Questions:
5. While cultural competence can help to understand the health care needs of any patient, some issues are more sensitive in creating trust and a communication bond between the patient and the clinician. Which of the following domains of geriatric assessment most benefit from special understanding in assessing culturally diverse elders who are not acculturated to American core values?
a) Physical exam, health, and social history
b) End of life preferences, and cognitive and affective status.
c) Functional status, and spirituality
d) Home, and living situation.
(Source: Core Curriculum in Ethnogeriatrics, a publication of the Stanford Geriatric Education Center, page 29-30)
If you selected a) Physical exam, health, and social history
.....Physical exam, health, and social history are common needs to all patient assessments. It is recommended to understand the cultural bias that may be present in some assessment tools, and the effect which communication has on eliciting answers. Cross gender physical examinations are unacceptable in many cultures. Phrasing of questions may bias the answers to questions in any culture. While there are cultural issues related to the areas in answer a), other answers hold greater potential for cultural misunderstanding.
Return to Question 5 and consider another option.
If you selected b) End of life preferences, and cognitive and affective status.
Correct! These areas, if not approached with cultural sensitivity have the potential to disrupt the patient-clinician relationship more than the other choices. Since talking about death is considered inappropriate in some cultures (e.g., Chinese, Navajo) the issue should be approached carefully and sensitively, and only in the context of an established trusting relationship. A possible introduction after several visits might be "In case something happens to you and you are not able to make decisions about your care, we need to know what your preferences are." In many cultures, there is not the assumption of patient autonomy in decision making as there is in the US ethical paradigm, and the family is assumed to be the decision maker about health care.
Related to cognitive and affective status, dementia and depression are seen as "craziness" in some cultures and highly stigmatized. In others dementia is seen as a normal part of aging and define it as a minimal problem. Either situation may alter the information provided to the clinician.
Proceed to Question 6.
If you selected c) Functional status, and spirituality
.....Functional status, and spirituality are important content of the assessment and require cultural competence. This question is a little tricky because all the answers have some potential for cultural misunderstanding, but one answer has more potential for disrupting the patient-clinician relationship than functional status and spirituality. When functional status is assessed, the clinician needs cultural competency for the interpretation as to whether the activities assessed are of slight or significant importance to the patient.
.....Spirituality varies across all populations and is an important consideration when working with patients whether or not they would be identified as a member of a minority ethnic group. In many cultures, health and spirituality are considered very closely linked. Knowing something about the older patient's spiritual beliefs can assist providers in understanding the patient's explanatory models of illness.
Return to Question 5 and consider another option.
If you selected d) Home, and living situation.
.....Home, and living situation are important considerations for any patient. This question is a little tricky because all the answers have some potential for cultural misunderstanding, but one answer has more potential for disrupting the patient-clinician relationship than home and living situation. The stereotype that ethnic families "take care of their own" can be misleading since intergenerational issues and expectations are seen across all populations, especially with differences in acculturation. Many elders are not part of strong family networks and are vulnerable to loneliness and isolation. This is accentuated when there are language barriers for the ethnic elder.
Return to Question 5 and consider another option.