Common cultural differences in expected participation by family members in elders’ health care:
- Disclosure of terminal/ serious condition to family members but not to elder.
- Decision making by family member(s) instead of by patient.
- Cultural show of respect to elder through family caregiving rather than encouraging independence.
- Spiritual/religious beliefs by family that elder’s life should:
- be preserved by all means despite decreased quality.
- allow time for a “miracle”.
- allow God to control the time of death.
- Importance of presence of large numbers of family members, which may interfere with medical or nursing routines.
- Cultural expectations of behavior (e.g., cross-gender touching).
Techniques to minimize conflict:
- Ask older patient’s preference for decision making early in care.
- Ask older patient to identify family spokesperson(s).
- In emergencies, ask the family to appoint a spokesperson.
- Respect appointment, even if the person is not a family member or does not live nearby.
- Use a cultural broker or cultural guide from the elder’s ethnic or religious background:
- to assist the health care team.
- to advise on cultural communication patterns (e.g., meaning of eye contact/body language).
- Familiarize multidisciplinary health care team with cultural explanatory models of elder’s condition(s).