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
- Degree of acculturation varies and should be considered in interactions
- Filial piety is generally esteemed
- Gifts are customary and express appreciation
Preferred Cultural Terms
- Use Japanese American or Japanese
- “Jap” is derogatory
Formality of Address
- Formal: Dr., Rev., Mr., Mrs., etc. + plus surname
- For very traditional patients, surname plus “-san”
- Avoid first names or “grandpa”/”grandma”
Effective Communication
- Restrained and respectful preferable to very direct and forthright but depends on degree of acculturation
- Open confrontation is embarrassing and shameful, thus patient may say “yes” although they do not agree
- Culture of “Gaman” may be present. To “gaman” is to not tell suffering, to endure, especially pain, as showing displaying suffering is considered a weakness
Tradition and Health Beliefs
- Most fully accept Western biomedicine
- Acupuncture, massage, moxibustion (mugwort burning), Kampo medicine (Japanese traditional herbal medicine) may be used
- Mental health care is underutilized, with association of strong stigma
- Some interpret disease as “karma” (result of their bad deed)
Culture-Specific Health Risks
- CAD, colon cancer rates increasing
- Diabetes not uncommon in thin people
- DVT/PE less common
- H pylori infection and gastric cancer are more common (if they are from Japan)
- Older generation: Hx of TB and pulmonary resection not uncommon
- Hx of BCG vaccine -> TB skin test positive
Practices and Health
- May have lower tolerance to alcohol
- Diet may be higher in sodium
- Traditional Japanese diet generally considered healthier than Western diet with more vegetables, fish, fruits, soy and less animal fat, added sugars
Approaches to Health Decision-Making
- Oldest male in family is traditionally the family decision-maker, with goal of leading respectful family consensus building
- Traditionally, respectful and restrained approach is favored over overt expressed disagreements
- Degree of advance care planning and formal advance directives may vary
Informed Consent
- Family may wish to hide bad news from patient, but patients may prefer honesty
- Ask for patient preference and reconfirm periodically
- Autonomy generally not regarded as important as in Western culture
- Involving family in decision making is important
Gender Issues
- Traditional families: men work, women stay home
- Roles are blurred more in modern families and degree of acculturation
- LGBT not generally widely accepted
End-of-Life Care
- Traditionally oldest male in family may still make decisions, but this may be changing with degree of acculturation
- “It cannot be helped” attitude generally allows open discussion
- Brain death not widely accepted
- Nursing home use generally avoided if possible
- Avoid early discussion of death; considered negative
- DNR discussion more productive as death approaches
- May be more amenable to DNR choice
- Being functionally independent and not being burden are important
- Generally, cremation is usual
- May prefer to avoid aggressive care and respect natural death
- Being present when their parents die is important