Culturally Appropriate Geriatric Care: Delivery of Care

Approaches to Decision-Making

Many traditional Asian Indian families have a hierarchy of decision-makers in place, usually beginning with the oldest son as the primary contact and disseminator of information. Families may often consult physicians who they know personally to get as much information as possible. This reflects a need to be well informed about the situation rather than a distrust of health care providers. Families may be reluctant to discuss personal, emotional, and financial issues with health care providers, because these matters are considered very private and traditionally are not shared with anyone other than those in the immediate household.

Traditionally, the Asian Indian society has been male dominated, with women assuming a submissive or passive role. In the modern era, the role of Hindu women is rapidly evolving. Many women play active roles in decision-making processes, although men may continue to serve as spokespersons of the family unit. Thus, clinicians should avoid stereotypical generalizations and ask open-ended questions to explore the values and decision-making styles of individual families.

There are aspects of the Hindu religion that commonly affect health care decisions. Hinduism is a social system as well as a religion; therefore customs and practices are closely interwoven. Karma is a law of behavior and consequences in which actions of past life affects the circumstances in which one is born and lives in this life. Despite complete understanding of biological causes of illness, it is often believed that the illness is caused by karma.