Older Adults From Indian

Conference held at Belmont Center for Comprehensive Treatment on October 6, 2004

New Directions in Geriatric Behavioral Health: Serving Older Persons of Different Cultures The Mental Health Association of Southeastern Pennsylvania

By Inderjit Jaipaul, DSW

Brief Facts About India And Indian Culture

India has over 1 billion population- area is smaller than United States.
It is a country of all religious found here, plus various sects indigenous to India. It is a country of many languages- 14 recognized by the Constitution, over 30 in Northern states.
It has 4 main castes; (Brahmans- religious, spiritual duties; Kshatgiyas, general administrative posts; Vaissya: merchants, farmers; Sudras- carry out menial tasks) and 2000 sub castes.
Considering all the diversity, it is hard for me to generalize and give you one perspective on elderly in India, or elderly who are here in the USA. However, I will give you some highlights

Indian Culture; Elderly and Health Care

Indians have a high degree of respect for their elderly. They are considered to have gained knowledge and wisdom through life long experience.
Older people are proud of their age, and are very open in acknowledging their age.
Importance of parents and grandparents is embedded in the culture. Adult children and grandchildren seek out the advice of their elderly.
There is a joint family support system- families live together- sons' family or families live with parents, or parents live with their sons or their sons' family.
Family does take care of the health of its members- help is extended by parents to children, and by children to parents. Of course people do not live as long as in the USA. Average age in cities is 60 to 70 for men and 55 to 65 for women. My father and mother lived longer, till 80-85 age, and my grandfather up to 90.
Poverty is a real challenge for the average family as far as preventive health care is concerned. There are some free health centers run by the government, and voluntary groups, organizations and individuals, but there is no consistency of these centers. My father used to finance and run a free health clinic from our car garage.
Mental health issues are also addressed within the family, although there is limited knowledge of mental illness. Early intervention is non-existing.

There are mental health hospitals, some run by the government, others by religious groups.. I am not sure of the "shame" factor as far as mental illness is concerned.

Now I will focus on Indian Elderly in the USA

I am not fully informed of Indian elderly living in the USA- as there has been no research on this subject. I have done some informal research among my Indian friends. Let me list some of my observations and informal findings.

1. Indian families here have better economic means to take care of their family's health needs. Majority are professionals, educated and employed. Majority have health insurance from their jobs. This is due to the fact that US immigration regulations favored entry to this country of professionals and those seeking higher education. However with the 1990 Family Reunification Act, many Indian couples brought their parents to this country. Usually those who came had lost their spouse, so either father or mother who was left alone in India was brought to this country or were willing to join their son or daughter. Majority of Indian couples who retired choose to go back to India. I have a number of friends who chose to go back after a few years of retirement. They had enough money to afford a comfortable life in India with their relatives. A number of them have homes here and in India and travel either when the weather is good, or just want to visit family and friends here.

2. Among Indians here, the majority are Hindus- 1 million of them are Hindus. In India, 85% are Hindus. Hindu culture has influenced the majority of Indians- including members of other religions. In health matters, even here, you can expect 100% involvement of family. Family and spiritual beliefs are strong. Churches, mosques, and temples play important roles. They facilitate group meeting on various aspects of living. Women play a greater role in the care of the elderly. Interdependence and interconnectedness is the foundation of well being. Hindus call it "Dharma." Dharma has both a religious context and a societal context the sacred order. Indians aim for eternal order, moral law, justice, righteousness and personal duty. Challenge is for individual and social well being.

3. To emphasize again, Indians place a high priority on the family. The individual is understood to be embedded in a family that is embedded in an extended family which in turn is embedded in an even wider kin network. There are 412 Hindu centers and at least 50 major temples in the US. There are more than 500 Hindu organizations, and about 6 national Hindu organizations. The social workers or service providers working with Indian elderly would have to understand concepts like:

Family and community over individualism.
Complimentary roles over equalitarian roles.
Spiritual over individual concepts of reality

The Indian elderly clients may resist help thinking that social workers from a different culture cannot understand and help them. Indians who were born here may be more like mainstream Americans- more individualistic and secular. However they are very small in number as far as people over 65 are concerned.

In order to be effective one would have to be sensitive and culturally competent. Cultural sensitivity is demonstrated by recognizing how Western Enlightenment derived theories are not universally applicable, and correspondingly, by adapting clinical strategies to comply with psychological and value orientation of Indian cosmology. For example, Indian consumers may make extensive use of religious mythology to communicate underlying problems.

To sum up I want to emphasize 8 important points for serving the elderly of Indian culture.

Supportive direct questioning combined with emphatic listening skills is important. Straight forward self revelation of personal experience and emotions may not occur, as such practices are often deemed to be too self focused. Direct questions are fine as Indians expect the professionals to be experts - leaders and facilitators.
Involving family members in therapeutic dialogue is considered very important. The intervention which balances autonomy and interdependence is well received. The family unit is a source of support, especially when extended family may in India, too far away to help.
Deference to husband is expected and is considered to be important.
Direct eye contact- with older family members may be perceived as being disrespectful.
Group intervention is in harmony with Hindu beliefs. Group based programs, however, have to be other centered. For example, 12-step programs are considered to be too self-centered.
Recognize the importance of rituals. One of these is meditation. Support these rituals when shared by clients.
Recognition of spiritual strength can help deal with problems and send a message that the consumer's culture is relevant. For example, taking a spiritual history.
Ayervedic (natural herbs and oils etc.) treatment is valued and can be encouraged. Belief in demons is part of religious beliefs. It is not a sign of psychosis.

In conclusion, cultural competence involves working in conjunction with natural, informal, support and helping network within the minority community, e.g., neighborhood churches, spiritual leaders, etc. Our service delivery system must sanction, and in some cases, mandate the incorporation of cultural knowledge into practice and policy making. Service has to match to the uniqueness of the client population.

Hodges, David R.
Reference-: "Working with Hindu Clients in a Spiritually Sensitive Manner," NASP Social Work, Vol. 49, No. 1/ Jan. 2004

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