characteristics and support systems Individual resources: Personal characteristics including personality, education, health, and economic well-being Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Ethnic Minority Older Adults (cont’d)  Resiliency and growth (cont’d) ‒ Aldwin and Igarashi’s Ecological Model of Resilience in Late Life (cont’d) Generalized resistance resources (GRR) Refers to the coping methods used to navigate stressful life experiences This model may help account for the degree of resilience described within ethnic minority aging groups Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults  Currently around 2.4 million lesbian, gay, bisexual, and transgender (LGBT) adults older than 50 in the United States ‒ By 2030, projected increase to 5 million  Approximately 5% of older adults report having same-sex partners ‒ These percentages appear to be consistent across ethnic identities  In studies of transgender older adults, the majority (97%) of those older than 65 reported transitioning at age 55 or older Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Cohort effects ‒ Many of today’s older adults identifying as LGBT grew up prior to the 1969 Stonewall Inn Riots, often considered the start of the Gay Liberation Movement This era criminalized homosexuality and considered it a mental illness ‒ Important historical events in the LGBT rights movement 1953: President Eisenhower signs Executive Order 10450, requiring dismissal of government employees deemed to be threats to national security Included those with mental illness and “sexual perversion” Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Cohort effects (cont’d) ‒ Important historical events in the LGBT rights movement 1956: Evelyn Hooker presented groundbreaking research demonstrating no differences in the mental health of heterosexual and homosexual adults 1962: Illinois legalizes private same-sex activity with another consenting adult 1973: Michigan establishes laws protecting LGB adults from discrimination 1993: Minnesota establishes laws to protect people identifying as transgender Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Cohort effects (cont’d) ‒ Important historical events in the LGBT rights movement (cont’d) 2003: Lawrence v. Texas: Strikes down the Texas sodomy law and sodomy laws in 13 other states 2011: Repeal of “Don’t Ask, Don’t Tell,” leading to open service in the military for LGBT individuals 2013: Defense of Marriage Act in United States v. Windsor Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Health disparities and cultural stressors ‒ Overall, LGBT adults have poorer health and higher rates of disability (47%) compared to the general population. ‒ Nearly half of LGBT older adults report having a disability and one third of LGBT older adults endorse depression. ‒ Older LGBT adults report higher rates of attempted suicide than non-LGBT older adults, with higher risk associated with histories of abuse and trauma. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ The Baby Boomers living with HIV and AIDS, independent of sexual orientation or gender identity, are one of the first generations to age with these illnesses. ‒ Many older adults are less likely to practice safe sex due to less concern for pregnancy risks, low health literacy for risk factors, and difficulty with condom use due to erectile dysfunction. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Health disparities and cultural stressors (cont’d) ‒ Utilization patterns of LGBTQ older adults demonstrate a tendency to delay or avoid use of formal health care services, often for fear of discrimination. ‒ Higher poverty rates for gay and bisexual men and women than their straight peers. Transgender adults are four times more likely to live in poverty. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Resiliency and growth ‒ Important to belong to a larger LGBT community to increase sense of empowerment and offset the history of discrimination and victimization experienced Degree of social support may differ by age group, with some of the oldest adults and transgender adults reporting the least sense of community. Copyright © Springer Publishing Company, LLC. All Rights Reserved.  Sexual and Gender Minority Older Adults (cont’d)  Resiliency and growth (cont’d) ‒ In a qualitative study of transgender older adults, these factors emerged that facilitated the aging process: Nurturing one’s spiritual self Exercising one’s sense of agency Practicing self-acceptance Maintaining caring relationships Engaging in advocacy and activism Enjoying an active and healthy life Copyright © Springer Publishing Company, LLC. All Rights Reserved. Intersectionality  The combined effect of gender, race, and class contributes significantly to oppression and inequality. ‒ Issues of age, race, gender identity, and sexual orientation do not exist independent of each other.  Health Equity Promotion Model ‒ (a) social positions and (b) individual and structural environmental context, intersect with (c) health-promoting and adverse pathways to influence the continuum of health outcomes in LGBT communities Copyright © Springer Publishing Company, LLC. All Rights Reserved. Conclusions  Cohort effects, health disparities, and cultural stressors contribute to the resiliency of sexual and gender minority older adults.  When working with older adults, it is important to understand all of these factors to provide adequate care. ‒ Intersectionality provides a model of how age, race, gender, and class may interact to influence the aging experience. Copyright © Springer Publishing Company, LLC. All Rights Reserved.