Mental health care of older adults: Does cultural competence matter?
What you need to know
By 2050, it is estimated that nearly 35% of older adults in the United States will be from a racial or ethnic minority group. The current evidence has found that a lack of culturally competent medical and mental health care leads to poorer outcomes, less commitment to care plan recommendations and greater differences among racial and ethnic minority groups. Psychiatric disorders in older adults can lead to poorer medical outcomes and are associated with increased health care resource utilization, longer hospital stays and higher medical costs. In addition, those individuals from racial and ethnic minorities are more likely to suffer from chronic diseases, including mental health illnesses such as depression and anxiety.
Overall, the authors identified that minority and underserved groups of seniors are known to suffer from lower health literacy, limited English proficiency and poorer health care outcomes. They found that there is evidence that cultural competence training improves provider awareness of the differences and cultural needs of older adults. The authors also found trends that suggest culturally competent care improves patient satisfaction and perceptions of healthcare providers.
What is this research about?
The authors focused on cultural competency and health literacy in the mental health care of older adults. They defined several concepts related to cultural competency, including:
- cultural competency as “the ability of an individual or organization to interact effectively with people from cultures other than one’s own”
- health care cultural competence as “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients”
- linguistic competence as “the ability to provide culturally appropriate verbal and written language services to persons with limited English proficiency (LEP).”
The authors found that health literacy rates are lower among minority, poor and undereducated individuals and most often among the elderly, where low health literacy is associated with poor health status and higher mortality rates.
What did the researchers do?
The authors reviewed the current literature on culturally competent mental health care for older adults in the United States. The literature review focuses on a minority group of seniors and seniors not fluent in English who are found to have multiple health disparities, including higher incidence and prevalence of various mental health conditions.
What did the researchers find?
From the literature review, the authors summarized their findings into four categories as follows:
- Linguistic Competence and Mental Health: The authors found that Asian-American seniors who are not fluent in English have the highest rate of linguistic isolation, which is defined as living in a household where a non-English language is spoken and there is limited ability to speak, write or understand English. Linguistic isolation can lead to social isolation and feelings of loneliness. The authors identified several studies that found associations between social isolation, poorer health and fewer healthy behaviours. The authors also highlight the importance of communication between the patient and healthcare provider, and found that misdiagnosis and delays in treatment can occur due to language difficulties. Overall, individuals who are not fluent in English are less likely to access mental health services, even when access is available.
- Cultural Competence and Provider Education: The authors found cultural competency training to be one key strategy that can achieve health equity, eliminate disparities, and improve the health of all groups. According to the authors, cultural competency training is now a requirement in undergraduate medical education and all residency training programs in the United States. They also found in systematic reviews that cultural competency improves the attitudes, knowledge and skills of health care professionals and also improves patient satisfaction.
- Cultural Competence and Patient Outcomes: The authors found limited evidence specifically focusing on mental health care outcomes among older adults.
- Delivery of Culturally Competent Mental Health Care for Older Adults: The authors highlight several models, standards and tools focusing on cultural competency. They found one tool called the Cultural Formulation Interview, which has 16 evidence-based questions that allow clinicians to obtain information on the impact a patient’s culture has on their clinical presentation, diagnostic considerations and treatment choices. They also found models of culturally competent geriatric mental health care being developed and implemented throughout the United States.
Furthermore, the authors highlight how medical documents such as consent forms, patient education materials and psychiatric assessment scales should all be translated and available to clinicians for use with older adults. In addition, it is important that language interpretation is available in the delivery of mental health services and provided through bilingual staff, staff interpreters, contract interpreters, telephone/telehealth interpreter services, or as a last resort, community volunteers or family members. Expanding the number of health care providers who are bicultural and bilingual to deliver culturally competent care is equally important and also needed to deliver mental health care to older adults.
Overall, the authors found that there is evidence that cultural competence training improves provider awareness of the disparities and cultural needs of a given target population. They also found trends suggesting that culturally competent care improves patient satisfaction and perceptions of healthcare providers.
Limitations of the research
No limitations identified by the authors.
How can you use this research?
The authors suggest that healthcare providers and organizations foster a culturally competent environment of care by using many of the government and professional resources available on cultural competence and health literacy. Several best practices and models that focus on patient outcomes have been identified and are currently in the development and implementation stages. However, there is still a need for research on identifying the features of these models and to define the degree to which culturally competent care is needed to reduce disparities and improve patient outcomes.
About the researchers
Maria D. Llorente1 and Margaret Valverde2
- Department of Veterans Affairs, Georgetown University School of Medicine, Washington, DC, U.S.A.
- George Washington University School of Medicine, Washington, DC, U.S.A.