In honor of Healthy Aging Month this September, we're highlighting the critical role culturally responsive care plays in improving health outcomes for older adults. As our population ages, it’s more important than ever for providers to develop the skills needed to address the diverse needs of older patients, ensuring they receive the respectful and personalized care they deserve.

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As the US patient population becomes increasingly diverse, and the percentage of patients over the age of 60 in the health care system continues to grow, it’s more important than ever for health care providers to have a good grasp on culturally responsive care for older adults.  By relying on the tenets of cultural competence, and fostering a deeper understanding of cultural attitudes towards aging, providers can build trust and improve outcomes for older patients. 

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Ethnocentrism and caring for older adult patients

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Ethnocentrism, or the belief that one's own culture, values, and practices are superior to those of others, can play a role in geriatric care for both the provider as well as the patient. 

In Western medicine, the predominant approach often emphasizes allopathic methods, sometimes leading providers to overlook or undervalue traditional and non-allopathic remedies, such as Traditional Chinese Medicine or spiritual practices. Dismissing or devaluing patients' traditional practices, can hinder effective communication and discourage patients from adhering to treatment. On the other hand, older adult patients who rely on traditional cultural practices may be wary of standard diagnostic procedures or interventions, and may be reluctant to engage with a clinician due to past trauma within the health care system. 

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The key to finding balance is keeping an open dialogue between patient and provider.  While it's true that some traditional remedies may conflict with conventional medications, these concerns can be addressed through respectful communication and collaboration between patients and providers. By understanding and integrating these traditions into care plans when possible, workarounds can be found that honor patients' cultural practices without compromising their health.

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Cultural beliefs around aging 

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Attitudes about aging vary widely across cultures. In many East Asian and Indigenous traditions, older adults are often respected for their wisdom and experience. In the US, youth is prioritized above old age, leading to ageism, discrimination, and stereotypes about older adults..  Unsurprisingly, ageism has significant health implications, contributing to poorer physical and mental health and a reduced quality of life. Ageism is so pervasive that even well-intentioned health care providers can unintentionally reinforce harmful stereotypes.

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Older adult patients also have differing values around independence and connection to family and community. In some cultures, families are extremely close-knit, and it’s the norm for multiple generations to live under the same roof. However, this may result in patients expecting their family members to be involved in their care, or serve as interpreters in clinical settings. 

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Health care staff may make assumptions about older patients based on implicit biases or generalizations related to age. They might assume that certain symptoms are simply a natural part of aging, rather than investigating them as potential signs of a treatable condition. Additionally, providers might presume that older adult patients are less capable of understanding their own medical care or making informed decisions, leading to a more paternalistic approach where the patient's preferences and autonomy are not fully respected. 

Older patients who lack English proficiency also face significant difficulties in accessing care. Communication barriers can make it challenging for them to accurately describe their symptoms, understand medical diagnoses, or follow treatment instructions, leading to potential misunderstandings. These patients may also have trouble scheduling appointments, understanding health insurance and Medicaid details, or accessing resources and services.

Cultural considerations when treating dementia

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Alzheimer's disease, the most common cause of dementia, is a condition characterized by a decline in cognitive function severe enough to interfere with daily life. Symptoms of the disease typically begin with mild memory loss and can progress to include difficulties with language, problem-solving, and other cognitive abilities.

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However, different cultural groups may have varying perceptions of dementia, which can influence how they seek care. Cultural background can also influence a person’s understanding of dementia, viewing the disease as a normal part of aging. There may also be stigma around mental health in general, which can also lead to delays in seeking treatment. 

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By being culturally competent, caregivers can communicate with patients and their families that avoids pathologizing dementia. Raising awareness about dementia through partnerships with  community health leaders can also help bridge any gaps in knowledge about the disease and signs to look out for. 

Discrimination for older adult LGBTQIA+ patients

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LGBTQIA+ individuals often face significant discrimination that can impact their well-being as they age. Many people in these communities have encountered a lifetime of bias, which continues into their later years. This can create challenges when seeking health care, housing, and social services. 

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In senior living communities, LGBTQIA+ people may experience social isolation, harassment, and a lack of cultural understanding. As a result, these individuals are at a higher risk for mental health issues, poor health outcomes, and economic insecurity.

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Social determinants of health

Factoring in social determinants of health (SDOH) is crucial when treating older patients because these factors significantly influence their overall well-being and access to health care. Social determinants such as transportation, flexible scheduling, and telehealth options are especially vital for older adults, who often face unique challenges related to mobility, isolation, and limited access to resources.

• Transportation is a key determinant, as many older adult patients may no longer drive or have easy access to public transit, making it difficult to attend medical appointments or obtain prescriptions. Without reliable transportation, their ability to maintain regular visits and adhere to treatment plans is compromised.
• Flexible scheduling and telehealth offers older patients more convenient ways to access care, especially if they have mobility issues or live in rural areas. 
• Community engagement is equally important, as strong social connections can combat isolation and provide emotional support. Community resources, such as senior centers and social groups, can help patients stay active and involved, contributing to better mental and physical health.

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Tips for avoiding ageism

Here are three tips to avoid ageism in communication based on the WHO guide:

1. Use inclusive language. Avoid terms and phrases that reinforce stereotypes about older people, such as "elderly" or "frail." Instead, use language that respects their individuality and experience, like "older adults" or simply "people." Don’t make assumptions about what to call a patient, instead ask them what name they’d like you to use.
2. Challenge stereotypes: Actively question and counteract common assumptions about aging. This includes recognizing that older adults are not a homogenous group and have different abilities, interests, and needs. 
3. Provide person-centered care: In clinical settings, treat older adults as individuals rather than making assumptions based on age. Tailor treatments and care plans to their specific needs and preferences rather than relying on age-related generalizations. Engage them in discussions about their health and respect their autonomy in making decisions.

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By challenging ageism, addressing ethnocentrism, and incorporating cultural beliefs into care plans, health care providers can offer more personalized and effective care. Ultimately, embracing cultural competence allows for a more inclusive and equitable health care experience for all older adults.

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Learn how Violet increases culturally competent care delivery for patients of all ages. Book a free demo.

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