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 socioeconomic backgrounds
- Older adults highly respected as advisors, historians, baby-sitters
- Interpreters usually needed: Creole, French (in more educated) spoken
- High illiteracy rate, although education valued
- Often traumatic homeland or immigration history
- No tradition of punctuality; appointment times need to be stressed
- Expectation of diagnosis, prescription, use of “white coat” and stethoscope, courtesy
Preferred Cultural Terms
- Haitian or Haitian American (not African American)
Formality of Address
- Usually French first-(hyphen)-middle, last names
- Initially formal: Dr., Rev., Mr., Mrs., etc., + surname
Effective Communication
- Firm handshake for clinical situation
- May avoid direct eye contact with authority figures
- Smiling, nodding, may conceal lack of understanding
- Same-gender touching, embracing, common in informal situations
- Modesty, privacy important; explain necessity of examination
Tradition and Health Beliefs
- Most Roman Catholic, but also voodoo/spirit beliefs
- Folk remedies, hot-cold balance, hexes combined with Western medicine
- Passive attitude to fate
- Ask about use of traditional remedies; direct questions about voodoo may be considered insulting
- Functionally impaired older adults live with children, avoid care facilities
- Mental illness, dementia carry social stigma
Culture-Specific Health Risks
- Western medicine is last resort, consulted late in illness
- Regular check-ups, screenings, need to be stressed
- In older adults, sex is not discussed unless brought up by patient
- Obesity considered healthy; thinness unhealthy
- Establish relationship before attempting to change health ideas
- Foods from home needed to ensure that hospitalized patients eat
Practices and Health
- Views and strategies concerning health care/pursuit of health involve biomedical care as well as complementary therapies. Haitian patients rarely discuss such complementary or alternative therapies with their caregivers but inquiry should be made.
- Haitian women are typically the primary caregivers, employing a variety of therapies in treating ill family members and in their own personal care, including physical attention, spiritual comfort, and folk remedies. Haitian women are twice as likely as men to be regular users of alternative medicines.
- New Haitian immigrants often live in constant fear of being deported and thrown into Haitian jails. This has led to stress-related emotional disorders, which frequently keep immigrants from using such facilities as public hospitals. Instead, they rely on folk medicine to cure ordinary aliments or seek a private clinic with Haitian medical personnel.
- Second generation or higher, city dwellers, educated Haitian Americans often initially try home remedies prepared by members of the older generation; if unsuccessful, advised to seek help from a physician or folk healer.
Approaches to Health Decision-Making
- Ask about family/social situation: extended family often lives together, intimately involved
- Family councils (including older adults) make decisions
- Clinician must inquire about decision-makers early, establish link with spokesperson
- Haitian Americans have a strong belief in the culture, traditions, and mores of their homeland. For example, some believe that several types of illness are of supernatural origin and caused by angry spirits.
- The Voodooist folk healer is a Voodoo priest who has studied the mythology of spirits and which plants have the properties necessary for home remedies; treatment involves prayers and herbal remedies
- Foods may be divided into hot, cold, or neutral categories and are believed to affect the health of an individual
- Anything that creates an imbalance between “hot” and “cold” factors may cause illness or discomfort
- Remedies used to treat these illnesses are the opposite of the class of the disease. For example, “hot”; medicines such as “Asorousi” (a type of hot tea) are used to treat “cold” (anorexia)
conditions - Prevention practices of health maintenance like proper nutrition and exercise deemed unimportant, so Haitian Americans are at risk for undetected medical problems such as hypertension, osteoarthritis, and cerebrovascular disease.
Informed Consent
- Doctor expected to make decisions
- Idea of informed consent needs explanation
Gender Issues
- Females considered subservient, supportive
- Immigration may put stress on these gender roles
- Sexual relationships are discussed in the context of the marriage system
- Haitian culture differs from Western culture in that sexual activity at an early age, premarital sexual activity, and same-sex coupling are not the norm in the Haitian community; such behaviors are considered inappropriate
End-of-Life Care
- Tradition of family rituals, prayers with dying patient
- Home death preferred; hospital death avoided
- Oldest family member gathers entire family
- Ritual bathing of body before burial
- Religious beliefs prohibit cremation
- Autopsy may be welcomed to confirm death (avoid zombie state)
- Organ donation often unwelcome
- DNR choices usually need explanation; discuss once relationship is established, before crisis