Cultural Competence: Vietnamese Older Adults

We’ve been talking about cultural competence here recently. Let’s turn our attention to another rapidly growing ethnic group: Asian Americans.

As with Latino Americans, Asian Americans are not a homogenous group. It’s important to know about your clients’ nationalities, how long their families have been in the U.S., why they immigrated here, and how assimilated they are into American culture. These factors play into how your clients face aging and health issues, and how you need to adjust what you do as a caregiver.

One important factor to consider is whether someone immigrated to the U.S. as a political refugee. If so, the trauma they experienced may have lasting effects on their health, effects that may be exacerbated at the end of life or by dementia.

That being said, let’s focus on just one Asian immigrant group: Vietnamese Americans. Vietnamese refugees flooded into the United States starting in 1975, in the years following the Vietnam War. That means most Vietnamese Americans are first or second generation Americans. Most Vietnamese American older adults immigrated as refugees, and may have experienced trauma as a result of the Vietnam War, and torture or incarceration. One important role for eldercare professionals is understanding and interpreting what may be the lasting effects of trauma, and communicating about this with the client’s family.

Here are some other important things to know about Vietnamese Americans:

• Vietnamese Americans have higher rates of civic assimilation compared to other Asian American groups, according to a 2008 Manhattan Institute study. As political refugees, they may see their immigration to the U.S. as more permanent than other Asian American groups. That means more Vietnamese immigrants become naturalized citizens and participate in the political process as compared to other immigrant groups.
• On the other hand, according to Census statistics, 93% of Vietnamese Americans do not speak English at home, as compared to 85% of Chinese and less than 50% of Japanese immigrants. Most Vietnamese older adults do not speak English and may also be illiterate in Vietnamese. Language barriers may be a significant issue for professional caregivers.
• Up to two-thirds of Vietnamese practice Buddhism; however, Vietnamese Americans are more likely to be Christian, with up to 23% of Vietnamese Americans being Christian (mostly Roman Catholic). Do not make assumptions about older adults’ religious beliefs.
• Vietnamese Americans have strong family ties, with mutliple generations often living together. Elders are highly respected and obeyed. Cultural guidelines suggest that you should wait for older adults to begin meals and other activities first.
• Families typically believe it is shameful to place loved ones in non-family residential care, and so they often oppose long-term care.
• According to the Alzheimer’s Association, most Vietnamese elderly are reluctant to display physical affection. Caregivers must not assume that physical contact is acceptable or even desirable.

The majority of Vietnamese Americans live in California and Texas, but more recently immigration patterns have shifted towards Oklahoma, Oregon, and Ohio. If you live and work in those areas, you are more likely to serve Vietnamese clients.

Pham Duy is one of the most important composers of modern Vietnamese music.

Music-Based Strategies for Vietnamese American Older Adults

So you know your client is from Vietnam. Then what? How can we use music and other creative experiences to connect with our Vietnamese American older adults?

• Talk with the family. There really is not substitute for this. Not only do you need to know about your client’s refugee and citizenship status, family connections, and religious beliefs, but you also need to know about your client’s music preferences and experiences with playing instruments, dancing, or singing. 
• Use YouTube. This is probably the quickest and easiest way to find a broad range of Vietnamese music. You can listen to Vietnamese songs or watch traditional dance.
• Explore traditional court music. As a country often occupied by foreigners, Vietnamese traditional music has been heavily influenced by many different cultures. The most notable feature is the pentatonic scale, also common in other Asian cultures. Nhã nhạc is the court music and dance performed by skilled musicians and dancers for formal events and celebrations. It was popular through the early 20th century and is still performed in the capital Huế. See an example here.
• Explore traditional folk music. Here, there are many forms to explore, including dân ca (a form of musical theatre), quan họ (a cappella alternate singing), hát chầu văn (a spiritual form used to invoke spirits), and ca trù (for female singers, once associated with prostitution).
• Explore popular music. Singer-songwriters in the mid-20th century responded to the Vietnam War and the rise of Communism with songs blending elements of traditional Vietnamese music and Western melodies and harmonies. The three most important composers in this genre were Phạm Duy, Van Cao and Trinh Cong Son. Much of their music was politically polarizing and banned at one time in Vietnam. Be aware that these songs may elicit strong feelings from your Vietnamese clients.
• Use Vietnamese instruments in rhythm-based experiences. If you have access to authentic Vietnamese instruments, great! If not, you can still show pictures of traditional instruments and make connections between those pictures and the instruments you do have.
• Sing lullabies. In my experience, the easiest songs for me to learn in a language I don’t know are lullabies and children’s songs. This makes sense, right? While kids’ songs are not always age-appropriate with seniors, that you make an effort to learn even a simple song for a client is quite meaningful. (Watch this video for some help from Liv.)

By approaching your client with an attitude of humility and a willingness to learn about their unique perspective, you can provide profoundly meaningful support for someone in a minority culture group.