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DATE: May 18, 2004

Changing family structures affect health care among elderly Arabs and Arab Americans in Detroit area, according to UM-Dearborn study

DEARBORN---In addition to the many cultural and language issues faced by elderly Arab Americans in the Detroit area, changes in family dynamics have resulted in increased challenges in providing health care and other social services to that group.

That was one of the findings of a survey and set of interviews conducted by researchers from the University of Michigan-Dearborn in 2002-03.

Paul Wong, former dean at UM-Dearborn who is now a dean at San Diego State University, conducted the study with a grant from the federal Administration on Aging, administered by Wayne County Senior Citizens' Services. The project was completed in conjunction with The Senior Alliance-Area Agency on Aging 1-C, which serves the elderly in western and southern Wayne County, and ACCESS, the Arab Community Center for Economic and Social Services.

"All of the respondents had quite a bit to say about changing roles and customs within the Arab American family of today," Wong said. "The biggest change, all agreed, was in the lesser amount of care and time devoted to the elderly due to economic and societal pressures, particularly the employment of women and other family members."

Wong and colleagues surveyed a random sample of 200 seniors from the Muslim and Christian Arab communities in 2003. They also conducted interviews with 16 professionals, including physicians, nurses, psychologists and social workers who serve those communities.

Topping the list of problems faced by Arab and Chaldean elderly in the survey was the problem of language, followed closely by issues connected to cultural differences. Language barriers can result in social isolation and contribute to depression in some cases. Some of the recent immigrants also suffer from depression or post-traumatic stress due to experiences in their countries of origin.

In addition to the cultural and language issues faced by many Arab elderly, changes in family dynamics have also had an impact. "A great concern of the interview participants was that Arab American women are often employed outside the home and can no longer care for the elderly as in the past," Wong said.

More of the elderly in the survey indicated a need for transportation (46.5 percent) than any other item in the needs-assessment section. Prescription assistance received the second highest rating of need, at 38.5 percent of the survey sample. The lack of adequate transportation prevents many of them from receiving services they need in the community.

"Transportation services and prescription assistance have been identified as the two most important unmet needs of older adults in western and southern Wayne County by our key informant survey the past two years," according to Mike Simowski, executive director of The Senior Alliance. "It is not surprising that Arab American elders are experiencing many of the same challenges faced by other older adults in the region."

In the random sample, 197 of those interviewed were immigrants, with the largest group, 70.5 percent, from Lebanon, and the second largest, 11.5 percent, from Yemen. Two-thirds were Muslim and one-third were Christian. Of the 200 surveyed, 16 percent were able to speak both Arabic and English and 82 percent were able to speak Arabic only. Some of the less-educated elderly surveyed were unable to read any language, thus compounding the language barrier.

Both the survey and qualitative interview questions focused on the quality of life and psychosocial as well as practical needs of elderly Arab Americans, including life satisfaction, social support, housing, health-care needs and needs for services such as transportation and assistance with meals and other household tasks.

"A new influx of Arab immigrants who have entered the country in the last two decades is of particular concern," Wong said. "Many of these immigrants brought their elderly with them or are now in their senior years themselves."

In general, the survey found that those elderly with more education and who are bilingual have distinct advantages over those who speak Arabic only or have little education.

"Due most probably to their language ability and educational advantages, the bilingual educated elderly perceive themselves as having a higher sense of well-being or life satisfaction, and a lower need for assistance with health care needs, transportation, personal emergencies, tax filing or other needs," Wong said.

Sixteen percent of the elderly surveyed did not have a health plan, and of those who did not, most were Arabic-speaking only, Wong said. While the figure is lower than the 25 percent of all immigrant elderly who do not receive Medicare, "it still represents a significant proportion of uninsured seniors," Wong said.

The UM-Dearborn study was developed in response to the changing senior citizen demographics in Wayne County, according to Wong. Wayne County gained nearly 3,000 older adults in the 1990s and many of them immigrated to this area from the Middle East.

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