Abstract
Application of principles of rehabilitation medicine to community health is an area of great importance to the care of the elderly. New York City has a high percentage of Chinese immigrants. The complexity of age and cultural and communication difficulties require special attention, and an interdisciplinary approach is essential for success. The "Convalescence Care for Seniors of Lower Manhattan," a program located at New York University Downtown Hospital, is able to reach out successfully to an underserved Chinese population in Lower Manhattan. Through educational workshops, health fairs, and physician referrals, patients were able to receive the benefit of a functional approach.
TALKING in Chinatown in the heart of New York City has something exotic for a non-Chinese speaking person. From street signs to restaurant menus, from bank information to church entrances, the Chinese culture is omnipresent. It is Eastern business in a Western culture.
According to the Census Bureau, 1 over half (51%) of the Asian population in the United States live in New York, California, or Hawaii. The 2 cities with the largest population are New York City with 872,777 and Los Angeles with 407,444 Asians. Manhattan itself has a population of 144,538 Asians, including Chinese, Indian, Korean, Vietnamese, and Filipinos, only to mention the most populous. Chinatown in New York City seems one of the favored destination points for new immigrants, and it is estimated that Chinatown has between 70,000 and 120,000 inhabitants.
Adjusting to a new way of life, new language, and new culture is often critical in successful integration of immigrants into the novel social and health care system. Chinese-only reading knowledge and regretting having come to the new country were found to be associated with poor or fair health rating by the Chinese immigrants in New Zealand. 2 The same group of researchers discovered that unemployment, low English proficiency, and expectations not met are predictive of major adjustment problems. 3
The elderly are most vulnerable to pressures of moving to a new land. In addition, the prevalence of functional disability in elderly Chinese is significant. 4 Nevertheless, the functional, educational, and psychosocial needs of elderly Chinese immigrants in the United States have not been explored to date. 5
The complexity of age and cultural and communication difficulties require special attention and an interdisciplinary approach is essential for success. Patients assigned to the multidisciplinary inpatient geriatric units were shown to have significant reductions in functional decline in a recent large randomized controlled trial. 6 The same study demonstrated improvements in mental health with outpatient multidisciplinary geriatric evaluation and management by a physician, a social worker, and a nurse, with no increase in costs. 6
Application of principles of rehabilitation medicine to community health is an area of great importance to the care of the elderly. In 1969, one of us created theoretical framework of rehabilitation as a "third dimension of medicine" or, more narrowly, tertiary prevention. Looking at disability from the epidemiological and public health perspective, the concept of preventive rehabilitation was developed. 7,8
Our community outreach, education and rehabilitation program was established with a goal of applying these principles in the care of elderly Chinese immigrants in Lower Manhattan.