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
- History may include
- war-related violence and trauma
- repression
- refugee experience
- loss of home
- loss of family members
- discrimination in US
- In the community, older adults are highly respected
Preferred Cultural Terms
- Vietnamese American or Vietnamese people
- Avoid “refugee” or “boat people”
Formality of Address
- Initially formal: Dr., Rev., Mr., Mrs., etc., + surname (Mr. Nguyen)
- Family name may be listed first, e.g., Nguyen Minh
- Informally use title plus given name, e.g. Mr. Minh
Effective Communication
- Respect shown to older adults
- Reserved demeanor preferred
- Slight bow at greeting
- Use both hands when giving an object
- Keep arms crossed or hands folded in front
- Avoid
- direct eye contact
- shaking hands
- loud voice
- beckoning someone with upturned finger
Tradition and Health Beliefs
- May combine Western and traditional approaches
- Strong influence of Confucianism and Taoism
- Major religions are Buddhism and Christianity
- Diseases have religious, spiritual causes
- Balance sought: yin/yang, hot/cold
- Cupping, coining are traditional healing practices
- Injections are expected
- Antibiotics may be stored
Culture-Specific Health Risks
- Higher risk for cancer
- in women: cervical, stomach, thyroid
- in men: nasopharynx, liver, stomach
- Higher risk related to smoking, especially for men
- cardiovascular disease
- stroke
- Diabetes, even in the absence of excess weight
- Hypertension
- Hepatitis B (80% exposure; 14% carriers)
- Depression and post-traumatic stress
- Parasites and ova
Practices and Health
- Balance between foods considered “hot” and those considered “cold”
- Older generation tends to avoid cold drinks, especially when sick
- Lactose intolerance is common
- Pain frequently not reported
Approaches to Health Decision-Making
- Family, or older patient, may make decisions
- Younger relatives may assume control of decision-making, especially if the older adults have limited English proficiency
- Ask patient for preference
Informed Consent
- Nodding head may not indicate understanding
- Family may wish to conceal bad news from patient
- Consult with family spokesperson first
Gender Issues
- Patriarchal society; men usually decision-makers
End-of-Life Care
- Religious aversion to dying in hospital
- End-of-life support may be considered
- an insult to ancestors
- contributing to death
- Resistance to organ donation
- Belief that a difficult death is karmic justice
- Wills, funeral often planned well ahead
- Lack of awareness of end-of-life care options