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Cultural Competence: African American Older Adults

As we wrap up this all-too-brief series on cultural competence in serving older adults, let’s focus on the largest minority group in the United States: African Americans.

Even though African American adults most often speak English and have lived in the U.S. all their lives, there are many cultural preferences and dynamics that deserve attention. As I’ve mentioned before, I’m white and a native-born American, so I don’t presume to know what it’s like to be Black in America now or in decades past, when our clients were younger adults. I do try to learn what I can, though, with an attitude of cultural humility.

(P.S. I’m following the lead of the Alzheimer’s Association in using “Black” and “African American” interchangeably. Of course, you should always try to find out which words your client uses to describe him or herself.)

Key Facts and Considerations

African Americans represent 12% of the American population. There are 2.7 million African Americans ages 65 and over, and by the year 2050, this number is expected to triple.

The older adults we serve today lived through the Civil Rights Movement in the 1960s. Although tremendous positive change has happened in the last fifty years, many African American older adults remember well the overt discrimination of the time before the Civil Rights Movement.

Blacks have historically faced many barriers to accessing high-quality healthcare services. Combined with a distrust of the medical establishment following programs like the Tuskegee syphilis experiment, elders and family caregivers may need time and understanding to build a trusting relationship with a healthcare provider. (As a side note, for an revealing look into this mistrust of the medical establishment, I highly recommend reading The Immortal Life of Henrietta Lacks.)

African Americans face an higher incidence of many chronic diseases compared to the general population, including heart disease, stroke, kidney disease, diabetes, vascular dementia, and Alzheimer’s disease.

Social support, particularly from faith communities, is extremely important for African Americans as a group. While the majority of African Americans are Christians, a growing number are Muslim, particularly recent immigrants.

Families frequently seek support and advice from their ministers and church groups. Caregivers often find solace in their religion and use prayer as an essential coping skill.

Extended family (and close friends who are considered to be family) provide care. Multiple generations often live in the same home, and older adults may have raised children and grandchildren. Families may refuse services because of a desire to take care of their elders. Long-term care may be seen as a last resort.

Black older adults may prefer to be addressed with titles of respect, such as “Mrs.” or “Sir.” Always ask, rather than reverting to the first name.

Implications for Creative Caregiving

Take time for exploration and discovery of African Americans’ rich cultural heritage. Black people have made incredible contributions to American culture, and there is much to be celebrated in the art, music, dance, and poetry created by people of the African American community. Not sure where to start? Read about the Harlem Renaissance and check out some of the artists that were making waves when our older adults were young.

Know your artists. Many of the musical styles that originated in the Black community eventually became very popular in the white majority culture. (Think jazz, rock and roll, hip hop…) That means many songs that were written or popularized by black performers were later performed and popularized by white performers. (For example, Big Mama Thornton popularized “Hound Dog” long before Elvis Presley came along.) It’s best to be familiar with as many performers as possible.

Be aware of music/art that pokes at racial sensitivities. For example, the familiar song “Dixie” is a cultural touchstone in the Southern U.S., but it was also used to intimidate African Americans during the Civil Rights era. Likewise, songs from minstrel shows, pictures of performers in blackface, and images of the Confederate flag may all bring up racial issues that you did not intend to bring into a session or activity.

Use music to talk about the Civil Rights era. While you probably want to avoid bringing up racial issues unintentionally, you may have occasion to talk specifically about the Civil Rights movement and your older adults’ experiences with it. In that case, music can provide a helpful framework for discussion. The documentary “Let Freedom Sing” and the White House performance “A Celebration of Music from the Civil Rights Movement” archived on PBS are both excellent places to start.

Don’t make assumptions about your clients’ preferences. I don’t think I can stress this enough. Some black people like country music and opera, just as some white people like the blues and gospel. The best policy is to listen to your clients, ask about their preferences, and provide a broad range of music and other art from which to choose.

What are your ideas for serving African American older adults with cultural competence and an attitude of cultural humility? Please share!

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