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
- Russian-speaking patients may have been victims of persecution
- Most highly educated (many physicians) but may lack spoken English
- Many live within insulated Russian enclaves in US
Preferred Cultural Terms
- Russian-speaking immigrant; avoid “Russian” immigrant – this is very important
- Many backgrounds, most Jewish, many Ukrainian, Armenian, others
Formality of Address
- Formal approach preferred, using given (first) name plus “patronymic” name
- Patronymic is based on father’s first name (e.g., Ivan, Vasiliy)
- For men, add suffix “evich” or “ovich” to produce “Ivanovich” or “Vasiliyevich,” e.g., Ivan Vasiliyevich
- For women, add suffix “ovna” or “evna” to produce “Ivanovna” or “Vasiliyevna,” e.g., Anna Ivanovna
- For Ukrainian women, patronymic suffix is “ivna”, not “ovna/evna”
- First name alone considered impolite, depending on how long they have lived in the US. It’s better to address as Mr./Mrs at the beginning until invited to use first name
Effective Communication
- Eye contact, smile, genuine interest appreciated
- Patients expect to contact physician directly by telephone
Tradition and Health Beliefs
- Western medical system preferred
- May supplement with massage, herbal remedies, chicken soup, etc.
- Herbs, home-made remedies, preventive measures and taking vitamins play a big role: honey, tea with lemon and/or honey, home-made cough syrups, mustard plaster, cupping, etc.
- May prefer aggressive treatment initially over wait-and-see approach
- May import medicines from Russia or buy medicine that they are familiar with from local Russian stores
- Prefer home care aid agencies, meal delivery
- Patients expect hospitalization, some families might prefer home-based palliative and hospice care
Culture-Specific Health Risks
- Depending on homeland: exposure to pollution, radiation, war, famine
- High rates of hypertension, cardiac and GI disease, diabetes, cancer
- Depression, anxiety, and other mental/psychiatric conditions are not uncommon but are stigmatized, hidden. Male patients rarely acknowledge symptoms of depression or anxiety.
- Many patients are not accustomed to health maintenance; may have chronic/indefinite use of medications for conditions like hypertension, diabetes, or dyslipidemia
- Older generations are not accustomed to physically active lifestyle or activities such as cardio or resistance exercises, but accustomed to regular long walks and spending time outside, even when sitting and chatting
Practices and Health
- High-fat, high-salt, fried foods are traditional
- Meat-heavy diet with high consumption of traditional smoked meats, sausages, and kolbasa/kielbasa
- Smoking, sedentary lifestyle common
Approaches to Health Decision-Making
- Physician seen as authority, decision-maker
- Asking for patient input suggests physician inadequacy
- Older adults have difficult time when presented with multiple choices of treatment and asked to make a decision. May expect their physician to make a recommendation and explain the rationale.
- Older adults rely on their adult children to make important health decisions for them
- Careful explanations of quality-of-life issues required
Informed Consent
- Informed consent is an alien, anxiety-producing concept
- Adult children often control consent, minimizing information to patient
- Interpreter will help in direct consultation with patient
- Present options in hopeful context
Gender Issues
- High degree of equality; women often highly-educated professionals
- Health decisions made equally
- Assumption that gynecologists are women, surgeons are men
End-of-Life Care
- Discussion of cancer, terminal illness may be sensitive issues and need to be navigated with care
- Begin end-of-life discussions focusing on quality of life and symptom management
- DNR orders, proxies, living wills are rare and poorly understood by the majority
- Expectation of aggressive, curative treatment
- Adult children may assume responsibility, protecting parents