Ethno Med Health and Health Care of Native Hawaiian & Other Pacific Islander Older Adults http://geriatrics.stanford.edu/ethnomed/hawaiian_pacific_islander © Thinkstock/Getty Images Course Director and Editor in Chief: VJ Periyakoil, MD Stanford University School of Medicine [email protected] 650-493-5000 x66209 http://geriatrics.stanford.edu Author: Marjorie K. Mau, MD, MS Dept. of Native Hawaiian Health, University of Hawaii at Manoa eCampus Geriatrics IN THE DIVISION OF GENERAL INTERNAL MEDICINE http://geriatrics.stanford.edu © 2010 eCampus Geriatrics eCampus Geriatrics native hawaiian and other pacific islander older adults | pg 2 CONTENTS Description 3 Culturally Appropriate Geriatric Care: Learning Objectives 3 Assessment 23 Topics— Copyright/Referencing Introduction & Overview 4 Population Diversity 23 Information Topics— Important Cultural Issues 24 Users are free to download Demographics 4 and distribute eCampus Background 7 Eliciting the Patient’s Geriatrics modules for Perspective 25 educational purposes only. Patterns of Health Risk 8 All copyrighted photos and Topics— Culturally Appropriate Geriatric Care: images used in these modules Life Expectancy, Mortality 8 retain the copyright of their Delivery of Care 26 original owner. Unauthorized Morbidity 8 Topics— use is prohibited. General Health Status 8 Preventive Care, Compliance/ Cardiovascular Healthcare Utilization, When using this resource and Cerebrovascular Traditional Healing please cite us as follows: Disease, and Use of Traditional Mau, M, MD, MS: Health and Dyslipidemia 10 Healers 26 health care of Native Hawaiian Hypertension, Diabetes 11 Community Based Health and other Pacific Islander Kidney and Renal Initiatives, Older Adults http://geriatrics. Disease 12 Caregiver Stress, End-of-Life stanford.edu/ethnomed/ Preferences 27 hawaiian_pacific_islander/. In Arthritis, Gout & Periyakoil VS, eds. eCampus Hyperuricemia; Geriatrics, Stanford CA, 2010. Cancer 13 Instructional Strategies: Case Studies 28 Mental Health, Case Study 1 28 Substance Abuse 16 Case Study 2 29 Infectious Diseases, Asthma 17 Case Study 3 30 Case Study 4 30 Culturally Appropriate Geriatric Care: Fund of Knowledge 18 Student Evaluation 31 Topics— Historical Background 18 References 33 Traditional Health Beliefs 20 Traditional Health Practices 22 © 2010 eCampus Geriatrics VJ Periyakoil, MD, Course Director & Editor in Chief [email protected] 650-493-5000 x66209 visit us online: http://geriatrics.stanford.edu eCampus Geriatrics native hawaiian and other pacific islander older adults | pg 3 DESCRIPTION This module presents available information about older adults who identify themselves as Native Hawaiian MODULE CHARACTERISTICS and/or Pacific Islander, including Samoans, Tongans, Micronesians, and Marshallese among others. The module discusses demographics, patterns of health Time to Complete: 2 hrs, 0 mins risk, and the role of cultural competency in the health assessment and treatment of Native Hawaiians and other Intended Audience: Doctors, Nurses, Pacific Islanders. Social Workers, Psychologists, Chaplains, Pharmacists, OT, PT, MT, MFT and all other Course Director and Editor in Chief of the clinicians caring for older adults. Ethnogeriatrics Curriculum and Training VJ Periyakoil, MD Peer-Reviewed: Yes Stanford University School of Medicine Author Marjorie K. Mau, MD, MS Department of Native Hawaiian Health, University of Hawaii at Manoa Learning Objectives After completing this module, learners should be able to: 1. Explain the difference between health care decision-making based on the principle of individual autonomy vs. that of group consensus particularly as it relates to Native Hawaiians and Pacific Islanders. 2. List at least four health disparities found in the Native Hawaiian and Pacific Islander populations. 3. Compare and contrast the differences in communication styles encountered when evaluating Native Hawaiians and Micronesians in the physician office or hospital setting. 4. Describe at least two components needed for a successful treatment intervention with Native Hawaiian and/or Pacific Islander populations. © 2010 eCampus Geriatrics VJ Periyakoil, MD, Course Director & Editor in Chief [email protected] 650-493-5000 x66209 visit us online: http://geriatrics.stanford.edu eCampus Geriatrics native hawaiian and other pacific islander older adults | pg 4 introduction and overview Demographics Data on Native Hawaiians and Pacific Islanders is For further information on demographics, extremely limited and is often confounded by the see the census web site: www.census.gov tendency to aggregate races with different patterns of health risk under headings such as Asians and Pacific Islanders (AAPIs). Such headings are problematic as they do not recognize the diversity that exists within Native Hawaiians & this population group (Louie, 2001). For example, the Fig. 1 Other Pacific Islanders average life expectancy for AAPIs is 80.3 years—higher (United States) than the life expectancy for the total US general population (75.2 years). However, AAPIs include Tongan, both the Japanese, who have one of the longest life Fijian, 4.2% expectancies at 82.1 years, and Native Hawaiians who 1.6% Guamanian/ have one of the lowest at 68.3 years. Data on specific Chamorro, races by age group is even less available, highlighting the 10.6% need for continued research in this area. Accordingly, the Office of Management and Budget (OMB) introduced a new racial category in 2000 that identified Native Hawaiians and other Pacific Samoan, Native Islanders as a separate category disaggregated from 15.2% Asian Americans (Executive Office of the President, Hawaiian, Office of Management and Budget (OMB), & Office 45.9% of Information and Regulatory Affairs, Accessed August Other Pacific 29, 2007). This curriculum will use OMB’s definition of Islander, race and ethnicity. 22.5% Within this new racial category, Native Hawaiians comprise the largest proportion of individuals followed by Samoan and Guamanian/Chamorro © Stanford eCampus Geriatrics,http://geriatrics.stanford.edu (See Figure 1) (US Census Bureau, Accessed August 29, Source: US Census 2000 2007). However, other Pacific Islander groups exist in the US but are limited by the relatively small size of their total population. © 2010 eCampus Geriatrics VJ Periyakoil, MD, Course Director & Editor in Chief [email protected] 650-493-5000 x66209 visit us online: http://geriatrics.stanford.edu eCampus Geriatrics native hawaiian and other pacific islander older adults | pg 5 (INTRODUCTION AND overview CONT’D) For the purposes of this curriculum, the scope was Ethnologically, the Pacific Rim area can be described by limited to the following racial/ethnic groups based on three regions: available literature: 1. Micronesia (i.e. Federated States of Micronesia, Native Hawaiian (the indigenous population of the Palau, Commonwealth of the Northern Marianas State of Hawaii), islands, Guam), Samoan (the indigenous population of Samoa or 2. Melanesia (i.e. Tonga, Fiji), and Western Samoa), 3. Polynesia (i.e. Samoa, Hawaii). Tongan (the indigenous population of the island These groupings can be helpful in that they cluster nation of Tonga), people by common heritage and in some cases by Guamanian/Chamorro (the indigenous population linguistics, cultural practices and values (Chappell, of the island nation of Guam), 1997). Micronesian (the indigenous population of Native Hawaiians and the cluster of islands of the Federated States Other Pacific Islanders: US Population of Micronesia, Palau, Marshall Islands, and the Approximately 32% of all Native Hawaiians and other Commonwealth of the Northern Mariana) and Pacific Islanders live in the state of Hawaii, followed Fijian (the indigenous population of the by California with 25% (Grieco, accessed August 29, island nation of Fiji). 2007). The distribution of Native Hawaiians and Pacific Islanders as a percentage of the total US population is shown in the map in Figure 3 (page 6). According to the 2000 Census, 5% of the total Native Hawaiian/Pacific Islander population is aged 65 and older (US Census 32% of all Native Hawaiians and Bureau, Accessed August 29, 2007). other Pacific Islanders live in the state of Hawaii, followed by In general, Native Hawaiians and Pacific Islanders are known to bear a disproportionately higher prevalence of California with 25% many common conditions such as obesity, diabetes, and cardiovascular disease. In addition, key health indicators such as life expectancy continue to document disparities that exist between Pacific Islanders and the general US population (Park, 2009). © 2010 eCampus Geriatrics VJ Periyakoil, MD, Course Director & Editor in Chief [email protected] 650-493-5000 x66209 visit us online: http://geriatrics.stanford.edu eCampus Geriatrics native hawaiian and other pacific islander older adults pg 6 | http://geriatrics.stanford.edu visit us online: 650-493-5000 x66209 [email protected] w CONT’D) VJ Periyakoil, MD, Course Director & Editor in Chief overvie AND © 2010 eCampus Geriatrics INTRODUCTION ( eCampus Geriatrics native hawaiian and other pacific islander older adults | pg 7 (INTRODUCTION AND overview CONT’D) Background In Hawaii, as in other isolated areas of Oceania, The islands comprising Oceania are widely dispersed contact with foreigners meant the introduction of and composed of both volcanic and coral land mass. Western diseases for which the native population Geologically, the oldest islands consist of relatively had no immunity,