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“Culture is the intersection of people and life itself. It’s how we deal with life, love, death, birth, disappointment…all of that is expressed in culture.”
—Wendell Pierce
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
4-1. Describe culture and its importance in client-centered practice.
4-2. Identify factors that vary cultural perceptions within the same cultural group.
4-3. Articulate how cultural perceptions of aging affect older adult participation.
4-4. Articulate how environmental systems affect older adult health outcomes.
4-5. Discern whether one’s own cultural biases hinder or facilitate client-centered practice.
4-6. Integrate cultural humility into client-centered interventions.
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Mini Case Study
Ann is an 85-year-old woman who tripped on a raised portion of the sidewalk during her daily walk. She sustained a hip fracture and is now post-op day one after a total hip replacement. Ann is a retired registered nurse who values a thorough understanding of her medical care to make the best healthcare decisions for herself. Although a longtime healthcare provider at the community hospital, she also draws upon holistic medicine, including the use of homeopathic treatments and wellness interventions, such as massage therapy, yoga, acupuncture, and a vegetarian diet. A native urbanite raised by a self-reliant, single mother, Ann loves the vibrancy of the city and prides herself in being independent. Throughout her life, she has lived in different downtown areas and enjoys making new friends, learning about the latest trends, and trying different restaurants. As she has aged, it has become more difficult to negotiate public transportation (e.g., climbing the stairs to change subway platforms, walking distances between bus stops) to do her shopping, explore the city, or visit her friends across town. She now uses a rideshare application on her smartphone to get around. Ann lives alone and has a very supportive son who lives in the area and is willing to help her at home during her recovery. Yet, she sees her role as his mother to take care of him, not vice versa, and does not want to burden him.
Provocative Questions
What are assumptions the occupation therapy practitioners may make based solely on Ann’s age, sex, and/or work history? Could these assumptions hinder or support client-centered practice?
How does the intersection of Ann’s different experiences and life spheres shape her values, goals, and role expectations?
How can the occupational therapy practitioners understand and integrate Ann’s culture into their interventions to make occupational therapy meaningful for her?
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In a fast-paced healthcare setting, occupational therapy practitioners may make assumptions based on the client’s background and circumstances to quickly make clinical decisions. This, however, may lead to stereotyping, overgeneralization of the client’s needs, and missed opportunities to provide personal and meaningful care (American Psychological Association [APA], 2017; Shepherd & Brochu, 2021). By understanding a client’s culture, the practitioner may better understand how clients view themselves in relation to others, discover what the ...