As the cultural diversity of older adults in the United States grows, clinicians are very likely to encounter older patients from a wide range of ethnic groups. The purpose of the Geriatrics Cultural Navigator is to provide cross-cultural assistance to clinicians with older patients from minority groups. The Geriatrics Cultural Navigator outlines factors for the practitioner to reflect upon before interacting with a patient.
Doorway Thoughts
- Many dialects, which may pose difficulty to interpreters
- Ask for questions, or to repeat information in own words
- National history may cause distrust of outsiders; take time
- High degree of illiteracy
Preferred Cultural Terms
- Portuguese American or Portuguese
- Acknowledgement of origin (Continental, Azorean) shows respect
Formality of Address
- Handshake with use of formal titles plus first or last name. Titles to use:
- Doutor or Doutora (if they have a higher education degree)
- Senhor or Senhora (or Dona)
- Physicians treated as authority, with unquestioning respect
Effective Communication
- Patient and doctor expected to be well-dressed, groomed
- Close personal relationship expected with physician
- Direct eye contact, handshake
Tradition and Health Beliefs
- Patients expect prescriptions; take time to explain if none given
- Mental illness and treatment are stigmatized; use care when asking about symptoms
- Wine is considered healthy and may be secretly consumed against advice
- Hidden use of alternative and homemade remedies, noncompliance common
- Spirits, amulets, cards, laying on of hands used by healers
- Reliance on Roman Catholic prayer
Culture-Specific Health Risks
- Preventive medicine (screening, check-ups) is unfamiliar concept
- Aversion to discussion of money may prevent assistance
- Heavy reliance on burdened children may produce family stress
- Risks for diabetes, heart disease, dyslipidemia, obesity, COPD
- High smoking rate
- Red wine consumed at most meals
Practices and Health
- Mediterranean diet, mostly cooked with olive oil instead of butter
- High consumption of vegetables, whole grains, fruits, nuts, and herbs
- Consumption of fish and white meats are preferred to red meats
- Lunch and dinner are the heavier meals, leading to overeating
- Low athleticism, mostly walks and occasionally soccer games
Approaches to Health Decision-Making
- Prefer physician to guide decisions
- Family plays essential role; older adults often defer to children
- Nursing home placement associated with guilt, abandonment
Informed Consent
- Patients may avoid discussion of death, fear it is self-fulfilling
- Although it is likely that older adults want to be told, traditionally, only family given bad news. Combined disclosure may be best. A family member should always be present as support
- Take time when giving patient bad news; ensure comprehension
Gender Issues
- Previous patriarchal society now more egalitarian
- Women accept treatment more readily
- Modesty may rule out gynecological care, despite female doctor
End-of-Life Care
- Schedule meeting with family present to discuss fully
- Slowly encourage older adults to clarify wishes with family/physicians
- May favor Do Not Resuscitate (DNR) orders as following “God’s will.” Careful explanations of DNR required
- Family may favor resuscitation, fearing neglect
- Home care preferred, as children have the moral obligation to take care of their parents; nursing homes avoided
- Few make proxy arrangements, formally or informally