Chapter 8: Working with Diverse Older Patients

"Cultural differences, not divides."

"Accurate and effective communication between patients and clinicians is the most essential component of the health care encounter. Lacking effective communication strategies, patients and clinicians can be frustrated and misunderstood.“
- U.S. Office of Minority Health

Appreciating the richness of cultural and ethnic backgrounds among older patients can help to promote good health care. Good communication skills enable you to listen closely to what your patients are saying, regardless of their cultural background. Understanding how different cultures view health care helps you to tailor questions and treatment plans to the patient’s needs. Although you cannot become expert in the norms and traditions of every culture, being sensitive to general differences can strengthen your relationship with your patients.

The use of alternative medicines, herbal treatments, and folk remedies is common in many cultures. Be sure to ask your patient if he or she takes vitamins, herbal treatments, dietary supplements, or other alternative or complementary medicines. By being respectful of native healers on whom your patient may also rely, you help to build a trusting relationship.

Older immigrants or non-native English speakers may need a medical interpreter. Federal regulations require physicians and health care providers to create a plan for serving their non-English speaking patients. Guidance for accommodating people with limited English proficiency is available.

Medical interpreters are more reliable translators than are family members or friends, who may be unable to interpret medical terminology or may inadvertently misinterpret information. Although a patient may choose to have a family member translate, he or she should be offered access to a professional interpreter. Whenever possible, offer patients appropriate translations of written material or refer them to bilingual resources.

When working with patients from other countries, be sure to ask which language they prefer to speak and whether or not they read and write English (and, if not, which language they do read). If translations are not available, ask the medical interpreter to translate medical documents.

Each culture has its own rules about body language and interpretations of hand gestures. Some cultures point with the entire hand, because pointing with a finger is extremely rude behavior. For some cultures, direct eye contact is considered disrespectful. Until you are sure about a patient’s background, you might opt for a conservative approach. And, if you aren’t certain about a patient’s preferences, ask.

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