Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Assuaging Death Anxiety in Older Overseas-Born Australians of Culturally and Linguistically Diverse Backgrounds Hospitalised for End-of-Life Care

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Assuaging Death Anxiety in Older Overseas-Born Australians of Culturally and Linguistically Diverse Backgrounds Hospitalised for End-of-Life Care

Article excerpt

Introduction

International research is increasingly showing that immigrants and ethnic minorities experience significant barriers to receiving high-quality end-of-life (EOL) care compared with the majority population of the countries in which they live (Gysels et al., 2012; Periyakoil, Neri, & Kraemer, 2015; Seeleman, Essink-Bot, Stronks, & Ingleby, 2015; Smedley, Stith, & Nelson, 2003). Moreover, as a consequence of these barriers, immigrants and ethnic minorities also experience disparities in the outcomes of their EOL care, which extends to their being enabled to experience a "good death". In an attempt to redress this problem, there has been mounting recognition by researchers and health service providers alike of the need to better understand the influence of culture on patient and family centred EOL care and on the processes that can be used to help enable immigrant and ethnic minority patients to experience a good death at the end of their lives (Cheng et al., 2015; Gysels et al., 2012; Kagawa-Singer & Blackhall 2001; Periyakoil et al., 2015; Seeleman et al., 2015).

Australia has one of the most culturally and linguistically diverse (CALD) populations in the world. According to the 2011 Census, Australia's population is composed of people originating from more than 200 countries, speaking more than 220 different languages other than English at home, and practising more than 120 religions (Australian Bureau of Statistics, 2012). Australia also has an aging population, with the Australian Institute of Health and Welfare (AIHW) estimating that people over the age of 65 years will increase by 21% within the next 40 years (AIHW, 2015). As of 2011, more than one-third (36%) of Australians aged over 65 years were born overseas, with 14% being from main English-speaking countries and a disproportionate 22% from non-main English-speaking countries (AIHW, 2013). Of those from non-main English-speaking countries (to be referred to herein as older immigrants of CALD backgrounds), the largest birthplace groups originate from Italy, Germany, Greece, China, the Netherlands, Croatia, Malta, and Poland (National Seniors Australia Productive Ageing Centre [NSAPAC], 2011). Significantly, the population of older immigrants of CALD backgrounds is projected to increase by 66%, compared with just 23% for the older Australian-born population in the forthcoming years (AIHW, 2004). Moreover, according to the NSAPAC, some overseas birthplace groups (even those who have lived in Australia for many years) will have relatively low levels of English language proficiency (NSAPAC, 2011). Some have estimated that as high as 34% of older immigrants of CALD backgrounds lack proficiency in the English language. Adding to this, for those who do have English language proficiency, this proficiency tends to decline with increasing age and as the older person reverts back to using their first language (NSAPAC, 2011).

In Australia most people who are expected to die, will die in hospital (AIHW, 2014; Clark, Collier, & Currow, 2015). Although the place of death for those in the older age groups (i.e. older than 65 years of age) will gradually shift from hospitals to residential aged care facilities (Broad et al., 2013), a significant number of older people will nonetheless die in hospital. This is because when ill and dying, the EOL care supports required by people are not readily available outside of the hospital setting (AIHW, 2014; Clark et al., 2015; Swerissen & Duckett, 2014).

In the cultural context of Australia, family members of older immigrants of CALD backgrounds have often successfully assumed the primary care of their older relatives with a chronic illness over an extended period of time (Federation of Ethnic Communities Councils of Australia, 2015). However, as older relatives approach the end of their lives and their symptoms become unmanageable at home it becomes necessary for them to be admitted to hospital for EOL care. …

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