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
- Diverse immigration patterns, literacy, education
- Possible history of discrimination, hardship, war (Bataan march)
- Many older Filipinos need an interpreter. Confirm language/dialect and offer an interpreter for those not comfortable with English
- Avoid asking “Do you understand?” and request that the patient repeat the information for clinicians to ensure proper understanding
- Filial piety, respect for elders is very strong within the family and community
- Many older Filipinos cope with illness and struggles with the help and encouragement of their family, community, and strong ties to their spirituality
- Many older adults will involve and incorporate specific family members (i.e. first-born, siblings) in decision-making and may be present during visit
- Creating a safe and welcoming environment will help combat “hiya” (shame, embarrassment)
Preferred Cultural Terms
- Filipino preferred
- Filipino American may be used for those born in the United States
- Pinoy (male) and Pinay (female) are other less commonly used terms
Formality of Address
- Respect for elders is extremely important within the Filipino culture
- Initially address formally (i.e. Dr., Rev., Mr., Mrs., etc.) and by their surname
- Adding “po” to end sentence conveys respect (“How are you, po?”)
Effective Communication
- Genuine smile, eye contact, handshake acceptable
- Avoid prolonged eye contact with very traditional older adult
- Head nodding conveys respect, acknowledgment, but not necessarily understanding; recommend asking patient to reiterate information to confirm comprehension
- Written, signed instructions on prescription pad are welcome
- Diverse literacy and education within the Filipino community
- Tagalog (or Pilipino) is one of the national languages of the Philippines, but there are major regional dialects that individuals may be more comfortable with (i.e. Tagalog, Cebuano, Ilocano, Hiligaynon or Ilonggo, Bicolano, Waray, Kapampangan, and Pangasinense)
Tradition and Health Beliefs
- Dependent on extended family unit (biological, social, spiritual)
- Blend of Malayan, Chinese, Asian Indian, Christian, Muslim, Spanish, American traditions
- Ask about and be supportive of traditional beliefs
- Traditional view of illness: hot-cold imbalance, divine retribution, spirits, witches, consequences of drafts, harsh weather
- Combined traditional and Western medicine acceptable
- Common coping styles among Filipino Americans
- “Hiya” – fear of embarrassment
- “Lakas Ng Loob“ and “Tiyaga”– courage and endurance through adversity
- “Bahala Na“ mentality – unwavering faith and leaving everything up to God or fate; may be used as an excuse to not put time or effort into a cause
- “Tawanan ang problema” – finding humor in adversity
Culture-Specific Health Risks
- Reluctance to access home-care or respite services outside family
- May initially turn to an “Albularyo” witch doctor, folk healer, or medicine men vs seeking consult with a licensed medical professional
- May initially turn to “hilot” or “tawas,” an ancient Filipino art of healing. It uses manipulation and massage and use of oil concoctions and herbs to achieve the treatment outcome, seen to have worsened fractures or sprain and causes wound infection
- High levels of salt, carbohydrate (rice) in diet
- Increased hypertension, CVD, CHD, diabetes, TB, gout, hepatitis B, metabolic disorders, breast cancer mortality
- Depression may present as somatic disorder; stigma of mental illness
Practices and Health
- High levels of salt, carbohydrate (rice) in diet
- Unbalanced diet consisting mostly of carbohydrate and fatty meat or fish
- Individual diet is largely influenced by diet of the entire family
- Traditional and common Filipino food typically does not include fresh vegetables
- Traditional desserts are high in carbohydrates
- Limited exercise; view household chores and physical work in occupation as exercise needed
- Annual physical check-up and exams not commonly practiced
- Use of herbal medicines, medicinal plants to relieve symptoms.
- Often delay seeing medical professionals when they become symptomatic especially among older adults, try to find cheaper form of relief of symptoms (over-the-counter medications or “hilot” and “albularyo”)
Approaches to Health Decision-Making
- Often prefer extended family involvement (biological, social)
- Eldest child or a specified family member typically has large influence in decision-making
- Ask about who will make decisions and be involved in decision-making early in care
Informed Consent
- Family may wish to protect patient from bad news
- Awareness of prognosis thought to be detrimental
- Patient may prefer that family makes decisions
- Tradition of stoicism requires sensitive inquiry about pain
- Offer options regarding disclosure and let patient decide
Gender Issues
- Families matriarchal, but men are head of household
- Women are active participants in decision-making
- Older female patients may prefer female physician
- Young female physicians should avoid unnecessary physical contact with male patients (e.g., holding hand for comfort)
End-of-Life Care
- Ask about preferences early in illness
- Same-gender, family care preferred at end of life in hospital
- Most Roman Catholic, many observe rituals and sacraments (Anointing of the Sick, Eucharistic Celebration (mass) and Rosary)
- Washing body, visitation in hospital common
- Resistance to organ donation, autopsy
- Resistance to advance directives discussion or decisions
- Hospice, DNR codes, in-home death less utilized
- Ask family spokesperson or priest for advice on how to discuss with patient and family