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
- Confucianism supports respect for education, authority, filial piety
- Older adults often do not speak English; interpreter needed
- Illiteracy, a source of embarrassment due to the importance placed on education, may be hidden
- Older adults may be quite isolated, living within family unit due to language and cultural barriers
Preferred Cultural Terms
- Korean American, or Korean
Formality of Address
- Formality, respect are expected with older adults
- Formal: Dr., Rev., Mr., Mrs., etc., + surname
- Avoid use of first name
- Professionals such as lawyers and physicians are respected
Effective Communication
- Respect conservative formality, sense of space
- Avoid extended direct eye contact
- Handshake may be unfamiliar; use a simultaneous bow
Tradition and Health Beliefs
- Herbal medicine known as “Han bang” or “Han yak” is practiced often in conjunction with western medicine
- Acupuncture, herbal medicines, moxibustion (mugwort burning), cupping are used as alternative medicine
- Causes of illness: failures in rituals, ancestral anger, spirits
- Expressing emotion may be thought to bring on disease
- Patient may alternate using Western, folk practitioners
- Sensitive queries needed to confirm folk remedy use
- Nursing home avoidance may cause caregiver stress
Culture-Specific Health Risks
- Patients who eat a traditional diet may have a high salt intake
- High rates of hypertension, CVD, cancers (stomach, liver), osteoporosis, TB, Hepatitis B, diabetes
- Most small business owners lack health insurance; low rates of cancer screening, and disease prevention
Practices and Health
- Medical diagnosis such as cancer may not discussed openly, but rather secretively
- Important to inquire about the use of herbal medicine due to practice of alternative or complementary medicine, to assess for potential interactions with prescribed medications
- Due to the popularity of the western diet/food in Korea, health issues such as obesity have increased
Approaches to Health Decision-Making
- Family unit takes precedence over patient autonomy
- Eldest son, older adults, family involved in decisions
Informed Consent
- Bad news often withheld from patient; considered contributory to poor outcome
- Family decides about tests, treatment, end-of-life care
- Clinician must ascertain disclosure preferences early
Gender Issues
- Patriarchal families, but female role is changing
- Many women work but are still expected to run the home
- Women are the caregivers, look after older adults
- Risk of female burnout and mental health issues due to too many responsibilities
End-of-Life Care
- Influence of religion, personal beliefs, cultural beliefs
- Oldest son or husband makes care and end-of-life decisions
- Belief that discussing death with patient hastens it
- Written directives rare, but important to have these discussions since less aggressive and appropriate medical treatments may be sought
- Family members usually enlisted for decision-making