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 values, beliefs, languages, socioeconomic status
- Two groups:
- Older adults sponsored by their adult children who had immigrated to the United States
- Adult immigrants who have been in the workforce and now are getting older
- Most Muslim, but religion should be ascertained
- Older, especially women, may need Urdu or Hindi interpreters
- Use same-gender professional medical interpreters
- Reassure about confidentiality, need for full symptom disclosure
Preferred Cultural Terms
- Pakistani American
Formality of Address
- Extreme respect, formality is the norm
- Formal address: Dr., Rev., Mr., Mrs., etc., + surname
- Physician may be addressed as Dr., plus first name
Effective Communication
- Respect is expected: open door, stand when patient enters
- Restrict unnecessary touching; only males shake hands
- Male-female touching may be prohibited
- Maintain formal, reserved but caring attitude
Tradition and Health Beliefs
- Traditional and Western health systems accepted together
- Acceptance of Allah’s decisions
- Health depends on avoidance of sin, rituals, ghosts, spirits
- Older adults, especially women, try traditional remedies first
- Hikmat: balance of 4 humors – blood, phlegm, yellow/black bile
- Homeopathy, holy water, oil, butter treatments, special foods, amulets (taawiz) have healing powers
- Religious objects (cap, amulets) need permission before removal
- Washing necessary before/after food, bathroom, prayers
- Mental illness may be a taboo topic
- Nursing home care may be considered shameful to family
Culture-Specific Health Risks
- High-salt, high-fat diet, smoking, sedentary lifestyle
- High risk for hypertension, dyslipidemia, diabetes, TB, oral submucous fibrosis, oral cancers, breast cancer, depression
Practices and Health
- Only halal (sanctified) foods: no pork, alcohol, blood products, gelatin, or pork derivatives
- Ramzan (Ramadan) fasting may be bypassed in frail older adults
Informed Consent
- Bad news, especially cancer, customarily hidden from patient
- May ask for family member to receive information, make decisions
- Ask patient about preferences early in treatment
- Older adults often defer to decisions of children
Gender Issues
- Female physicians preferred by female patients
- Women avoid disrobing, need much reassurance
- Women more likely to defer to decision of spouse, children
- Questions of sex must be asked carefully to avoid insult
- Males, used to authoritative role, may struggle with dependence
End-of-Life Care
- End-of-life planning is an unfamiliar, threatening concept
- Need adequate time, family present, to initiate discussion
- Withholding food is forbidden in Islam
- Preference for dying at home, or at least with family/friends
- Visiting dying person is Muslim duty; many visitors common
- Rituals include washing, positioning body toward southeast
- Same gender workers handle body, if possible, minimizing contact
- Post-mortem examinations cause great family stress