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Talking with Your Older Patient

Working with Diverse Older Patients

Appreciating the richness of cultural, religious, and ethnic backgrounds among older patients and providing interpretation for those with limited English can help to promote good health care.Hispanic man smiling at a doctor

When 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.

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Using an Interpreter

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). Approximately 20 percent of the U.S. population speaks a language other than English at home, according to the Census Bureau.

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.

For More Information About Diverse Older Patients

Limited English Proficiency: A Federal Interagency Website

National Board of Certification for Medical Interpreters

National Council on Interpreting in Health Care

National Library of Medicine