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
- Trusting relationship prized (culture of personalismo)
- Prefer Hispanic/Latinx clinicians, but others accepted
- Ask about traditional observances
- Gently explore immigration history
- Assure confidentiality to assuage immigration status concerns
Preferred Cultural Terms
- Refer to country of origin (Cubano, puertorriqueño) or use
- Hispanic, Latino(a), Hispanic-American, Chicano, Latino(a)-American, Mexican-American, etc.
- Ask about preferred designation
Formality of Address
- Initially formal: Dr., Rev., Mr., Mrs., etc., + surname
- Later feeling of kinship, friendly gestures, therapeutic touch is welcomed.
Effective Communication
- Avoid
- overly firm handshake
- continuous eye contact
Tradition and Health Beliefs
- Some believe spirits (good and evil) influence health
- Relatively few adherents to folk remedy systems
Culture-Specific Health Risks
- Preventive screening often inadequate
- Healthcare access/information limited by
- language
- socioeconomic factors
- feelings of powerlessness
- Acculturation improves risk control in
- diabetes
- hypertension
Practices and Health
- Food has important social and health role
- Dietary change should be culturally appropriate
- Preference for family caregivers vs strangers
- Geographical distance brings a challenge to family caregiving
- Increasing use of smart phones but many apps not culturally appropriate
Approaches to Health Decision-Making
- Family takes priority (Familismo): idea of mutual responsibility
- patriarchal family structure: oldest male makes decisions
- acculturated family members may not fulfill expectations
- Religion, prayer, considered in health decision
- Focus on present, rather than future
- Decisions optimized with mutual
- respect for patient’s and clinician’s needs
- access facilitated
- information adequately transmitted
- acceptance regarding referrals
- reassurance regarding behavior
- agreement on course of action
Informed Consent
- Ensure adequate
- personal trust before delivery of poor prognosis
- time with patient and family before and after disclosure
Gender Issues
- Traditional gender roles
- male authoritative
- women submissive, self-sacrificing
- followed by older Hispanic/Latinx more than younger
- In the US, many women manage both home and work
End-of-Life Care
- Influenced by
- family
- physician
- religion
- Patient autonomy less important, family decision-making favored (familismo)
- Aggressive treatment usually favored
- Strong disapproval for assisted suicide
- Palliation acceptable
- Final DNR decisions may require family authority figure
- Fear of losing all care if DNR orders are given
- Religious considerations may be very strong