Best Practices in Care Management for Asian American Elders: The Case of Alzheimer's Disease

Article excerpt

This article addresses practice concerns and special issues for professionals doing case management for older Asian Americans using Alzbeimer's disease as the case example. Highlighted are cross-cultural issues in assessment for depression in this population, as well as caregiving and community service utilization issues. The research is based on the author's own work and the literature, as well as results from a population-based study of caregivers of the elderly in California.

Keywords: dementia; depression; caregiving

It is important to determine what constitutes "best practice" in care management for older Asian Americans. This is especially vital when the elder has Alzheimer's disease (AD), a debilitating disorder with eventually fatal consequences for the patient that also takes a serious toll on the caregiver in terms of both their mental and physical health (Baumgarten et al., 1992; Dunkin & Anderson-Hanley, 1998; Ory, Huffman, Yee, Tennstedt, & Schultz, 1999). These negative effects appear to be present regardless of the race or culture of the care provider (Janevic & Connell, 2001). Indeed it is a myth that people who are non-White-especially the foreign born-are able to manage the care of people with AD with no negative outcomes or costs to themselves or their families (Arnsberger, Fox, & Zhang, 2003; Asahara, Momose, & Murashima, 2002). It is possible that care managers often fail to assist these families as they should partly because they are not always sure how to proceed, but also because they accept the myth that these families can always "care for their own" without the need for outside assistance.

It is also important to determine best practices for care managers in the case of AD because it has been suggested that the way in which a care manager delivers services affects client outcomes (Arnsberger, 1997). Care managers need to be also aware of the barriers to service utilization with elders in general and Asian American elders in particular to ensure that they have the services they need (Arnsberger, Zhang, & Fox, 2003; USDHHS Surgeon General's Report, 1999).

Based on research conducted by this author, as well as others, this article will address four areas where utilizing evidence-based practice can contribute to the development of best practice in the field of care management for Asian Americans with AD:

* Assessing for depression

* Assisting with caregiving burden

* Managing Alzheimer's disease

* Addressing Asian American issues

BACKGROUND

Asian Americans are one of the fastest-growing groups in the US. Between 1980 and 1990 their numbers grew by 108% (Ulincy et al., 1995) and from 1990-2000 the population grew by 43% to 10.8 million. The foreign born make up nearly three quarters (74%) of this group (Dhooper, 2003). Asian Americans and Pacific Islanders (AAPI) are extremely heterogeneous in terms of their country of origin and language, with the largest Asian groups being Chinese, Filipino, Japanese, Asian Indian, and Korean. Because of such diversity, the U.S. Census in 2000 separated "Asian Americans" from "Native Hawai'ians and other Pacific Islanders" as two distinct racial categories (U.S. Census Bureau, 2001). Each of these groups represents a culture unique in language, values, lifestyles, history, and patterns of movement and adaptation to America and experience major challenges in their attempts to access the U.S. health and mental health care systems (USDHHS, Office of the Surgeon General, 1999). Finally, as age is the only known risk factor for the nonhereditary form of AD, it is important to note that the aged are the fastest-growing subgroup within AAPI populations (Ong, 1989). The AAPI elderly population (65 +) is expected to increase by 285% between 1999 and 2030, as compared to 81% for White elderly (U.S. Census Bureau, 2002).

While AD is recognized as an illness among most Asian American populations, it is a relatively recent recognition. …