Working with Culturally Diverse Elders and Family Members

Common cultural differences in expected participation by family members in elders’ health care:

1. Disclosure of terminal/ serious condition to family members but not to elder.
2. Decision making by family member(s) instead of by patient.
3. Cultural show of respect to elder through family caregiving rather than encouraging independence.
4. Spiritual/religious beliefs by family that elder’s life should:
   1. be preserved by all means despite decreased quality.
   2. allow time for a “miracle”.
   3. allow God to control the time of death.
5. Importance of presence of large numbers of family members, which may interfere with medical or nursing routines.
6. Cultural expectations of behavior (e.g., cross-gender touching).

Techniques to minimize conflict:

1. Ask older patient’s preference for decision making early in care.
2. Ask older patient to identify family spokesperson(s).
3. In emergencies, ask the family to appoint a spokesperson.
4. Respect appointment, even if the person is not a family member or does not live nearby.
5. Use a cultural broker or cultural guide from the elder’s ethnic or religious background:
   1. to assist the health care team.
   2. to advise on cultural communication patterns (e.g., meaning of eye contact/body language).
6. Familiarize multidisciplinary health care team with cultural explanatory models of elder’s condition(s).