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Health, Psycho-social and Cultural Determinants of Medication Use by Chinese-Canadian Older Persons

Published online by Cambridge University Press:  31 March 2010

Erin Yuet Tjam  and
John P. Hirdes
Erin Yuet Tjam*
Affiliation:
St. Mary's General Hospital, University of Waterloo
John P. Hirdes
Affiliation:
University of Waterloo
*
Requests etc: Dr. Erin Yuet Tjam, Director of Research, St. Mary's General Hospital, 911 Queen's Boulevard, Kitchener ON N2M 1B2, ([email protected])
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Abstract

Variations in health and medication use exist across cultures. Medication use among Chinese-Canadian older persons is complicated by many factors including combined use of Western and traditional Chinese medicines (TCM). There is little research on health, psycho-social and cultural determinants of medication use in the Chinese. A cross-sectional census study of community-based Chinese-Canadian older persons in the Kitchener/Waterloo area was conducted using the Minimum Data Set for Home Care and a supplementary questionnaire for cultural issues. The response rate was 89.1 per cent with 106 participants using face-to-face assessments. Socio-demographic and cultural variables were summarized. The multivariate logistic model for TCM use included pain symptoms and being hospitalized, and a curvilinear association between TCM use and health beliefs. For combined medicine use, living with a child, pain symptoms, hospitalization, and social isolation problems were the main effects. Living with a child, physical health problems and number of diseases were associated with Western medicine use. Health, psycho-social and cultural factors were significant determinants for medication use. Education programs for both Chinese-Canadian older persons and health care providers are necessary to understand the appropriate use of Western and TCM treatments.

Résumé

Il existe des différences en matière de santé et de médicaments entre les cultures. Plusieurs facteurs viennent complexifier l'usage des médicaments que font les personnes âgées sino-canadiennes, y compris l'utilisation combinée de médecine occidentale et traditionnelle chinoise (MTC). Peu de recherches ont été effectuées sur la santé et sur les déterminants psycho-sociaux et culturels des médicaments utilisés par les Chinois. On a mené une étude de recensement transversale sur les personnes âgées dans la communauté sino-canadienne de la région de Kitchener/Waterloo en utilisant un ensemble de données minimales sur les soins à domicile (Minimum Data Set for Home Care) et un questionnaire supplémentaire sur les incidences culturelles. Le taux de réponse a été de 89,1 pour cent et 106 participants ont utilisé l'évaluation personnelle. On a résumé les variables socio-démographiques et culturelles. Le modèle logistique à variables multiples utilisé pour la médecine traditionnelle chinoise relatait des symptômes de douleurs, l'hospitalisation et une association non linéaire entre l'utilisation de la MTC et les croyances reliées à la santé. Lorsque les deux médecines étaient combinées, vivre avec un enfant, les symptômes de la douleur, l'hospitalisation et les problèmes d'isolement social étaient les principaux effets. Vivre avec un enfant, les problèmes de santé physique et certaines maladies étaient associés à l'utilisation de la médecine occidentale. La santé, les facteurs psycho-sociaux et culturels étaient des facteurs déterminants reliés à l'utilisation de médicaments. Des programmes d'éducation tant pour les personnes âgées sino-canadiennes que pour les fournisseurs de soins de santé s'imposent si l'on veut comprendre l'utilisation appropriée des traitements occidentaux et de médecine traditionnelle chinoise.

Keywords

Traditional Chinese MedicineMinimum Data Set - Home CareCultural FactorsEthnicityMedication Usemédecine traditionnelle chinoiseensemble de données minimales – soins à domicilefacteurs culturelsorigine ethniqueusage de médicaments
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 21 , Issue 1 , Spring/Printemps 2002 , pp. 63 - 73
Copyright
Copyright © Canadian Association on Gerontology 2002

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Footnotes

*The authors gratefully acknowledge the financial support of their project through the Seniors Independence Program (SIP# 4687-06-93-458) and through a Canada's Drug Strategy - Community Health Researcher Award to Erin Y. Tjam (Grant #6606-5560-603). Dr. Hirdes' work was supported by the Providence Centre Foundation and by interRAI. Translation of the MDS-HC into Chinese was completed by Erin Y. Tjam and Iris Chi.

References

Bergob, M. (1994). Drug use among senior Canadians. Canadian Social Trends, Summer, 25–29.Google Scholar
Brown, S.L., Salive, M.E., Guralnik, J.M., Pahor, M., Chapman, D.P., & Blazer, D. (1995). Antidepressant use in the older persons: Association with demographic characteristics, health-related factors, and health care utilization. Journal of Clinical Epidemiology, 48(3), 445–453.CrossRefGoogle Scholar
Chan, T.Y.K., Chan, A.Y.W., & Critchley, J.A.J.H. (1992). Hospital admissions due to adverse reactions to Chinese herbal medicines. Journal of Tropical Medicine and Hygiene, 95, 296–298.Google ScholarPubMed
Chan, T.Y.K., Chan, J.C.N., Tomlinson, B., & Critchley, J.A.J.H. (1993). Chinese herbal medicines revisited: A Hong Kong perspective. The Lancet, 342, 1532–1534.CrossRefGoogle ScholarPubMed
Chi, I., & Lee, J.J. (1991). Health education for the older persons in Hong Kong. Educational Gerontology, 17, 507–518.CrossRefGoogle Scholar
Chrischilles, E.A., Foley, D.J., Wallace, R.B., Lemke, J.H., Semla, T.P., Hanlon, J.T., Glynn, R.J., Ostfeld, A.M., & Guralnik, J.M. (1992). Use of medications by persons 65 and over: Data from the established populations for epidemiologic studies of the older persons. Journal of Gerontology, 47(5), M137–M144.CrossRefGoogle Scholar
Danesi, M. (1993). The semiotic representation of "health" and "disease". In Masi, R.M., Mensah, L., & McLeod, K.A. (Eds.), Health and cultures: Exploring the relationships, policies, professional practice and education. Volume I (pp. 243–254). Oakville: Mosaic Press.Google Scholar
Employment and Immigration Canada. (1985). Business immigrants. Ottawa: Minister of Supply and Services.Google Scholar
Evans, C.A., & Cunningham, B.A. (1996). Caring for the ethnic elder. Geriatric Nursing, 17(3), 105–110.CrossRefGoogle ScholarPubMed
Fillenbaum, G.G., Hanlon, J.T., Corder, E.H., Ziqubu-Page, T., Wall, W.E., & Brock, D. (1993). Prescription and nonprescription drug use among black and white community-residing older persons. American Journal of Public Health, 83(11), 1577–1582.CrossRefGoogle Scholar
Fong, C. (1985). Ethnicity and nursing practice. Topics in Clinical Nursing, 1, (3), 40–47.Google Scholar
Guttman, D. (1978). Patterns of legal drug use by older Americans. Addictive Diseases, 3, 337–356.Google Scholar
Hamilton, J. (1996). Multicultural health care requires adjustments by doctors and patients. Canadian Medical Association Journal, 155(5), 585–587.Google ScholarPubMed
Hanlon, J.T., Landerman, L.R., Wall, W.E., Horner, R.D., Fillenbaum, G.G., Dawson, D.V., Schmader, K.E., Cohen, H.J., & Blazer, D.G. (1996). Is medication use by community-dwelling older persons people influenced by cognitive function? Age and Ageing, 25, 190–196.CrossRefGoogle ScholarPubMed
Health and Welfare Canada. (1992). Alcohol and other drugs used by Canadians: A national alcohol and other drugs survey (1989), Technical Report. Ottawa: Health Canada.Google Scholar
Hershman, D.L., Simonoff, P.A., Frishman, W.H., Paston, F.& Aronson, M. (1995). Drug utilization in the old-old and how it relates to self-perceived health and all-cause mortality: Results from the Bronx aging study. Journal of the American Geriatrics Society, 43, 356–360.CrossRefGoogle ScholarPubMed
Hirdes, J.P., Fries, B.E., Morris, J.N., Steel, K., Mor, V., Frijters, D., LaBine, S., Schalm, C., Stones, M.J., Teare, G., Smith, T., Marhaba, M., Perez, E., & Jonsson, P. (1996) Integrated health information systems based on the RAI/MDS series of Instruments. Healthcare Management Forum, 12(4), 30–40.CrossRefGoogle Scholar
Hirdes, J.P. (1999) Society's adaptation to its own ageing: a new challenge for community-based health care. Preceedings of a WHO Symposium. Kobe. 10-13 Nov. 1998, 205–212.Google Scholar
Homma, M., Oka, K., Niitsuma, T., & Itoh, H. (1993). Pharmacokinetic evaluation of traditional Chinese herbal medicines-letter. The Lancet, 341, 1595.CrossRefGoogle Scholar
Inaba, T. (1987). Inter-ethnic difference in response to drugs. In Anonymous, Preceedings-partnerships in health symposium. Toronto: Multicultural Health Coalition.Google Scholar
Katzung, B. (1992). Basic and Clinical Pharmacology. Norwalk, Connecticut: Appleton and Lange.Google Scholar
Kitano, H.H.L., Lubben, J.E., Berkanovic, E., Chi, I., Chen, C.Z., & Zhu, X. (1994). A cross-national study of older persons Chinese and Chinese Americans. In Stopp, G.H.J. (Ed.), International perspectives on healthcare for the older persons. New York: Peter Lang.Google Scholar
Kotzan, L., Carroll, N.V., & Kotzan, J.A. (1989). Influence of age, sex, and race on prescription drug use among Georgia Medicaid recipients. American Journal of Hospital Pharmacy, 46, 287–290.Google ScholarPubMed
Kwan, C.W., Chi, I., Lam, T.P., Lam, K.F., & Chou, K.L. (2000). Validation of Minimum Data Set for Home Care Assessment Instrument (MDS-HC) for Hong Kong Chinese elders. Clinical Gerontologist, 21(4): 123–145.CrossRefGoogle Scholar
Lai, M.C., & Yue, K.M.K. (1990). The Chinese. In Morrison, N. Waxler-, Anderson, J.M., & Richardson, E. (Eds.), Crosscultural caring: A handbook for health professionals in Western Canada (pp. 68–90). Vancouver: University of British Columbia Press.Google Scholar
Landi, F., Gambassi, B., Pola, R., Tabaccanti, S., Cavinato, T., Carbonin, P., & Bernabei, R., (1999). Impact of integrated home care services on hospital use. Journal of American Geriatrics Society, 47, 1430–1434.CrossRefGoogle ScholarPubMed
Laukkanen, P., Heikkinen, E., Kauppinen, M., & Kallinen, M. (1992). Use of drugs by non-institutionalized urban Finns born in 1904-1923 and the association of drug use with mood and self-rated health. Age and Ageing, 21- 343–352.CrossRefGoogle ScholarPubMed
Lin, K., Poland, R., Smith, M., Strickland, T., & Mendoza, R. (1991). Pharmacokinetic and other related factors affecting psychotropic responses in Asians. Psychopharmacology Bulletin, 27(4), 427–437.Google ScholarPubMed
Lister, L. (1977). Cultural perspectives on death as viewed from within a skilled nursing facility. In al., E. R. Prichard et (Eds.), Social work with the dying patient and the family (pp. 216–229). New York: Columbia University Press.Google Scholar
Lo, A.C.T., Chan, K., Yeung, J.H.K., & Woo, K.S. (1992). The effects of Danshen (Salvia Miltiorrhiza) on pharmacokinetics and pharmacodynamics of warfarin in rats. European Journal of Drug Metabolism and Pharmacokinetics, 17, 257–262.CrossRefGoogle ScholarPubMed
Lubben, J.E., & Becerra, R.M. (1987). Social support among Black, Mexian, and Chinese older persons. In Gelfand, D.E. & Barresi, C.M. (Eds.), Ethnic dimensions of aging. (pp. 130–144). New York: Springer.Google Scholar
Lum, O.M. (1995). Health status of Asians and Pacific Islanders. Clinics in Geriatric Medicine, 11(1), 53–67.CrossRefGoogle ScholarPubMed
McKim, W.A., & Mishara, B.L. (1987). Drugs and aging. Toronto: Butterworths.Google Scholar
McKim, W.A., Stones, M.J., & Kozma, A. (1990). Factors predicting medicine use in institutionalized and non-institutionalized older persons. Canadian Journal on Aging, 9(1), 23–34.CrossRefGoogle Scholar
Montbriand, M.J. (1993). Decision heuristics of patients with cancer: Alternate and biomedical choices. Unpublished doctoral dissertation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.Google Scholar
Montbriand, M.J. (1995). Decision tree model describing alternate health care choices made by oncology patients. Cancer Nursing, 18(2), 104–117.CrossRefGoogle ScholarPubMed
Morioka-Douglas, N., & Yeo, G. (1990). Aging and health: Asian /Pacific Island American Elders. Stanford Geriatric Education Center Working Paper Series, No. 3, Ethnographic Reviews, Stanford, Stanford Geriatric Center.Google Scholar
Morris, J.N., Fries, B.E., & Morris, S.A. (1999). Scaling ADLs within the MDS. Journal of Gerontology: Medical Sciences, 54(A), M546–M553.Google ScholarPubMed
Morris, J.N., Fries, B.E., Steel, K., Ikegami, N., Bernabei, R., Carpenter, G.I., Gilgen, R., Hirdes, J.P. & Topinkova, E. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45, 1017–1024.CrossRefGoogle ScholarPubMed
Nemeroff, C.B., Devane, C.L., & Pollock, B.G. (1996). Newer antidepressants and the cytochrome P450 system. American Journal of Psychiatry, 153, 311–320.Google ScholarPubMed
Nolan, L., & O'Malley, K. (1988a). Prescribing for the older persons: Part I - Sensitivity of the older persons to adverse drug reactions. Journal of the American Geriatrics Society, 36(2), 143–149.CrossRefGoogle Scholar
Nolan, L., & O'Malley, K. (1988b). Prescribing for the older persons: Part II - Prescribing Patterns: Differences due to age. Journal of the American Geriatrics Society, 36(3), 245–254.CrossRefGoogle Scholar
O'Hara, E.M., & Zhan, L. (1994). Cultural and pharmacologic considerations when caring for Chinese elders. Knowledge of traditional Chinese medicine is necessary. Journal of Gerontological Nursing, 20(10), 11–16.CrossRefGoogle ScholarPubMed
Poliakoff, M. (1993). Cancer and cultural attitudes. In Masi, R. M., Mensah, L., & McLeod, K.A. (Eds.), Health and cultures: Exploring the relationships, policies, professional practice and education. Volume I (pp. 271–290). Oakville: Mosaic Press.Google Scholar
Simons, L.A., Tett, S., Simons, J., Lauchlan, R., McCallum, J., Friedlander, Y., & Powell, I. (1992). Multiple medication use in the older persons - use of prescription and nonprescription drugs in an Australian community setting. The Medical Journal of Australia, 157, 242–246.CrossRefGoogle Scholar
Skelton, D. (1985). Drug utilization in a relatively fit eldelry population. Paper presented at the Canadian Association for Gerontology.Google Scholar
Statistics Canada. (1992). Profile of census divisions and subdivisions in Ontario - Part A. Ottawa: Statistics Canada.Google Scholar
Sutter, M.C., & Wang, Y.X. (1993). Recent cardiovascular drugs from Chinese medicinal plants. Cardiovascular Research, 27, 1891–1901.CrossRefGoogle ScholarPubMed
Swinkels, H., Hirdes, J.P., & Ellis Hale, K. (1996). A comparison of sleeping pill and tranquilizer use among community-based adults in Canada and the Netherlands. Hong Kong Journal of Gerontology 10(supplement), 96–102.Google Scholar
Tjam, E.Y. (2001). How to find Chinese research participants: use of phonologically based surname search method. Canadian Journal of Public Health, 92, 138–142.CrossRefGoogle ScholarPubMed
Tjam, E.Y., Hirdes, J.P., Kan, K., & Chi, I. (1996). A survey of proprietary traditional Chinese medicines in the Waterloo region - labelling and regulation issues. Hong Kong Journal of Gerontology, 10(suppl.), 103–107.Google Scholar
Tuominen, J.D. (1988). Prescription drugs and the older persons in B.C. Canadian Journal on Aging, 7(3), 174–182.CrossRefGoogle Scholar
Ujimoto, K.V. (1988). Aging, ethnicity and health. In Bolaria, B.S. & Dickinson, H.D. (Eds.),. Sociology of health care in Canada (pp. 220–243). Toronto: Harcourt Brace Jovanovich.Google Scholar
Waxler-Morrison, N. (1990). Introduction. In Waxler-Morrison, N., Anderson, J.M., & Richardson, E. (Eds.), Crosscultural caring. (pp. 3–10). Vancouver: UBC Press.Google Scholar
Wu, T. (1996). The implication of Andersen's model to the study of intergenerational comparison of Chinese American families health care behavior. Presented at the 25th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Quebec.Google Scholar