In cross-cultural interactions, communication issues become paramount. If the provider is not familiar with the elder’s cultural background, the provider needs to have assistance from a cultural guide (sometimes also called a cultural broker or cultural navigator). This is a bilingual/bicultural person who is from the patient’s ethnic community but also knows the health care culture who can advise the provider on choice of words, pitfalls to avoid, and nonverbal issues. It could be an interpreter, a religious or clan leader, or another health care worker.

These guidelines are general and may not apply to all cultural groups and individuals. Please refer to ethnic specific modules for additional information.

Developing Trust

Demonstrating respect to older patients in culturally appropriate ways is crucial to establish a trusting relationship. Specific strategies to foster development of trust include the following:

  1. Ask a cultural guide or informed individual how to greet and show respect to an elder appropriately from their specific culture, especially in relations to shaking hands, eye contact, bowing, and touching when the patient is the opposite sex.
  2. Generally, acknowledge and greet older persons first.
  3. Generally, use formal term of address (Mr., Mrs.), at least initially.
  4. Consider use of informal conversation prior to formal assessment. It may not be respectful to ask business oriented questions without first acknowledging the patient in a more personal way. For example, Mexican Americans may prefer to begin a conversation with questions such as “How is your family?” or “Did you have to travel long to come here?” before they wish to respond to more formal questions such as “What brings you here today?”
  5. Avoiding the “invisible patient syndrome”: Older patients need to be talked to and with, rather than talked about. Talking to someone else in the room as if the patient weren’t there, or is incapable of understanding demonstrates disrespect, even if the elder does not speak the language of the provider.
  6. Acknowledge the importance of culture in health care interactions and ask for the patients’ help as experts in their own cultures, for you to understand and incorporate salient cultural components in the plans of care.