Clinical Assessment Domains: Health and Social History

Mental Health

Risk factors for depression among elderly Asian American women, including Filipino immigrants, include:

• • poor general health with increased impairment of activities of daily living (ADLs)
• • social isolation
• • stressful life changes
• • requiring a higher level of assistance from children
• • being less religious
• • experiencing a greater cultural gap between themselves and their children. (Asian American Federation of New York, 2003)

The care giving or surrogate-parenting role can also place a burden on elderly individuals, which could result in situational depression (McBride 2006; Tompar – Tiu & Sustento – Seneriches, 1995).

Clinicians should be cognizant about common indigenous traits and perceptions among elderly Filipino Americans suffering from mental illnesses such as depression.

Several validated screening tests can be utilized to facilitate the detection of depression in elderly adults, including:

• • Center for Epidemiologic Study Depression Scale
• • Geriatric Depression Scale
• • General Health Questionnaire
• • Beck Depression Inventory

Recommendations:

• • Pay attention to the level of education and acculturation and English language proficiency. Always ask for professional interpreters when administering such screening tests.
• • Assess for social support and availability of other community resources.

Risk of Elder Abuse

Risk factors for abuse may include:

• • lower levels of acculturation,
• • living with non-family members or in an intergenerational household,
• • dependence on other adults to move about,
• • lack of ability to use simple technology (e.g. telephone),
• • lack of English proficiency,
• • degraded physical appearance (i.e., self neglect) (Lewis, Sullivan & McBride, 2000).

Also assess for other suspicious physical signs of abuse, and for other types of abuse (emotional abuse, sexual abuse, neglect by caregivers, self-neglect, financial exploitation, and health care fraud and abuse).

Use of Community-Based Healers and Spiritual Counselors

Traditional treatment (herbals, nutritional supplements, prayers, etc.) often are used concurrently along with Western medical treatment (Grudzen & McBride, 2001; McBride, 2006). Thus, we stress the importance of eliciting the usage of indigenous healing practices in a gentle and non-judgmental manner and take time to educate patients and families about the potential for adverse interactions between the different systems of healing.

Other Sources of Health Care

Older adults who frequently travel to the Philippines or visit other family members in the US may be receiving medical care from a physician in the Philippines or in other locations.

Dietary History

The Filipino American diet is relatively high in fat and cholesterol compared to the diets of other Asian Americans. Organ meats such as tripe, pork blood, pork and chicken intestines, and poultry liver are well-liked. The typical diet uses high-sodium condiments such as fish sauce (Patis), shrimp paste (Bagoong), soy sauce (Toyo), anchovies and anchovy paste. Pastries and rice cakes high in concentrated sugar are often eaten for dessert. Due to these dietary practices, Filipino Americans are at high risk for developing cardiovascular-related conditions (coronary artery disease, hypertension, hyperlipidemia, obesity, diabetes, hyperuricemia and gout). Filipino Americans exhibit significantly higher levels of hypertension than other Asian Americans. These levels are similar to those in African Americans who live in the US (Nguyen, 2006).

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