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Talking with Your Older Patient

Providing Care to a Diverse Population

Appreciating the richness of cultural, religious, and ethnic backgrounds among older patients can help to promote good health care.

Hispanic man smiling at a doctorWhen you understand how different cultures view health care, you are better able to tailor questions and treatment plans to the patient's needs. Although you cannot become an expert in the norms and traditions of every culture, being sensitive to general differences can strengthen your relationship with your patients.

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.

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. Also, in order to help build a trusting relationship, be respectful of native healers on whom your patient may also rely.

Researchers need the participation of older people in their clinical trials so that scientists can learn more about new drugs, therapies, medical devices, surgical procedures, or tests will work for older people. It is important for clinical trials to include diverse participants so the study results may have wider applicability.

Learn more about why clinical trials need older and diverse patients.

Using an Interpreter in Healthcare Settings

When working with patients who don't speak English as a first language, be sure to ask which language they prefer to speak and if they can read English (if not, ask which language they read).

Some older immigrants or non-native English speakers may need a medical interpreter. Federal policies require clinicians and healthcare providers who receive Federal funds, such as Medicare payments, to make interpretive services available to people with limited English.

Many clinicians rely on patients' family members or on the ad hoc services of bilingual staff members, but experts strongly discourage this practice and recommend the use of trained medical interpreters. Family members and office staff may be unable to interpret medical terminology, may inadvertently misinterpret information, or may find it difficult to relay bad news. Although a patient may choose to have a family member translate, the patient should be offered access to a professional interpreter.

A number of states have associations and foundations that can help with locating, and in some cases provide funding for, medical interpreters. Some state Medicaid offices offer reimbursement for medical interpretation services.

Whenever possible, offer patients appropriate translations of written material or refer them to bilingual resources. The National Institute on Aging, for example, provides a number of resources in both English and Spanish, as well as links to resources in other languages. If translations are not available, ask the medical interpreter to translate medical documents.

Discussing Patient Values in Healthcare

Consider starting an appointment with the following question: "What are your goals for your care?" Although clinicians typically focus on diagnosing and treating disease, older people generally care most about maintaining the quality of their lives. They are not necessarily preoccupied with death. In fact, many older people are relatively accepting of the prospect of death and want to make the most of their remaining years. Younger family members, who might have to make life-and-death decisions when an older person is incapacitated, may be unaware of the patient's views and preferences. It is important to acknowledge that these views may vary depending on the patient’s cultural background.

Attitudes on Aging May Vary

Ageism can work both ways. Doctors can make assumptions about their older patients. Older people may unwittingly assume the stereotypes of old age. Those with treatable symptoms may dismiss their problems as an inevitable part of aging and not get medical care. As a result, they may suffer needless discomfort and disability. Some may not even seek treatment for serious conditions.

The process of aging may be troubling for older adults. It can be especially hard for people who were generally healthy and could bounce back quickly from an illness. Experts observe that baby boomers bring different expectations, experiences, and preferences to aging than did previous generations. For instance, some boomers will want to participate actively in their health care and work collaboratively with clinicians to determine what treatments might best work for them.

For More Information About Diverse Older Patients

Limited English Proficiency
www.lep.gov

MedlinePlus
National Library of Medicine      
www.medlineplus.gov

National Board of Certification for Medical Interpreters
1-765-633-2378
staff@certifiedmedicalinterpreters.org
www.certifiedmedicalinterpreters.org

National Council on Interpreting in Health Care
info@ncihc.org
www.ncihc.org

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.