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Culture, Heritage, and Diversity in Older Adult Mental Health Care

Edited by Maria Llorente, M.D., FAPA
APA Council on Geriatric Psychiatry

  • ISBN 978-1-61537-205-8
  • Item #37205

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Health care organizations are beginning to recognize the importance of cultural competence as it relates to efficiency, quality, and equity in the delivery of care within a competitive health care market, and Culture, Heritage, and Diversity in Older Adult Mental Health Care is designed to train mental health clinicians to deliver culturally sensitive care to an increasingly diverse patient population. Projections indicate that 35% of patients older than age 65 will be from a racial or ethnic minority group by 2050, compared with 11% in 1970. Today's mental health practitioners require knowledge, sensitivity, and an understanding of institutionalized practices and systems that undermine their patients' health and well-being.

The term culture is multifaceted and may refer to one's belief system, values, religion, race, socioeconomic status, ethnicity, language, sexual orientation, geographic location, educational level, age, occupational risks and exposures, and gender. The authors of the book examine mental health care through these lenses, teaching the reader about implicit biases and potential miscommunication and offering strategies for overcoming these difficulties. The editor, who has worked in leadership positions overseeing veterans' mental health services, has assembled an impressive and diverse roster of contributors, each with specific expertise in his or her assigned subject.

  • The ways in which cultural competency interacts with the six Accreditation Council for Graduate Medical Education core competencies are explored in detail. For example, in terms of patient care, cultural competency plays an important role in gathering subjective data about a patient that may ultimately impact outcomes. Teaching methods to increase cultural sensitivity and build skills in this area are highlighted, as are training modalities and clinician evaluation.
  • The effects of migration and acculturation on mental health are examined, providing clinicians with several theoretical frameworks for understanding the migratory experience in older adults and exploring psychosocial factors associated with psychological risk in aging immigrants.
  • Linguistic competence, defined broadly as effective communication with individuals speaking a nondominant language, is an essential component of culturally competent health care and is of particular importance in mental health care. Accordingly, the authors analyze linguistic competency in both administrative and clinical encounters and present strategies for achieving mastery in this critically important area.
  • The text provides an abundance of tables and pedagogical features designed to enhance comprehension, including learning objectives, key points, and study questions.

Cultural competence in health care systems is defined as the ability to understand and integrate the features listed above into the provision of health care services. Culture, Heritage, and Diversity in Older Adult Mental Health Care prepares clinicians to provide sensitive, high-quality, culturally competent care to geriatric patients from diverse backgrounds and will prove indispensable as patient demographics continue to change.


  • Contributors
  • Foreword
  • Preface
  • Chapter 1. Why Is Cultural Competency Important When Working With Older Adults?
  • Chapter 2. Cultural Competence in Geriatric Psychiatry Teaching and Evaluative Methods
  • Chapter 3. Migration, Acculturation, and Mental Health
  • Chapter 4. Asian Americans and Pacific Islanders
  • Chapter 5. Culturally Competent Care for Geriatric Indigenous Peoples American Indians, Alaska Natives, First Nations, and Native Hawaiians
  • Chapter 6. African American Older Adults
  • Chapter 7. Cultural Competency and Latino Elders
  • Chapter 8. Older Lesbian, Gay, Bisexual, and Transgender Adults
  • Chapter 9. Rural Elderly
  • Chapter 10. The Seventh Age Centenarians
  • Chapter 11. Cultural Competency and Veterans
  • Answer Guide
  • Index


    Iqbal Ahmed, M.D.
    Yasmin Banaei, M.D.
    R. Dakota Carter, M.D.
    Carl I. Cohen, M.D.
    Ebony Dix, M.D.
    Amy Gajaria, M.D.
    Jai C. Gandhi, M.D.
    Rita Hargrave, M.D.
    Shuo Sally He, M.D.
    Vicenzio Holder-Perkins, M.D.
    Marilyn Horvath, M.D.
    Raya Elfadel Kheirbek, M.D.
    Shiv Lamba
    Pachida Lo, M.D.
    Linda Nahulu, M.D.
    Madeline Nykamp
    Carine Nzodom, M.D.
    Siddarth Puri, M.D.
    Rebecca Radue, M.D.
    Mary Hasbah Roessel, M.D.
    Elspeth Cameron Ritchie, M.D., CPT, MC
    Samra Sahlu, M.D.
    Ken Sakauye, M.D.
    Susan K. Schultz, M.D.
    Daniel D. Sewell, M.D.
    Raissa Tanqueco, M.D.
    Nhi-Ha Trinh, M.D.
    Lan Chi Vo, M.D.
    Mira Zein, M.D.

About the Authors

Maria Llorente, M.D., FAPA, is Deputy Chief of Staff, Washington DC VA Medical Center, Department of Veterans Affairs, and Professor of Psychiatry at Georgetown University School of Medicine in Washington, D.C.

Dr. Maria Llorente's comprehensive review, Culture, Heritage, and Diversity of Older Adult Mental Health Care, represents an important contribution to our field of geriatric psychiatry and calls attention to the importance of culturally appropriate and competent care for older adults in a mental healthcare setting. The review is both accessible and engaging, providing a background on the current challenges faced by underserved groups of older adults and the clinicians that serve them. This excellent review highlights the importance of cultural sensitivity, the concept of unconscious bias and the impact of aging out of place while bringing attention to areas of mental health care that desperately need restructuring. Overall, this is a thoughtful review that provides insightful tools for clinicians to care for a growing population of underserved and misunderstood older adults facing the challenges of aging with psychiatric illness.—Brent P. Forester, M.D., M.Sc., Chief, Division of Geriatric Psychiatry, Mclean Hospital, Medical Director – Behavioral Health, Center for Population Health, Partners HealthCare

The volume will be of great use to scientists, educators, practitioners, and students—not only those in mental health, but also those teaching, training, and working in the general health sector. Each chapter is accompanied by a comprehensive bibliography of primary source references and systematic reviews, as well as by study questions to focus readers on key take-home points.

We owe much gratitude to Dr. Llorente and colleagues for this volume, reflecting their important legacy in science and in health justice.—Charles F. Reynolds III, M.D., Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry emeritus, University of Pittsburgh School of Medicine, Editor-in-Chief, American Journal of Geriatric Psychiatry

With our country's increasing age and diversity, mental health clinicians must appreciate culture's role in mental health and mental health care treatment. Culture, Heritage, and Diversity of Older Adult Mental Health Care will become the cultural competence resource for mental health trainees, educators, and clinicians and ultimately lead to less disparities and better patient outcomes.—Mark E. Kunik, M.D., MPH, Baylor College of Medicine, Michael E. DeBakey VAMC

This book fills a large gap in psychiatry diversity training for the elderly. There are other books available for psychiatric diversity training, but none that are tailored specifically to the geriatric population. There are added layers of complexity in this population, such as the individual's experience of being an elder in their own culture, how this experience changes while in the U.S., and their life course perspectives. This book does an excellent job of covering these dimensions. It succeeds in educating readers about important historical experiences for older adults that may affect their perspective. It is not only informational, it also gives techniques to address bias and conduct a culturally competent interview. This book is instrumental in devising a geriatric psychiatry course for diversity training and will prove an invaluable resource for educators, students, practitioners, and researchers. It is an important contribution to the field of psychiatry.—Danielle Anderson, M.D., Doody's Book Review

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