Inpatient Care

Inpatient Care

Hospital food can present a problem for Asian Indians, Hospitalization/institutionalization is stressful both for older adults and their families. Attention to the issues below will help greatly alleviate their stress.

Hospital Food

Many Asian-Indian older adults observe religious dietary restrictions. Many of vegetarians or vegans. Even non-vegetarians may refuse to eat meat unless it is specially prepared (e.g. halal procedure for Muslims). Older adults will often consume milk and butter, but not cheese or eggs. Clinicians should be mindful of the fact that there is a high incidence of lactose intolerance in this population. Hospital meals may also be too bland for most Asian-Indians. Many will prefer to know whether the food served to them contains beef as beef is forbidden for Asian Hindus. Foods containing pork (including jello, marshmallows, yogurt stabilized with gelatin) are prohibited for Muslims and many Hindus as well who follow religiously prescribed diet.

Hospital Dress Code

Some patients hesitate to wear hospital gowns and pajamas as these have been used by others, even if you assure them that these have been washed and sterilized. When a patient is in the hospital the sacred thread across the chest in men (upanayanam) and around the neck in women (mangalsutra) should not be removed or cut without the permission of the patient or family. Sikh men do not cut their hair and wear a bracelet and kirpan.

Surgeries and Procedures

Some older adults may prefer to have the surgery only on some auspicious days or refuse to have surgery during inauspicious parts of the day. While these considerations can be less important during emergency procedures, they become a challenge during elective procedures.

For example, older adults will refuse to permit caesearian operations for their daughters and daughters-in-law for fear of the baby being born during an inauspicious time (it is thought that the time of birth is critical in determining the fate of the individual and the birth time is used to create the astrological chart of the baby). Older adults may also refuse to have elective surgeries like prostactomy, etc. during inauspicious times.

This creates a challenge in the modern hospital environment where operation room time is scarce and the surgeons and interventionalists are challenged for time. It is important to gently question the patient and family when scheduling elective procedures and surgeries and negotiate a solution that is acceptable to them as well as to the health care institution.

Medications

Many older adults may not be adhering to their prescribed out-patient medication regimen. Great caution must be exercised in managing their in-patient medications. For example, an older adult may be on Glucotrol 15 mg per day according to their out-patient chart. When admitted to the hospital, the clinician is naturally likely to continue the same dose for the patient. However, if the patient was not taking the medication as prescribed, a sudden introduction of Glucotrol 15 mg could lead to severe and even potentially fatal hypoglycemia. Many older adults may be using Ayurvedic/Siddha/Unani medications and it is important to elicit and document this. A very gentle and non-judgemental approach is most likely to be successful in eliciting the true practices of the patient.

Body care

Modesty (Shrm) is a strong Asian Indian value, especially for women. Older adults are loath to be touched and examined and thus wary about breast examinations and pap smears. This is also true for procedures such as an enema or bladder catheterization. Patients will likely strongly prefer care from persons of same gender as feasible. Family members may want to help in providing intimate body care to avoid care from persons of the opposite gender.

Communication

Communicating with persons with Limited English Proficiency is challenging. Family members may insist on serving as interpreters. Using professional interpreters is strongly recommended. Always avoid using children and grand children under 18 years of age as interpreters.

Visiting Hours

Family and friends will likely want to stay with a hospitalized person and be included in performing personal care. The patient will be more likely to feel happy rather than tired after a visit by their family members and friends, and may be disappointed if all members of the extended family as well as close friends. This can result in a high volume of visitors that me be disruptive in a hospital environment. Also, visitors are expected spend significant time with the patient at the bedside (as opposed to dropping in for a courtesy visit) . For many Asian Indians, hospital visits are a very important way to provide support for the sick person and the family.

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