Cultural Considerations in Palliative Practice for Native Americans.ppt

Cultural Considerations in Palliative Practice for Native AmericansGeriatric Grand RoundsUNMApril 9, 2009Timothy Domer MDFort Defiance AZ 88 yo Navajo female, advanced Parkinson’s, assist will all ADLs ED with hypoxia, hypotension, bilateral infiltrates, unable to adequately oxygenate, intubated, pressors. Baseline alb. 1.8 Now in ICU after 4 days, CXR is worse, 70% FiO2, requiring low dose pressors, PEEP, third-spacing No AD, no MDPA Causes of death US vs.. Native Americans US top 11 (CDC 2004): AI/AN (2000) Heart Disease Heart disease Malignancies Malignancies CVA Unintentional injuries COPD Diabetes Unintentional injuries CVA Diabetes Liver disease Alzheimer’s COPD Acute resp. illness Suicide Renal disease Acute resp. illness Septicemia Renal disease Suicide Homicide 15 Alzheimer’s Death rates are significantly higher for: Alcoholism 638 % Tuberculosis 400% Diabetes mellitus 291% Unintentional injuries 215% Suicide 91% Homicide 81% Pneumonia and influenza 67 Gastrointestinal diseases 38% Heart disease 20% Malignant neoplasms 1% lower HIV disease is 43% less. Epidemiology CDC US 2004 Expected Life Males 75.7 yrs (white) 69.8 (black) Females 80.8 yrs 76.6 CDC/IHS Navajo Area 1999 Expected Life Males 66.1yrs Females 77.5 yrs Average age at death FDIH past 2 years: Males 56 years (US 75 years) Females 64 years (US 80 years) Hospice Usage: 2004 (31%) Medicare decedents opted for hospice - up from 22 percent in 2000 CMMS: Report to Congress: Increasing the Value of Medicare, June 2006 /publications/congressional_reports/Jun06_TOC.pdf 1999-2003 (2.8%) IHS Medicare patients in 2 IHS hospitals enrolled in hospice when they died - State average - 30.8%. Dartmouth Atlas utilization data, NM Medical Review Association (NMMRA), the Medicare Quality Improvement Organization for New Mexico () (.shtm) Tribal and regional diversity: Each Tribe has unique traditions, customs and beliefs. Variation in