Doorway Thoughts

There’s a moment, just before crossing the threshold to an examining room or the room of a resident in a long-term care facility, when most healthcare providers pause—to review a chart or recall their last meeting with the patient or resident they’re about to see.

That moment is also an ideal time to consider an aspect of provider– patient and provider–resident relationships that significantly influences the quality of care you provide: cultural differences between the two of you.

“Doctors and other health care providers may miss the importance of culture, but cultural differences can greatly influence the dynamic between providers and their older patients—for better or worse,” says Sharon A. Brangman, MD, professor and chief of Geriatric Medicine at SUNY Upstate Medical University in Syracuse, NY. A member of the American Geriatrics Society’s Ethnogeriatrics Committee, Dr. Brangman is also coeditor of its Doorway Thoughts: Cross-Cultural Health Care for Older Adults guides, which are designed to help clinicians and geriatrics educators appreciate important cultural differences.

The first volume of Doorway Thoughts, published in 2004, examines cross-cultural care for African-American, American-Indian, Asian-Indian, Chinese-American, Hispanic-American, Japanese-American, and Vietnamese-American older adults. The Ethnogeriatrics Committee released the second volume during AGS’ annual scientific meeting last month. It explores culturally-aware care for Arab-American, Cambodian-American, Filipino-American, Haitian-American, Korean-American, Pakistani-American, Portuguese-American, and Russian-American older adults.

Among other areas, the guides focus on cross-cultural differences in: preferred terms for cultural identity and degree of formality in interactions; what constitutes respectful nonverbal communication; underlying assumptions about health, illness, and medical care; approaches to medical decision making; and attitudes about full disclosure of health information.

In some cultures, Dr. Brangman notes, it’s considered disrespectful to make eye contact with an authority figure, such as a health care provider, while in other cultures, failure to make eye contact may be interpreted as a sign of social disengagement. Similarly, some Latino and Asian groups believe providers should not tell patients bad news about their health; rather, they should relate this news to the patient’s spouse or children. Yet, among other groups, keeping such information from a patient is considered unacceptable.

“In long-term care we have lots of different issues in which culture comes into play,” Dr. Brangman adds. “For example, people come to nursing homes to live, and certain cultural groups may delay that transition (to nursing homes) because they perceive these as places where they won’t be comfortable. They may be concerned about differences in the food served and language spoken. There may be more complicated issues because not only providers, but also aides and others working at the nursing home come from different cultures than they. There are lots of different cultural interfaces.”

Next on the Ethnogeriatrics Committee’s agenda is a third volume of Doorway Thoughts, which will cover health, aging, and end-of-life care from the perspective of several religions. The Committee is considering having writing teams—each including a physician and a religious leader from a particular religious tradition—each contribute a chapter.

“The way we health care providers address cultural differences can have a tremendous impact,” Dr. Brangman concludes. “It can significantly affect the willingness and ability of our patients and their loved ones to understand and follow the health care regimens we prescribe.”

For more information or to order either or both volumes of Doorway Thoughts: Cross-Cultural Health Care for Older Adults, call (800) 832-0034 or visit https://www.americangeriatrics.org.