The client in this scenario is a 68-year-old African American female who has some significant cardiovascular issues, as evidenced by her reported medications, and is reported not to be compliant with her medications.  The purpose of this assignment is to identify cultural factors that relate to this client based on the provided information.  In this assignment, I will identify factors of socioeconomic status, spirituality, lifestyle, and what would be a sensitive topic for this client. 

               As a psychiatric nurse practitioner understanding a client’s cultural background is required to develop an understanding of a client’s belief system and attitudes towards healthcare (Ball, Dains, Flynn, Solomon, & Stewart, 2019). I believe the essential concept of this assignment is to recognize that there is a significant difference in physical appearance and cultural background (Ball et al., 2019).  As this assignment does not include the socioeconomic, spiritual, and lifestyle information other than this client is a black female, lives alone, and she is 68-years-old, am I to make assumptions based on this client’s skin color, age, and sex?  While certain cultural aspects of this client’s perceived cultural background may be statistically probable, assuming this client’s cultural background would be to stereotype her.  As a healthcare professional, I should view each client as an individual and not as a statistical probability (Ball et al., 2019).  While I do not believe that this client’s skin color, age, and sex should be used to make assumptions about her culture, these factors could have an impact on the probability of this client developing medical conditions. 

Socioeconomic

             The frequency of elderly individuals living alone is growing, particularly amongst females.  This trend is particularly true for those 65 years of age and older (Refer & Requena, 2018).  The rising trend of women living alone is related to the death of their spouses and the divorce rate (Refer & Requena, 2018).  The Percentage of men and women aged 65 + living alone is approximately 40% of females and 22% of males (Refer & Requena, 2018).  The socioeconomic status of these women is much dependent on the amount of money they were able to save, pension plans, and public assistance programs (Refer & Requena, 2018).  Many of the elderly are not financially capable of seeking medical attention or have the ability to pay for their medications or refill their medications. Some elderly are forced to cut their medications in half, so their medications last longer or may not have the financial capability to purchase more medications when they run out of their medications. The client, in this scenario, may have extra medications and missing others due to the lack of resources to purchase more medications.  

Spirituality

              In the article “Medication adherence and spiritual perspectives among African American older women with hypertension,” spirituality among African Americans were identified as being beneficial to promoting adherence to antihypertensive medications (Lewis, 2011). This qualitative data obtained in this research project from African American women indicated that faith played a significant role in their compliance with taking their hypertensive medications (Lewis, 2011). The participants of this research project were comprised of 76% single, and 24% married African American older females (Lewis, 2011). The participants of this research project communicated that they have been given a chance by God to help themselves by taking their medications and that the prescribing physicians were put in their path by God to help them get better (Lewis, 2011). This concept could be beneficial for the client in this scenario if she had faith or a belief in God. Identifying if the client draws strength from her spirituality could be a crucial aspect tending to her needs and having her be compliant with her medications.  

Lifestyle

              Approximately 28 percent of older adults live alone in the United States; this equates to approximately 13.8 million (National Institute on Aging [NIA], n.d.).  Those that live alone have an increased probability of poor aging outcomes, including a reduction in their cognitive ability, depression, obesity, Alzheimer’s disease, and cardiovascular disease (NIA, n.d.).  The adverse effects of the elderly developing both mental and physical conditions are directly related to living a lifestyle that involves social isolation and loneliness (NIA, n.d.). The combination of living alone, being an older adult, and developing cognitive impairments places these individuals at an elevated risk of harm.  The combination of worsening physical conditions with diminished cognitive ability is likely to lead to poor aging outcomes, noncompliance with medication regimens, and the inability to meet basic health needs. 

Sensitive Topic

              With this client not meeting her medical needs independently and being of advanced age, I believe the sensitive question to ask would be the possible necessity of this client needing to live in a long-term facility. In this scenario, this client clearly has not been taking her medications as ordered for at least a year.  This may be due to financial reasons but most likely due to diminished cognitive abilities. This is a 68-year-old woman who has been living independently and is not likely to be easily persuaded that she needs to move into a long-term care facility. If this client was reluctant to move to a long-term care facility, other options include home health care that can assist her with her medications, meal preparations, fall alarms, and transportation to medical appointments.  The level of care needed by this client would require testing to determine if she does have a cognitive deficit and or the severity of the cognitive deficit. A neuropsychological assessment would be appropriate for evaluating this client’s cognitive processing, encoding, storage, and retrieval of visual and auditory stimuli, cognitive function, motor control, and interpretation of visual information (Huang et al., 2019).

               The questions that I would ask this client would include questions that determine cognitive impairment. As a psychiatric nurse practitioner, I will routinely be monitoring my client’s mental health status, including cognitive impairment, which could be related to a mental health condition or possible adverse reactions to medications. A few of the questions I would ask would be 

                         • How are you feeling today? 

                         • Do you have trouble with maintaining conversation?

                         • Do you leave the stove on, tap running, or forget to lock the house?

                          • Do you have any difficulty with remembering the names of people?

                           • Do you ever feel lost or unable to remember where you are at? 

                           • Can you tell me when you need to take your medications? 

Conclusion

               Understanding a client’s cultural background is an essential component of enabling healthcare professionals to provide optimal and sustainable treatment measures for his or her clients. A client’s cultural background should not be prejudged by determinates such as age, sex, skin color, or any other factor other than information gained by gathering a client’s history and physical.  Determining a client’s socioeconomic status can identify barriers that can prevent a client from having his or her medical needs met appropriately. Research indicates that spirituality can improve an older African American female client’s medication compliance.  The lifestyle of living alone for older clients can cause the development of poor aging outcomes such as cognitive deficits, depression, and cardiovascular issues. As a psychiatric nurse practitioner, one of the most challenging conversations with a client is the need for long term care after all alternatives have been exhausted. 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier. 

Huang, Y. P., Singh, A., Chen, S., Sun, F. J., Huang, C. R., & Liu, S. I. (2019). Validity of a novel touch screen tablet-based assessment for mild cognitive impairment and probable AD in older adults. Assessment, 26(8), 1540-1553. http://dx.doi.org/110.1177/1073191117748395 

Lewis, L. M. (2011). Medication adherence and spiritual perspectives among African American older women with hypertension. Journal of Gerontological Nursing, 37(6), 34-41. http://dx.doi.org/10.3928/00989134-20100201-02 

National Institute on Aging. (n.d.). Social isolation, loneliness in older people pose health risks. Retrieved from https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks 

Refer, D., & Requena, M. (2018). Living alone in later life: A global perspective. Population & Development Review, 44(3), 427-454. http://dx.doi.org/10.1111/padr.12149

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