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
- Population culturally diverse – can consist of patients born in the U.S. as well as immigrants from the Caribbean and African countries
- Ask what patient’s expectations are from HCP
- History of being less likely to have had a long-term relationship with clinicians
- Wide variation in language and literacy
- ensure comprehension by asking patient/family to express physician’s information in their own words
- adjust information according to comprehension
- Fear of “being experimented on” may be an issue; likelihood of receiving care in a clinical setting with many learners leading to concerns of young doctors “practicing” on them
- Consider history of racism and discrimination in the medical setting
- Avoid stereotypes: personalize approach
Preferred Cultural Terms
- Current usage: African-American or Black
- Terms “colored” or “Negro” considered offensive
Formality of Address
- Initially formal: Dr., Rev., Mr., Mrs., etc., + surname
- Inquire about preferred form of address
Effective Communication
- Maintain eye contact whenever possible
- Physical proximity preferable during dialogue
Tradition and Health Beliefs
- Diverse health beliefs
- Many follow Western biomedical approaches
- Others believe
- disease results from systemic imbalance or impurity
- results of wrong food, chill, sin
- Patient may hide traditional practices, resist questions
Culture-Specific Health Risks
- High rates of
- Hypertension
- CAD
- CVD
- Dementia
- Diabetes
- Arthritis
- Depression/Anxiety/Stress
- Obesity, chronic conditions associated with end-organ damage
- High cancer rates
- Prostate
- Lung
- Cervix
- Esophagus
- Increased risk for Alzheimer’s disease, and related dementias
Approaches to Health Decision-Making
- Family usually involved
- Non-blood kin may necessitate formal health care proxy
- Ask patient about preference for decision makers
Informed Consent
- Minimize suspicions about health care by individualizing care
- Discuss patient preferences for transmitting bad news:
- direct to patient
- through family
- piecemeal
- not at all
- Confirm that patient and family understand illness and options
Gender Issues
- Most older black women have worked outside the home
- Many are heads of families, matriarchs
- If married, decisions are made with spouse
End-of-Life Care
- Discuss issues early, in office, before health crisis occurs
- High-intensity therapies usually preferred
- Resistance to DNR orders, POLST forms, based on
- spirituality
- views on suffering, death, and dying
- social support networks
- mistrust of the health care system
- Clergy may be welcome support