As a person ages, the number of medications prescribed for chronic disease usually increase. Older adults typically have a number of co-morbid conditions necessitating an average of 5-8 medications daily. Approximately 50 percent of patients who are prescribed these medications fail to take them, however, resulting in medication nonadherence rates in older adults, reportedly as high as 77 percent.1
Nurses need to anticipate providing appropriate interventions to meet the needs of an increasing number of older adults. Indeed, according to the Administration on Aging, 38.9 million people in the U.S. were age 65 or older in 2008. That number is predicted to increase to 55 million by 2020, and to 72.1 million by 2030. This population of older adults currently occupies 50 percent of all physician hours and 49 percent of hospital services.2
Of particular concern for nurses should be that elderly patients are more vulnerable to medication errors, due not only physical factors common to aging, but also the quality of the relationship an older patient has with his providers.3
That’s especially true when the provider and the patient are from different cultures. Without a clear understanding of the medications, the patient is not likely to adhere to the medication regime. Take for example, the elderly Chinese-American population. If the patient believes strongly in Chinese medicine, he may take only Chinese medicine, especially if he does not fully comprehend his prescribed medication regime.
Less Understood
While medication practices in older adult populations in general have been researched, an examination of available literature finds relatively little research focused on adherence to prescriptions among Asian-Americans and, in particular, Chinese-Americans.4
Li, et al (2007) examined Chinese immigrants for hypertension control and medication adherence and found only 69 percent of Chinese women and 75 percent of Chinese men adhered to the prescribed medication regime. The researchers also found more women used herbal remedies to control their hypertension than men, which was one of a number of gender-specific findings. In addition, Chinese men whom resided in the U.S. for a longer period of time than the average study participant were less adherent to their prescribed medication regime.5
Chinese-American elders also are known to be at high risk for drug-related iatrogenic adverse effects due to their medication practices and health beliefs (Zhan & Chen, 2004). Medication practices of this population may be influenced by the meaning associated with the presenting symptoms, the level of congruence between their culture and that of healthcare providers, difficulty in communicating with healthcare providers and their own knowledge about prescriptions.6
Cultural Satisfaction
The healthcare system involves many different beliefs about wellness and illnesses, and the actions patients take in response to treatment. More importantly, the degree of congruence between the patient’s cultural perceptions and the healthcare provider may subsequently affect the quality of the care delivered. The degree in which the patient adheres to and seeks help about their medication plan largely depends on the meaning of the relationship they have with the provider.6,7
The Institute of Medicine (2003) suggests providers be aware of healthcare disparities among people of various cultural backgrounds.8 Some studies have tied patients’ perceptions of their primary care providers and the healthcare system as a whole to the cultural competence of staff.7
In one study, minorities were more likely to perceive being judged unfairly or treated with disrespect by medical personnel based on race or ethnicity or how well they spoke English.9 Another study found Asians were more likely to report that their regular doctor did not understand their background and values, and that their doctors did not listen or involve them in decisions about care (Ngo-Metzger, Legedza, & Phillips, 2004).10
Decreasing Disparities
To decrease healthcare disparities and give culturally competent care, nurses and other healthcare providers must add the following to their plan of care:
• Assess the patient’s level of English comprehension. Translators are a necessary component to effective therapeutic communication.
• Uncover the cultural beliefs of the patient’s population.
• Be mindful of cultural barriers. Taking a thorough health history of the patient becomes very crucial when a nurse assesses a patient of a different cultural origin. Cultural barriers are eased when nurses ask patients about their beliefs regarding medication practices. Nurses should also be aware of their own behavior and attitudes when assessing patients. Like many people in society, we may not recognize the subtle manifestations of prejudice in our own behaviors.
• Keep in mind gender-specific differences. For example, gender-dependent use of herbals and rates of nonadherence among Chinese-American women and men.
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Considering Cultural Factors
Minority elders adhere to their own cultural health belief practices. These beliefs can impact medication practice and cultural considerations should be integrated in the continuum of care provided.
It is thus imperative for nurses and other healthcare providers caring for this population to be familiar with the ethno-cultural factors and their influences on medication practice.
References for this article can be accessed here.
Cindy Y. Leung is . and Maria Rosen is Associate Professor of Nursing, Massachusetts College of Pharmacy and Health Sciences.