Sr Research Scholar, Medicine - Family & Community Medicine
Honors & Awards
Betty and James E. Birren Senior Scholar Award, California Council on Gerontology and Geriatrics (2005)
Fellow, American Geriatrics Society (205)
Milldred Selzer Distinguished Service Recognition, Association of Geronotology in Higher Education (2004)
Current Research and Scholarly Interests
Ethnicity and Dementia
Vietnamese American Dementia Caregivers' Perceptions and Experiences of a Culturally Tailored, Evidence-Based Program to Reduce Stress and Depression
JOURNAL OF GERONTOLOGICAL NURSING
2019; 45 (9): 39–50
Vietnamese American dementia caregivers are at increased risk for adverse mental health compared to the general U.S. population given their sociodemographic and immigration experiences, yet programs that address their needs are lacking. The current article describes Vietnamese American dementia caregivers' perceptions and experiences of a culturally tailored, evidence-based intervention to reduce stress and depression. A convenience sample of caregivers was recruited from the San Francisco Bay area and randomly assigned to intervention ("Our Family Journey"; OFJ) (n = 30) or control (written dementia caregiving information) (n = 30) groups. All intervention and 76.7% of control caregivers reported that the OFJ or educational materials, respectively, were very/somewhat helpful. Three or more skills were refined/learned by 96.7% of OFJ and 36.6% of control participants. Qualitative findings indicated that the intervention had positive effects on well-being and taught new caregiving skills. This first U.S. study to address the mental health needs of Vietnamese American dementia caregivers shows positive perceptions/experiences and demonstrates a model to address a significant need in the community. [Journal of Gerontological Nursing, 45(9), 39-50.].
View details for DOI 10.3928/00989134-20190813-05
View details for Web of Science ID 000483303800006
View details for PubMedID 31437289
- To the Future of Ethnogeriatric Research and Publication JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2019; 67 (6): 1120–22
Promising results from a pilot study to reduce distress in Vietnamese American dementia and memory loss caregivers.
Alzheimer's & dementia (New York, N. Y.)
2019; 5: 319–27
Introduction: This study developed and examined the feasibility of a culturally tailored, evidence-based skill-building program to reduce stress and depression of Vietnamese American dementia caregivers.Methods: This pilot randomized controlled trial included pretest and posttest measures using the Center for Epidemiologic Studies-Depression Scale and the Revised Memory and Behavior Problems Checklist. The intervention (n=30) group participated in a culturally tailored, 4-week Vietnamese-language cognitive-behavioral skills evidenced-based program (Our Family Journey); caregivers in the control condition (n=30) received dementia-related educational materials (education control condition).Results: Our Family Journey caregivers showed significantly lower somatic scores on the Center for Epidemiologic Studies-Depression Scale and reported lower frequency of care recipients' disruptive behaviors. However, they also reported being more stressed by their care recipients' depressive symptoms on the Revised Memory and Behavior Problems Checklist compared to caregivers in the education control condition.Discussion: These promising results suggest that a culturally adapted program can benefit Vietnamese dementia caregivers. Additional research is needed to develop and evaluate stronger, more impactful interventions for this underserved group.
View details for DOI 10.1016/j.trci.2019.05.006
View details for PubMedID 31384663
Perspectives and Insights from Vietnamese American Mental Health Professionals on How to Culturally Tailor a Vietnamese Dementia Caregiving Program
2018; 41 (3): 184–99
Little is known about dementia and caregiving among the rapidly growing Vietnamese American population. This qualitative study elicited insights on culturally tailoring an intervention to address mental health needs in Vietnamese American dementia caregivers from Vietnamese American mental health professionals.Eight Vietnamese American mental health professionals were interviewed to explore: experiences working with and needs of the community; Vietnamese attitudes toward treatment; and acculturation in Vietnamese caregiving. Participants provided recommendations on tailoring a program for Vietnamese dementia caregivers. Content analysis of their responses was conducted.Themes included: a) caregivers' unique needs and experiences; b) different waves of immigration and acculturation levels affect views on mental health, treatment, and caregiving; c); traditions and beliefs on caregiving; d) mental health, help-seeking and health services; e) how to culturally tailor a program for Vietnamese dementia caregivers; and f) cultural acceptance of the program.An intervention to reduce stress and depression among Vietnamese American dementia caregivers should recognize the special risks of the experiences of war and immigration of the caregivers as well as the pressure of the expectations of the Vietnamese culture on family care. For the program to be acceptable and effective, it needs to consider all aspects of caregivers' health, and incorporate Vietnamese cultural values/beliefs.A successful Vietnamese dementia caregiver intervention should include traditional Vietnamese values/beliefs, holistic experiences, spirituality, and background/immigration experiences. Evidence-based programs may be used with this population if they are culturally tailored.
View details for PubMedID 29419364
- Systematic review of dementia prevalence and incidence in United States race/ethnic populations ALZHEIMERS & DEMENTIA 2017; 13 (1): 72-83
Evaluation of a Video-Based Seminar to Raise Health Care Professionals' Awareness of Culturally Sensitive End-of-Life Care.
Journal of pain and symptom management
2017; 54 (4): 546–54
Health care workers serve diverse communities and face challenges in delivering culturally responsive EOL care, especially when caring for Latino elders.The objective of this study was to investigate the effect of a newly developed telenovela, or video soap opera, on health care professionals (HCPs)' awareness of caregivers' stress and patients' cultural approaches to end-of-life (EOL) care decisions.A multicenter cross-sectional study among three communities in New York, Miami, and Missouri. Participants from a convenience sample of multidisciplinary HCPs were randomly assigned to view power point presentation with either a control video or an intervention-telenovela about caregiving as part of a one-hour audiovisual seminar and completed a pre- and post-test questionnaire to evaluate reaction and learning.Participants (N = 142) were mostly female (80%) nurses (54%) with a mean age of 44.5 ± 12.4 years and from non-Hispanic white (41%) or Hispanics (37%) ethnicity. In both control and intervention groups, post-test responses demonstrated a high level (87%) of satisfaction with seminar and an increase in openness to discuss EOL issues with culturally diverse patients (P < 0.001). Although both groups reported post-test improvement in awareness of health literacy, cultural competency skills, cultural differences about EOL attitudes, family caregiver stress, and possible interventions, this improvement was significantly higher in the intervention group (P < 0.05) compared with the control group.The telenovela was effective in increasing health care workers' awareness of caregivers stress and cultural approach to EOL decisions. There is need for ongoing efforts to educate HCPs on cultural sensitivity to help ethnically diverse caregivers and their patients benefit from EOL care.
View details for PubMedID 28716618
The Impact of a Faculty Development Program in Health Literacy and Ethnogeriatrics
2014; 89 (12): 1640-1644
A faculty development curriculum aimed at increasing health literacy and awareness of patient care issues in ethnogeriatrics is essential to address serious deficiencies in faculty and health professionals' training and to prepare future health care professionals to care for older adults.Authors from the Stanford Geriatric Education Center developed and implemented a faculty development program in Health Literacy and Ethnogeriatrics (HLE). The goal was to enhance faculty and health professionals' knowledge, skills, and attitudes in HLE-related areas (e.g., health disparities, low health literacy, quality of care for ethnically diverse elders, patient/provider communication). The curriculum was implemented during an intensive weeklong program over a three-year period (2008-2010). The eight-module core curriculum was presented in a train-the-trainer format, supplemented by daily resource sessions.Thirty-four faculty participants from 11 disciplines, including medicine, came from 19 institutions in 12 states. The curriculum positively affected participants' knowledge, skills, and attitudes related to topics in HLE. Participants rated the curriculum's usefulness highly, and they reported that over 57% of the content was new. The HLE curriculum provided a mechanism to increase the self-assessed knowledge, skills, and attitudes of participants. It also fostered local curricular change: Over 91% of the participants have either disseminated the HLE curriculum through seminars conducted at their home sites or implemented HLE-related projects in their local communities, reaching diverse patient populations.Next steps include measuring the impact on the participants' teaching skills and at their home sites through their trainees and patients.
View details for DOI 10.1097/ACM.0000000000000411
View details for Web of Science ID 000345919500024
View details for PubMedID 25006703
- Introduction: Care Concerns for Elders in Korean and Korean American Communities CLINICAL GERONTOLOGIST 2011; 34 (4): 267-270
- Outcomes and Challenges of Familias Saludables: A Rural Latino Chronic Disease Screening and Management Project. Hispanic Health Care International 2011; 9 (3)
Causal attributions of dementia among Korean American immigrants.
Journal of gerontological social work
2010; 53 (8): 743-759
To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.
View details for DOI 10.1080/01634372.2010.515290
View details for PubMedID 20972929
How Will the US Healthcare System Meet the Challenge of the Ethnogeriatric Imperative?
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
2009; 57 (7): 1278-1285
Much of the geriatric imperative that is facing providers in the United States is an ethnogeriatric imperative, because one-third of older Americans are projected to be from one of the minority populations by mid-century, and that vastly underrepresents the actual diversity providers will see. Because of the vast heterogeneity of culture, language, health beliefs, risk for disease, and other factors, it is important for policy makers and health providers to be familiar with the diverse characteristics and needs of the various groups that will need geriatric care if they are to receive effective services. Challenges to high-quality ethnogeriatric care include disparities in health status and health care, differences of acculturation level and other characteristics within the populations, language and limited English proficiency, health literacy, culturally defined health beliefs and syndromes, and specific beliefs and preferences about long-term and end-of-life care. Some models of successful ethnogeriatric care have been identified and have in common the involvement of members of the target population in the development and design of the services and the use of cultural liaisons from the ethnic community being served, such as community health workers, or promatores. Thirteen recommendations are suggested for policy and practice changes in multiethnic and ethnic-specific health programs to provide competent ethnogeriatric care in the U.S. healthcare system.
View details for DOI 10.1111/j.1532-5415.2009.02319.x
View details for Web of Science ID 000267539800020
View details for PubMedID 19558479
- Family Caregiving for Elders with Dementia in Three Asian American Populations Hallym International Journal of Aging, 2008; 10: 85-89
Ethnogeriatric education: a collaborative project of Geriatric Education Centers.
Gerontology & geriatrics education
2006; 26 (4): 87-99
Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the GEC Collaborative on Ethnogeriatric Education developed a Core Curriculum on Ethnogeriatrics and Ethnic Specific Modules. Faculty from 34 GECs wrote, reviewed, revised, expanded, and disseminated the Curriculum in Ethnogeriatrics. The 16-module, web-based Curriculum provides detailed information and teaching resources about important historical and cultural influences on the health care experience of the diverse U.S. population of elders. The Stanford GEC has tracked usage of the ethnogeriatric curriculum and reports favorable responses regarding its effectiveness. Many GECs have used the modules in their continuing education programs. GEC faculty share their teaching methods with others at professional meetings and present training sessions in their own geographical areas.
View details for PubMedID 16537310
- Role of community health workers in dementia case finding JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2005; 53 (10): 1829-1830
Conceptions of dementia in a multiethnic sample of family caregivers
56th Annual Meeting of the Gerontological-Society-of-America
WILEY-BLACKWELL PUBLISHING, INC. 2005: 1405–10
Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross-sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African-American, Anglo European-American, Asian-American, and Latino. In-depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers (P<.02) and those with less formal education (P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross-ethnic differences in a larger, more-representative sample is needed.
View details for DOI 10.1111/j.1532-5415.2005.53409.x
View details for Web of Science ID 000230726800020
View details for PubMedID 16078970
Issues in caring for Afghan American elders: insights from literature and a focus group.
Journal of cross-cultural gerontology
2004; 19 (1): 27-40
To increase the information available for clinicians and educators to care for, and educate others to care for, elders from Afghan backgrounds more effectively.Focus group methodology.Community senior center in Fremont, CA, United States.Nine leaders of an Afghan elders group.Content analysis of translated proceedings of focus group.The two most important themes were: 1) Participants identified their health status and effective treatments with their faith in, and practice of, Islam. 2) They also emphasized the importance of care given by same-sex providers.Clinicians providing care for older Afghan refugees need to be aware of the importance of respecting the practices of Islam, especially using same sex providers. Allowing for Muslim practices in the hospital is also important, such as washing before daily prayers, not serving pork products (e.g. gelatin), and having the bed face Mecca (Southeast) for prayers, especially for a dying patient.
View details for PubMedID 14767176
Curricular framework: Core competencies in multicultural geriatric care
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
2004; 52 (1): 137-142
Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.
View details for Web of Science ID 000187451000023
View details for PubMedID 14687329
The ethnogeriatric imperative.
Care management journals : Journal of case management ; The journal of long term home health care
2003; 4 (1): 37-45
View details for PubMedID 14502877
- Ethnicity and dementia JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2001; 49 (10): 1393-1394
- Conceptions of dementia among Vietnamese American caregivers Journal of Gerontological Social Work 2001; 36 (1&2): 131
Ethics in rehabilitation with culturally diverse older adults
TOPICS IN GERIATRIC REHABILITATION
1997; 12 (3): 10-18
View details for Web of Science ID A1997WK54300004
Using explanatory models to understand chronic symptoms of Cambodian refugees.
1996; 28 (4): 271-276
Case reports indicate that understanding patients' "explanatory models" can improve diagnosis, patient compliance, and satisfaction. However, few studies have examined explanatory models within specific cultural groups to understand their symptoms.Seventy-six older Cambodian refugees were interviewed using measures of symptom frequency, explanatory models, help-seeking patterns, and use of traditional Cambodian remedies. Psychiatric patients were compared with non-patients.Headache was the most common symptom, reported by 58% of those interviewed, and also the most frequent chief complaint (41%). Headache was reported in both groups but was reported by significantly more psychiatric patients. Headache was positively associated with the diagnosis of depression. More than half explained their headaches as a result of sadness, grief, and anxiety. Explanatory models did not differ significantly between groups. All participants maintained Cambodian medical beliefs, and 83% used traditional Cambodian remedies.Results suggest a high prevalence of headache among older Cambodian refugees, for whom it may be a manifestation of depression. Emphasis on this somatic complaint does not preclude patients' recognition of psychological factors. Addressing explanatory models can help clinicians determine underlying etiology and understand challenging patients.
View details for PubMedID 8728521
Ethnogeriatrics: Cross-cultural care of older adults
GENERATIONS-JOURNAL OF THE AMERICAN SOCIETY ON AGING
1996; 20 (4): 72-77
View details for Web of Science ID A1996WC86300016
Faculty development in ethnogeriatrics
1996; 22 (1): 79-91
View details for Web of Science ID A1996TT15300008
- STRUCTURED STUDENT INTERVIEWS OF ELDERS AT HOME DURING A FAMILY-PRACTICE CLERKSHIP ACADEMIC MEDICINE 1995; 70 (5): 446-447
ETHICAL CONSIDERATIONS IN ASIAN AND PACIFIC ISLAND ELDERS
CLINICS IN GERIATRIC MEDICINE
1995; 11 (1): 139-152
A brief overview of the demographic and psychosocial characteristics and medical problems of African Americans age 65 and older provide the context for a discussion of the mental health issues of older African Americans. With this background, specific concerns regarding diagnostic bias are reviewed. Existing epidemiologic data on the prevalence of psychiatric symptoms and disorders are summarized and the specific mental health issues affecting older African Americans are described. Specific research strategies are suggested to address the areas of absent data.
View details for Web of Science ID A1995QE54300013
View details for PubMedID 7720017
THE IMPACT OF AN EDUCATIONAL-PROGRAM ON PROVISION OF SERVICES TO ETHNICALLY DIVERSE ELDERS
JOURNAL OF APPLIED GERONTOLOGY
1993; 12 (1): 34-43
View details for Web of Science ID A1993LZ29100003
Cardiovascular disease risk factors and attitudes towards prevention among Korean-American elders.
Journal of cross-cultural gerontology
1993; 8 (1): 17-33
The leading cause of death among the aging population is cardiovascular disease. Cardiovascular disease prevention and modification of disease risk factors are important and worthwhile directions for study because this population is rapidly increasing. Past studies have shown the significance of modifying cardiovascular disease risk factors in Anglo populations where major risk factors of hypertension, elevated cholesterol levels, diabetes, obesity, physical inactivity and smoking have been identified. However, the prevalence of these risk factors and the attitudes towards modifying them have not been studied in the Korean-American elderly population. This preliminary study used questionnaires given to fifty older recently immigrated Korean-American participants of a Korean senior center. Results show that this population has a lower frequency of cardiovascular disease and all risk factors, except for diabetes compared to an Anglo elderly population In addition, older Korean-American elders were generally unaware of risk factors for cardiovascular disease and uninterested in changing their habits to avoid cardiovascular disease. Increased availability of educational campaigns and health care in Korean are recommended.
View details for DOI 10.1007/BF00973797
View details for PubMedID 24389754
Ethnogeriatric education: Need and content.
Journal of cross-cultural gerontology
1991; 6 (2): 229-241
The population of elders from ethnic minority populations in the U.S. is growing much more rapidly than the exploding older population as a whole, yet few geriatric providers are being educated concerning ethnic elders' diverse health care needs. Examples are given of the diversity of ethnic elders' health risks, health beliefs and expectations of treatment, and utilization patterns of health care services being incorporated into ethnogeriatric curriculum being developed by the Stanford Geriatric Education Center.
View details for DOI 10.1007/BF00056760
View details for PubMedID 24390515
The effects of a program for faculty development in geriatrics for physician assistant teachers.
Gerontology & geriatrics education
1989; 9 (4): 83-94
A Geriatric Education for Physician Assistant (PA) Faculty program enrolled teachers from 21 of the 55 PA training programs in the country to participate in three-week training sessions at Stanford University. The faculty trainees took part in lecture/discussion, audio-visual review, clinical training, and individual conferences. They prepared a lecture and a complete geriatric teaching plan for their home program, and were assigned a text and numerous articles to read. Measures of effect of the training found the following: a significant increase in knowledge scores, although the trainees came into the program with relatively high scores; a heightened awareness and increased positive attitudes toward aging; high ratings of performance on a functionally oriented comprehensive health assessment; and augmented geriatric curriculum and clinical training in their home PA programs.
View details for PubMedID 2573563
EFFECTS OF A GERIATRIC CLINIC ON FUNCTIONAL HEALTH AND WELL-BEING OF ELDERS
JOURNALS OF GERONTOLOGY
1987; 42 (3): 252-258
Using a prospective, randomized design, the effects on self-reported functional health and well being of 18 months of primary outpatient care in a geriatric clinic staffed by a multidisciplinary team with geriatric training were compared with traditional Veterans Administration care for 205 elders. Significantly less decline in functional health was found for the geriatric clinic participants on the total Sickness Impact Profile (SIP) (M = .18 vs. 3.12, p = .029) and its physical dimension (M = .28 vs. 4.39, p = .011), but not for the psychosocial dimension of the SIP, life satisfaction, depression, self-rated health, or affect balance. In addition, twice as many geriatrics clinic patients died (p = .10) during the study. Further clarification of the impact of a multidisciplinary geriatrics clinic on health outcomes and cost in VA and other settings are needed prior to recommending that this model of geriatric health care be adopted.
View details for Web of Science ID A1987H194400003
View details for PubMedID 3571860
UTILIZATION BY FAMILY PHYSICIANS OF SUPPORT SERVICES FOR ELDERLY PATIENTS
JOURNAL OF FAMILY PRACTICE
1986; 22 (5): 431-434
Some elucidation of the functioning of the primary care physician in the role as gatekeeper to health and social services for elderly patients is provided by a survey of family practice preceptors. Analysis of knowledge and utilization patterns of 37 types of services by 38 family physicians revealed high utilization of most health services, but there were some gaps for respite, meal site, alert system, and insurance counseling programs. The recommendations of respondents for increasing knowledge and referral coordination could facilitate the access of elderly patients to the needed services.
View details for Web of Science ID A1986C232600008
View details for PubMedID 3701282
An interdisciplinary teaching program in geriatrics for physician's assistants.
Journal of allied health
1984; 13 (4): 280-287
An interdisciplinary curriculum committee within the Division of Family Medicine, Stanford University Medical Center, developed and taught a beginning course in clinical geriatrics for medical students and student physician's assistants, physical therapists, and nurse practitioners. Through a series of Saturday classes held in community facilities serving seniors, physician's assistant students had the opportunity to learn clinical geriatrics from a faculty team including a physician's assistant, physician, nurse, physical therapist, social worker, gerontologist, and health educator. Local seniors served as consumer consultants and models of health and vigor. This interdisciplinary approach was modeled by the faculty to demonstrate the need for a team approach to deliver quality care to seniors. In this well-received course, the role of the physician's assistant in health care was made evident to their future physician employers and physical therapy co-workers through faculty modeling as well as through informal contacts and patient conferences. Older people constitute a growing and increasingly medically underserved population. Team training may serve to stimulate physician's assistant students to include geriatrics in their career plans while educating their future physician employers about their role.
View details for PubMedID 6150927