Clinical Issues in Delivering Rehabilitation Services To Asian Chinese in NYC Chinatown

1
Clinical Issues in Delivering Rehabilitation
Services To Asian Chinese in NYC Chinatown

• Presented By
• Victoria Zhang M.D.
• Medical Director, Rusk Institute of
  Rehabilitation Medicine at New York Downtown
  Hospital
• Clinical Assistant Professor, NYU Rusk Institute
  of Rehabilitation Med.
• Mathew Lee M.D.
• Professor Chairman, Rusk Institute of
  Rehabilitation Medicine at New York University
  Hospital

2
Introduction

• 3 Disability Issues in Chinese American Women
• 1) Osteoporosis
• 2) Osteoarthritis
• 3) Back pain
• Due to language barriers as well as cultural
  factors, Chinese American women do not know how
  to seek healthcare, preventions, and treatments
  leading to such consequences.

3
Statistics of the Asian population

• Over half (51) of the Asian population in the US
  either live in New York or California.
• Statistics show that there are 872,777 Asians in
  New York City, with144,538 residing in Manhattan.
• There are 4,407,444 Asians living in Los Angeles.
  

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Chinatown in New York City

• Chinatown in New York City is one of the favored
  destination points for new immigrants, and it is
  estimated that between 70,000 and 120,000
  inhabitants reside there. The total elderly
  population increased by 15 percent in Chinatown
  between 1990 and 2000.
• Between 1990 and 2030 older Chinese Americans are
  projected to be one of the fastest growing
  segments of the U.S. population. Those aged 65
  and older are projected to increase by 643 in
  comparison to the 91 projected for the white
  non- Hispanic population.

5
Senior Citizens in Chinatown

• About 35 Chinatown senior citizens lived below
  the poverty line, compared with 19 of senior
  citizens citywide. These individuals have poorer
  health status, lack of insurance, and do not have
  access to health care.
• Among elderly adults, 62 in Chinatown spoke
  little or no English, compared with 49 percent
  city-wide. Being deeply ingrained in the
  traditional Chinese culture, many elderly Chinese
  are more likely to resort to self- care. Because
  of language barriers, activities are often
  restricted within Chinatown.

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New York Downtown Hospital

• New York Downtown Hospital (NYDH) located
  adjacent to Chinatown has many Chinese language
  services. Over 60 of the Hospitals inpatients
  and 83 of its outpatients are from New York
  Citys Immigrant Chinese community.
• NYDH seeks to serve the total health care needs
  of the Chinese community. Three off-site primary
  care center located within three different
  boroughs Manhattan, Brooklyn, and Queens offers
  health education, preventive care, and early
  detection services for New Yorkers. Downtown
  Family Care Center, located in Chinatown, offers
  a free Bone Mineral Density (BMD) screen study
  for early detection of osteoporosis.
• They found.

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Osteoporosis in Chinese American Women

• 14 of 55- 60 year old women already have
  fractures.
• 20 of Asian women age 50 or older are estimated
  to have osteoporosis.
• Foreign born Chinese have lower BMD at every age
  than US born Chinese and US white women.
• Elderly Chinese women and recent immigrant living
  in inner city Chinatown are at high risk for
  osteoporosis due to
• 1) poor nutrition during childhood the diet
  lacks of calcium and due to aging, the body will
  have a decrease in calcium absorption
• 2) small and thin body frame
• 3) lack of exercise
• 4) lack of acknowledgment of causes, preventions
  and treatments
• 5) difficulty accessing medical care or distrust
  of the medical system

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Figure 1. Example of Kyphosis in Chinese Women
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Case Study

• A 74 year old Chinese female with severe
  Kyphosis, lower back pain, and leg pain. She was
  unable to lie down in bed at night. The patient
  was treated with Fosamax and Oscal 500 with D for
  1.5 years, but the pain persisted. The patient
  fell down and suffered a left hip fracture.
• The patient had ORIF and went to the
  Rehabilitation Center for 3 months. She is now
  able to ambulate with a walker at home.
• SH She came from China 50 years ago. She lived
  in Chinatown most of her life.
• FH Her mother and sister also had severe
  Kyphosis. Her mother died in a nursing home one
  year after a left hip fracture.
• Lab DEXA T- score -3.5 at the spine -3.0 at
  the femoral neck 2 years ago
• Repeat T- score -3.6 at spine -3.2 at femoral
  neck now.

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Rusk Institute of Rehabilitation

• The Rusk Institute of Rehabilitation at NYDH has
  an interdisciplinary community rehabilitation
  team composed of Chinese speaking bilingual
  Rehabilitation physicians, Physical and
  Occupational therapists, clinical coordinators
  and social workers. Application of the principles
  of Rehabilitation medicine to the community is an
  area of great importance to the care of the
  elderly and disabled individuals.

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Chinese Elderly Immigrants

• The elderly are most vulnerable to pressures from
  immigrating to a new land. In addition, the
  prevalence of functional disability in the
  elderly is significant. Nevertheless, the
  functional, educational, and psychosocial needs
  of the Chinese elderly immigrants in the United
  States have not been explored to date.
  Application of principles or rehabilitation
  medicine to community health is an area of great
  importance to the care of the elderly. In 1969,
  one of us created theoretical framework of
  rehabilitation as a third dimension of medicine
  or, more narrowly, tertiary prevention. Looking
  at disability from the epidemiological and public
  health perspective, the concept of preventive
  rehabilitation was developed.

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Convalescence Care for Seniors

• So our interdisciplinary community rehabilitation
  team participates in the community outreach,
  education, and rehabilitation program. The
  mission of Convalescence Care A Comprehensive
  Approach for seniors in the Chinese Community.
  This program is funded by a grant from the
  Langeloth Foundation to ensure that Chinatowns
  most vulnerable elderly will receive the
  necessary care to return to the highest possible
  level of functional ability. In addition, the
  goals are to provide assistance in living
  resulting with less isolation, more independence,
  and more meaningful lives.

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Interdisciplinary approach- Teamwork

• The program aims to provide high quality,
  efficient, and effective health care services and
  promotes wellness, dignity, mobility, and
  independence for elderly persons with functional
  or psychosocial needs. One of the key
  characteristics of the program is its
  interdisciplinary approach. Teamwork was the
  original and unique approach that rehabilitation
  brought to medical care. Teamwork characterized
  the relationship and interaction of medical and
  paramedical professionals in their effort to
  restore the disabled.

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Found Chinese Elderly Needs

• First, we found baseline needs through our
  outreach programs. Figure 1 shows the summary of
  70 participants, who underwent initial screening
  (average age 70 years old.)
• It is clear that cultural, communication, and
  transportation issues have a greater influence on
  the quality of life in this population than that
  of medical, vocational, and financial barriers.

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Figure 1. Barriers of life participation for
Chinese elderly in the convalescence care program
16
Break Language Barriers

• Addressing these factors, our program focuses on
  education to improve cultural understanding of
  health care and common diseases. The programs are
  available in the participants own native language
  to better improve communication and
  understanding. Language barriers are prevented by
  the availability of interpreters 24/7 and having
  a 50 bilingual staff in every department.
  Assistance with transportation can be provided by
  Shuttle Buses offered by the hospital. Physical
  barriers are prevented by having Chinese signs in
  hospitals, Chinese menus in dining facilities,
  and Chinese registration forms. There are many
  advertisements relative to health care in Chinese
  newspapers and in addition, the radio broadcasts
  many information regarding healthcare daily.

17
Educational Workshops- Coping with Arthritis

• During the 15 month program, we organized 17
  workshops in community sites including clinics, 8
  senior centers, and assisted living housing
  facilities to present 2 topics of interest for
  1000 elderly participants.
• The First series of workshop was titled, Coping
  with Arthritis without Medication or Surgery.
  (Figures 2. and 3.)

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Figure 3. Osteoarthritis of the Hand
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Back pain in the Chinese Elderly

• The second workshop was about Back pain in the
  elderly. (Figure 4.)
• The topic focuses on common causes, diagnosis,
  treatments, and rehabilitations of lower back
  pain and osteoarthritis. Moreover, the workshop
  focuses on how the elderly can benefit from our
  Rehabilitation services for education treatment
  to prevent disability.

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Cultural Understanding

• Research supports our choice of topics as Chinese
  patients showed an increased risk due to hard
  labor in farms, factory works, and long hours of
  working in restaurants. Many of these occupations
  lead to the abuse and overuse of the joints. They
  have a false belief that work is equivalent to
  exercise, therefore, this leads to the risk of
  getting osteoarthritis and back pain. Even though
  limitations in daily activities are associated
  with osteoarthritis, they do not seek for
  treatment because of the belief that it is a
  natural occurrence. Furthermore, they have no
  acknowledgment of treatments and preventions.
  That is why we have to approach them in our
  outreach programs, workshops, and health fairs
  for them to gain more knowledge of preventions
  and treatments. (Fig. 5)

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Figure 5. How much did workshop add to
participants knowledge?
22
Work in the Community

• We participated in 8 community health fairs, 3
  based at NYDH and 5 street fairs in Chinatown.
  (Figure 6.) It was another good way to reach out
  to the community elderly and we were able to
  present out our programs and rehabilitation
  services to over 250 people each time. Most of
  the patients were recruited through the
  educational workshops or the health fairs.
  (Figure 7)

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Figure 6. Referral Source
24
Figure 7. Street Fairs

• Cholesterol, glucose, blood pressure, Body Mass
  Index, height, weight, osteoporosis
  rehabilitation consultation were offered free of
  charge.

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Prevention Program

• The patients recruited through the workshops,
  health fairs, or through physician referrals are
  scheduled for initial screening by the geriatric
  outreach social worker. The physiatrist and the
  social worker see the patients at the Rusk
  Institute at NYU Downtown Hospital. The hospital
  setting is favorable because of its location
  (within walking distance from Chinatown),
  directories in Chinese, the Chinese health care
  staff, and the familiarity of the place, as well
  as the close relationship to physical and
  occupational therapy services. Referrals to
  medical specialty services are arranged within
  the hospital to encourage the elderly to join
  local senior centers, community dances, Tai- chi,
  and other physical and recreational activities.
  (Figure 8.)

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Figure 8. Exercise for Prevention

• Community members enjoyed an aerobics performance
  by The Salvation Army Senior Center, a tai chi
  demonstration by the New York Downtown Tai Chi
  Club and traditional Chinese music by the Chinese
  American Arts Councils orchestra.

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Conclusion

• The Convalescence Care for Seniors of the
  Chinese Community is able to reach out
  successfully to an underserved Chinese population
  in Chinatown. The location of NYU Downtown
  Hospital is very beneficial because of vicinity
  to Chinatown, familiarity among Chinese people,
  Chinese- speaking health care staff, and
  directories in their language. The
  interdisciplinary team is important for an
  excellent outcome of the program and consists of
  an physiatrist, geriatric outreach social worker,
  program/ research coordinator, and rehabilitation
  staff (physical and occupational therapists).
  Through educational workshops, health fairs, and
  physician referrals, the Chinese patients were
  able to get services and benefits from the
  functional approach of rehabilitation.

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• Existing Problems
• Future Studies
• Questions and Answers?

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• Thank you