A sense of humour about small misunderstandings is crucial. Asking for explanations about the patient’s culture and offering explanations to the patient about the biomedical culture shows goodwill and a desire to communicate. None of the cultures involved are problems to be overcome. Rather, they are opportunities for sharing.
Table 8.7 ETHNIC(S) mnemonic for improving communication.
| Explanation Treatment Healers Negotiate Intervention Collaborate Spirituality/seniors |
Be prepared to address potential cultural differences when they arise. Not all patients identify strongly with their ethnic culture. Educational level, dominant language, religion, gender, year of immigration, and even personality may have more of an effect on interactions with health care providers than cultural identity.59 The best way to find out what influences the patients’ cultures have on their health is to ask them directly and listen carefully to what they have to say.
Improve communication
The simple mnemonic ETHNIC(S) (Table 8.7) provides an easily remembered framework for providers to use in providing culturally appropriate geriatric care.60 ETHNIC(S) can serve as a clinically applicable tool for eliciting and negotiating cultural issues during health care encounters. Geriatrics health care providers need to be aware of the effect that culture has on establishing treatment priorities, influencing adherence, and addressing end‐of‐life care issues for older patients and their caregivers.
Explanation
It is the practitioner’s job to elicit explanations from the older adult as to why they are seeking care. This may be achieved by asking direct questions about what they think the symptoms indicate and/or what they think family members or other sources may have suggested. It is a rare patient who is unaffected by television or the Internet. This is a good time to evaluate how well the older adult understands the symptoms and what they are worried about.
Treatment
Ask what the patient has already tried to alleviate symptoms, and specifically mention some commonly used complementary and alternative medicine treatments. All older adults have home remedies that are used when a symptom first presents. Sometimes those remedies are helpful, and sometimes they are harmful.
Healers
This is an opportunity for providers to indicate to the older adult that they understand that they may not be the sole health care provider for the older adult. Knowing who the other healers are goes a long way toward knowing who needs to be included in the treatment plan when applying more complicated remedies.
Negotiate
Recovery from an illness requires teamwork, especially with the older adult. Informal caregivers may need to be engaged in the healing process. The provider needs to know how much of a partner the older adult intends to be in their own recovery.
Intervention
The degree to which the older adult is willing to participate in proposed medical interventions must be determined. If compromises must be made based on cultural conditions, or if misunderstandings can be resolved, then the planned interventions can be implemented or modified in a timely manner.
Collaborate
Not only do the older adult and provider need to work together, but informal caregivers and family members, other healers, other members of the interdisciplinary geriatrics health team, and community services must also be included. Continuum of care for older people is very much a team endeavour. Effective collaboration from the beginning makes the transitions easier.
Spirituality/seniors
Spirituality is an often‐overlooked aspect of health care for both providers and older adults. The provider should take the lead in asking whether the older adult would like to discuss the role of their beliefs in their health care. This is particularly important for end‐of‐life care.
Understand non‐verbal cues
Communication goes beyond language and medical jargon. The use of technical terms should be minimised to ensure patient understanding. Take care to understand when common terms such as stomach may be used to refer to a different part of the abdominal area. The observation of non‐verbal cues such as pointing or guarding a body area will help locate areas of concern even when a common word cannot be found to describe the location of an illness or pain.
Use professional translators when possible
It is usually advisable to engage a professional translator or use translated written materials for patients who are not fluent in the language commonly spoken in the medical office. Although it may be tempting to ask for help from a young relative who accompanies the older adult, this is seldom advisable. Children as translators are especially problematic, especially if the medical topic is not appropriate for a child. That said, sometimes even minimal communication may be better than none at all. However, take care to understand the social contract between the child and the older adult. A particularly sensitive child may wish to protect the older adult’s dignity, not understanding that the provider–patient relationship relies strongly on honesty. Alternatively, an older adult may not be comfortable communicating through a child of the opposite gender, thus leading to more confusion and under‐reporting of symptoms. Attention to non‐verbal communication becomes particularly important when children are being used as translators.
Promote health
Good nutrition, exercise, and other lifestyle‐related changes, such as smoking cessation, are cornerstones of successful ageing for all patients. Cultural differences in the perception of what defines a good diet61‐64 or the proper amount or form of exercise28,65,66 may be difficult to address but well worth the effort. Lack of physical activity, combined with poor dietary habits, contributes to increased obesity in older people. Regular exercise and increased aerobic fitness are associated with a decrease in all‐cause mortality and morbidity and are proven to reduce disease and disability and improve quality of life in older people.
Resources
Low or inadequate health literacy is a powerful barrier to good health. Following are websites that provide resources for those who wish to better understand and address health literacy.
European Union Health Literacy (http://healthliteracycentre.eu): Provides resources on recognising, measuring, and improving health literacy and includes a special web page for health literacy in older adults: http://healthliteracycentre.eu/knowledge‐base/#topics=health‐literacy‐defined‐and‐measured.
United States Centers for Disease Control and Prevention Health Literacy (https://www.cdc.gov/healthliteracy/index.html): Provides information, tools, and links on health literacy research, practice, and evaluation for public health topics and situations. Resources available on the website include ‘Understand Your Audience’ tools and resources on ‘Older