Russian Speaking Older Adults and American Health Care System: the challenge we face

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Russian Speaking Older Adults and American
Health Care System the challenge we face

• Tatyana Kemarskaya, M.D.,
• IM, Geriatrics, Hospice and Palliative Care
• Center for Healthy Aging, LVH, Allentown PA

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Statistics

• The Russian speaking population grew from 241 797
  to 706 242 in 10 years
• Rank went up from 15th to 9th
• 20 of Russian speaking immigrants were over 65
  y.o which made them one of the oldest groups of
  immigrants in the country

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English Language

• Ability to speak English
• very well 304,89143
• well 209,05730
• not well 148,67121
• not at all 43,623 6
• Those who are not very well considered to have
  problems with the language, 50
• Shin HB, Bruno R. Language use and
  English-speaking ability 2000. Washington DC US
  Census Bureau, 2003.

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ELAS English Language Acculturation Stress

• 300 Russian immigrants mean age 73 (59 to 92
• Average stay in the US 7years,
• 85 of participants college degree or above
• 94 had yearly income below 10,000
• Male/female 50/50
• Tran TV,Sung T,Huyhn-Hohnbaum A-LT. A measure of
  English Acculturation Stress and its Relationship
  with Psychological and Physical Health Status in
  a sample of Elderly Russian Immigrants J of Geron
  Soc Work, Vol 50 (3/4) 2008
• 
  
  
• Available on line at http//jgsw.haworthpress.com

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ELAS English Language Acculturation Stress

• 5 questions on English language skills (reading
  and oral comprehension, ability to write and
  speak, ability to read notices posted in the
  building)
• 6 questions on experiencing difficulty with
  different functional tasks or leisure activities
• a factor analysis allowed to break the test onto
  3 interpretable factors, grouped as Basic English
  sckills, survival English Skills and Social
  Involvement English Skills
• 
  
• Tran TV,Sung T,Huyhn-Hohnbaum A-LT. A measure
  at http//jgsw.haworthpress.com

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ELAS English Language Acculturation Stress

• The correlation analyses revealed higher language
  gauge acculturation stress is related to higher
  frequency of depression and poor health status
• Overall the results indicated that ELAS scale has
  acceptable criterion validity
• 
  Tran TV,Sung T,Huyhn-Hohnbaum
  A-LT. A measure at http//jgsw.haworthpress.com

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DEPRESSION

• Lack of Intrinsic motivation for immigration
• Loss of country, work and status
• Identity Conflict
• Language barrier between generations
• Separation from friends, relatives left behind
• Gutkovitch Z et al, Depression and
  demoralization among Russian-Jewish Immigrants in
  primary Care. Psychosomatics 1999 40117-25

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DEPRESSION

• Usually presents with increased somatic
  complaints
• Unwillingness to use social or psychiatrist
  service
• Low use of support groups and psychologist
  service for dual reason language barrier and
  different cultural upbringing
• Aroian KJ,Khalutsky G, Tran TV, Balsam AL Health
  and social service utilization among elderly
  immigrants from the former Soviet Union. J Nurs
  Scholarsh. 200133(3)265-71

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I hope youre not one of those people who have
trouble swallowing pills.
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DEPRESSION

• Remeron (mirtazapine )
• Lexapro (escitalopram oxalate) SSRI
• Cymbalta (duloxetine hydrochloride) (SSNRI)

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DEPRESSION and DEMENTIA

• Depression is associated with cognitive
  impairment in older people
• Depressive symptoms are commonly found in
  patients with SDAT
• There is proven benefit and improvement in
  behavior and well being with the use of SSRI in
  patients with AD
• Depressive symptoms were associated with
  cognitIve decline and the risk of AD.
• Wilson RS,Barnes LL et al, Depessive symptoms,
  cognitive decline and rismk of AD in older
  persons Neurol, Aug 2002 vol 59(3)

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DEMENTIA

• Definition deficit in at least 2 areas of
  cognition that affects ability to function in a
  given role (work role, social domain, etc)
• Increased incidence and prevalence due to aging
  of the population
• Less recognized in Russian-speaking immigrant
  population

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DEMENTIA

• Challenging to evaluate functional decline
  (instrumental ADLs)
• Difficulty using memory evaluation tools since
  they are designed and validated for
  English-speaking population (MMSE)

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DEMENTIA

• therefore, use of clock-drawing close
  correlation with driving ability
• Short-term memory test
• semantic and phoenemic fluency tests allows for
  quick screening for 2 major dementias, Alzheimer
  type and vascular
• Canning SJ D, Leach L, Stuss D,Ngo L Black SE
  Diagnostic Utility of abbreviated fluency
  measures in Alzheimer disease and vascular
  dementia Neurology, Feb 24,2004, vol 62 (4)
  556-562

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DEMENTIA

• Treatment options are extremely limited
• Anticholinesterase inhibitors
• Donepezil (Aricept) 5mg and 10 mg
• Galantamine (razadyne) start 4 mg BID, max
  24 mg daily sustained-release tabs available as
  well as liquid form
• Rivastigmin (Exelon) available via patch
• MMDA-receptor antagonist
• Memantadine (Namenda) per scheme
• Quaseem A, Snow V, Cross JT Jr, et al. Current
  Pharmacological Treatment of Dementia A Clinical
  practice Guideline form the American Academy of
  Family Physicians and the American College of
  Physicians. Ann Intern Med 2008 148370-8

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Infectious diseaseHIV/AIDS TB

• Growing number of cases of HIV/AIDS in the
  republics of former SU which remains under
  diagnosed and underreported (between 300K-900K)
• Lack of knowledge and misconceptions
• Rising number of TB cases (from 45 K to 124 K in
  1991-99) with Russia being 11 country in the
  world with the highest burden of TB
• Shpilko I. Russian_american health care Bridging
  the communication gap between pysicians and
  patients Pat edu coun 2006 (64)331-341

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Infectious disease HEPATITIS

• Hepatitis A moderately endemic in the countries
  of former Soviet Union
• Hepatitis B is highly endemic in the former Asian
  Soviet Republic
• There is no specific link between prevalence of
  Hep C and the former Soviet Union republics
  
• 
  
  WHO
  Hepatitis B factsheet 1999

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CANCER

• Customary in Soviet health system to inform the
  patient family first
• Patients themselves maybe unaware of the
  diagnosis, esp. successfully treated ones, for
  example renal cell carcinoma or melanoma
• Age-appropriate cancer screening physician role
• Althuasen L,. Journey of Separation Elderly
  Russian Immigrants and Their Adult Children in
  the Health Care Setting, Soc Work Health Care
  19931961-75

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Cultural Competence

• Is a means, not an end
• Ability of health care providers to deliver
  effective services to racially, ethnically and
  culturally diverse patient population
• Cross-Cultural Medicine ed by J Bigby American
  College of Physicians, Philadelphia 2003

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The End!
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BIBLIOGRAPHY

• Shin HB, Bruno R. Language use and
  English-speaking ability 2000. Washington DC US
  Census Bureau, 2003
• Benisovich SV,King AC.Meaning and knowledge of
  health among older adult immigrants from Russia
  a phenomenological study Helath Educ Res
  200318134-44
• Tran TV,Sung T,Huyhn-Hohnbaum A-LT. A measure of
  English Acculturation Stress and its Relationship
  with Psychological and Physical Health Status in
  a sample of Elderly Russian Immigrants J of Geron
  Soc Work, Vol 50 (3/4) 2008
• Available on line at http//jgsw.haworthpress.com
• Quaseem A, Snow V, Cross JT Jr, et al. Current
  Pharmacological Treatment of Dementia A Clinical
  practice Guideline form the American Academy of
  Family Physicians and the American College of
  Physicians. Ann Intern Med 2008 148370-8
• Hepatitis Bigby 35 p 232 WHO Hepatitis B
  factsheet 1999
• Althuasen L,. Journey of Separation Elderly
  Russian Immigrants and Their Adult Children in
  the Health Care Setting, Soc Work Health Care
  19931961-75
• Aroian KJ, Khatutsky G, Tran TV, Balsam AL Health
  and social service utilization among elderly
  immigrants from the former Soviet Union. J Nurs
  Scholarsh. 200133(3)265-71
• Brod M, Heurtin-RobertsS Older Russian emigre and
  Medical Care, in Cross-Cultural Medicine A
  Decade Later (special issue) West J Med 1992
  157333-6
• Gutkovitch Z et al, Depression and
  demoralization among Russian-Jewish Immigrants in
  primary Care. Psychosomatics 1999 40117-25
• Goldberg Elkhonon The Executive Brain Frontal
  lobes and the Civilized Mind New York Oxford Univ
  Press 2001
• Barbara Freund, PhD,1 Stefan Gravenstein, MD,1
  Rebecca Ferris, BS,1 Bonnie L Burke, MS,2 and
  Elias Shaheen, BS3 Drawing Clocks and Driving
  Cars Use of Brief Tests of Cognition to Screen
  Driving Competency in Older Adults J
• Gen Intern Med. 2005 March 20(3) 240244.
• Canning SJ D, Leach L, Stuss D,Ngo L Black SE
  Diagnostic Utility of abbreviated fluency
  measures in Alzheimer disease and vascular
  dementia Neurology, Feb 24,2004, vol 62 (4)
  556-562
• Wilson RS,Barnes LL et al, Depessive symptoms,
  cognitive decline and rismk of AD in older
  persons Neurol, Aug 2002 59(3)
• Shpilko I. Russian_american health care Bridging
  the communication gap between pysicians and
  patients Pat edu coun 2006 (64)331-341

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Did I remember to mention the Possible Side
Effects