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
- Appointment times may be viewed as flexible by some recent immigrants, with late arrival or skipped appointments; transportation may be a barrier.
- Visitors may bring food and attempt to stay longer than facility restrictions allow.
- Reluctance to disclose private information, even to physicians.
- If Muslim, same-sex medical providers preferred.
Preferred Cultural Terms
- Arab American; originate from 22 Arab countries.
- Most are Muslim, but many are Christian.
- Immigrants from Afghanistan, Iran, Turkey speak Farsi, not included as Arab origin.
Formality of Address
- Formal: Dr., Rev., Mr., Mrs., etc., + surname.
- Conservative approach preferred.
- Physicians are considered authoritative, but not nurses, others.
Effective Communication
- Handshake acceptable for men, but not for many Muslim women.
- Both men and women may avoid smiling/eye contact (lowering of gaze) with any health worker.
- Use conservative demeanor, restraint, closed body language.
Tradition and Health Beliefs
- Dietary issues:
- Halal meats (kosher may be acceptable)
- No alcohol, pork or lard (restricts baked goods), blood products
- Encourage food from home; usually preferred
- Cleanliness important:
- Washing before daily (5 times) prayers
- Avoidance of unclean things, e.g., bodily excretions, blood, corpses, pigs, dogs, alcohol
- Blood transfusions, drawing, are acceptable.
- Forbidden substances possible in medications (e.g., alcohol, porcine insulin, gelatin capsules made from pork by-products).
- Ramadan: sick older adult may be exempt from daytime fast.
- Traditional concerns may play a role in health beliefs (e.g., misfortune can be transmitted by another’s envy or evil eye).
- Mental illness feared as possession by evil, loss of faith:
- Medical care may be neglected
- Condition may be denied, hidden
- Concept of preventive medicine viewed with suspicion:
- Compliance issues may emerge after acute condition subsides
- Adherence to long-term, repetitive treatments for chronic conditions may be difficult to fulfill over time, prescription drugs may be abandoned
Culture-Specific Health Risks
- Hypertension, dyslipidemia, type 2 diabetes with acculturation.
- Adherence to diabetic regimens may be obstructed by lack of accessibility and cost for some.
- Linguistic and cultural interventions are suggested to improve weight and diabetes control.
- Cancers of the liver, thyroid, brain, kidney and bladder, as well as leukemia, are more common among Arabs in the US.
- Hereditary conditions may be hidden, denied to prevent family embarrassment.
Practices and Health
- Need for improved awareness and prevention of intimate partner violence and elder abuse.
- Some immigrants will have been subject to female genital mutilation (FGM), which may result in gynecological complications across the life course.
- Mental and physical wellbeing is associated with social capital such as family availability and resources.
- There may be lower rates of routine and seasonal vaccinations (flu, pneumonia) compared to non-Arab, non-Hispanic Whites.
- Smoking, substance abuse, and alcoholism are lower among Arab Americans than others, particularly for women.
- Those men who have been in the U.S. for a shorter amount of time are more likely smokers, may use a water pipe.
- Health promotion activities, such as stress management and physical exercise, may benefit from improvement among women.
Approaches to Health Decision-Making
- Question patient about decision autonomy early.
- Males usually have authority in the family; widowed women may have sons who serve as the contact.
- Presence of family is often requested.
Informed Consent
- Early in care, ask patient about preferences regarding disclosure.
- Bad news traditionally held back from older patients.
- Ranking male receives information, makes decisions.
Gender Issues
- Males are authoritative, women caregivers, although this is changing
- Consult older women for role preferences
- Gynecological services should be provided by female clinicians
- Removal of head scarf (hijab) may cause great discomfort
End-of-Life Care
- Cultural practices involve strong family care preference, with long-term care only if relatives are unavailable
- Language, cultural, dietary challenges may cause great distress
- Medical treatment balanced with acceptance of God’s will
- Traditions concerning washing, wrapping of dead body
- Immediate burial preferred, perhaps same day; avoid unnecessary delays
- COVID-19 pandemic has led to changes in burial practices, due to a lack of immediate burial which may intensify the suffering of survivors