The influence of ethnicity on the health of older women.

There is increasing evidence that ethnicity is an important factor as one ages that serves as an integrating force to help an older woman filter her personal experience with aging and to pass through significant life changes, such as being a cultural and health resource for family and community, becoming a grandmother, retiring, or moving in with family when frailty occurs. Ethnicity also can act as a buffer to the visccitudes of old age. When the surrounding environment, especially the health care environment, encourages expression and the reaffirmation of ethnicity, we find examples of successful aging in many ethnic communities; however, aging is often less successful when poverty, lack of informal and or formal support, or dislocation through immigration or separation from ethnic community and family disrupt the process of coming to terms with old age. The process of counseling an older patient is a complex one, particularly when ethnicity is a strong factor in the patient's identity. Ethnicity acts as a filter to the aging process, influencing health, health beliefs and behavior, as well as interaction with health professionals. Many ethnic groups, while identifying and incorporating certain elements of scientifically based understanding of disease and illness into their lives, nevertheless also adhere to more traditional paradigms of health and illness, or associated health beliefs and behaviors sometimes called folk beliefs that diverge from mainstream Western scientific medical concepts. Older women, who are often more steeply versed in traditional health beliefs than men and often act as the first line of medical advice within the family, may adopt a combination of orthodox (scientific) and folk traditions to attempt to address illness or malaise. This multiple approach is not necessarily harmful; rather, many folk treatments (which include specific ritual behaviors, and use of teas and other folk remedies) may, from a strictly medical standpoint, play a neutral role in terms of biochemical activities but a highly positive role in terms of psychological well-being. Folk treatments allow an individual to address the social imbalances that are considered significant in causing a particular condition within the ethnic tradition. Health professionals who work with particular ethnic groups would benefit from a deeper understanding of cultural beliefs and practice, and an acknowledgement of respect for these practices. Among the variety of writings on ethnicity and health or ethnicity and aging that have appeared are practical texts on communication strategies with various ethnic groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Patient-physician communication when blindness threatens.

The threat of blindness creates a difficult and challenging environment for communication between patients and their ophthalmologists. This study examined concordance between what patients want to know from their physicians about their eye condition and what physicians believe their patients need to know. Eight retinal specialists and 24 of their patients with proliferative diabetic retinopathy and at risk of blindness were interviewed using parallel-constructed instruments. Although all recognized that blindness was the patients' greatest concern, disparities were noted that involved the desire/need to know about the possibility of vision loss, the causes of the eye condition, the results of each eye exam, and the extent of patient confusion. Physicians, while conscientious about informed consent, described various communication behaviors to avoid discussing bad news.

Factor associated with diabetic control and utilization patterns in a low-income, older adult population.

The importance to health educators of identification of factors associated with diabetic control is underscored by the prevalence of the disease and its physical, psychological and economic impacts, all of which appear greatest for the poor. An investigation of social, attitudinal, and physical characteristics of 161 low income, predominantly black and female diabetic clinic patients was conducted. Results indicate that the factors associated with poor control (higher mean fasting blood glucose) include being older, lack of belief in control over health, lack of belief in the efficacy of treatment, a belief that diabetes is less serious than three curable illnesses, reported lack of social support in a crisis with diabetes, reported low satisfaction with the clinic, and finally, higher levels of reported problems with the self-care regimen, particularly diet. Moreover, poor control was also significantly associated with an increase in the number of emergency room visits and clinic visits. Increased clinic visits were also significantly associated with younger age, a higher number of prescribed medications and the requirement for insulin therapy, higher knowledge scores, and two health beliefs, the belief that diabetes is more serious than curable illnesses, and the belief that the treatment is likely to help. More frequent emergency room visits were also associated with being white, a higher number of complications of the disease, and more reported problems with self care. A higher number of days hospitalized was significantly associated with more complications, lower satisfaction with the clinic, and lack of belief in control over health. The results suggest the potential usefulness of a number of activities by health educators to positively influence diabetes control and decrease negative utilization patterns, such as hospitalizations. These include education aimed at refocusing health beliefs to emphasize the individual's control outcomes as well as the efficacy of treatment, and behavioral training to increase practical dietary skills. Finally, altering structural characteristics of clinics to better meet patient needs, such as decreasing waiting times, may encourage patient efforts towards diabetic control.

A randomized study of the impact of home health aides on diabetic control and utilization patterns.

Home health aides were offered to half of a group of 227 low-income diabetic clinic patients; in the group offered aides, fasting blood sugar (FBS) declined when compared to control group (10.1 mg/dl vs an increase of 5.1 mg/dl), and missed clinic appointments and emergency room use also decreased. The group of 44, who, upon offer of an aide actually accepted one, showed a significant increase in eye clinic appointments as well as the greatest decline in FBS (13.9 mg/dl).