Older Hindus often practice regular upwas or fasts during which they may not eat or drink for extended periods. This may be done regularly (weekly, monthly, etc), and strict practitioners may not take their medications during a religious fast. In some cases, older patients may take their medications during upwas but refuse to take any food or fluids. This can be problematic in diabetic patients who may be taking their oral hypoglycemic medications during upwas days but not food, or taking neither food nor medication.
Certain days of the month are thought to be auspicious times and days (based on the Hindu lunar calendar). Traditional Hindu Americans may request that elective surgical procedures (e.g., hip replacements) be performed on these days.
Raahukala and Yamakanda
These are 90-minute periods in the Hindu calendar day, during which time older Hindu adults may be reluctant to undertake important actions (like important medical visits or procedures). Patients may be worried that taking actions during these inauspicious periods may have a negative impact on the outcome.
Married Indian women often wear the Mangalsutra, a sacred necklace around their necks. Some Hindu men wear the Upanayanam Poonal (Tamil), Janhav (Marathi), Janeu (Hindi) sacred thread around their torso. These items are considered sacred and important and should never be cut or removed without the explicit consent of the patient or family.
Ritualistic wristbands (amulets) or waistbands also should be considered sacred too. Hindu married women often wear a bindi or tilak (dot on the forehead) with Sindur or Kumkum (red pigment on the hairline). Other symbols of marriage are bangles and toe rings and may vary in different regions of the country. Widows, divorcees, and unmarried women may not wear these symbolic articles.
When asked to remove these religious paraphernalia as a part of preoperative preparation, some patients may offer resistance. If resistance continues after the patient and family have been educated about the need for a sterile field in surgical procedures, the patient should be allowed to retain these items but requested to sign an informed consent form about the risk of infection.
Stigma Associated with Mental Illness
Mental illness is often considered a taboo, especially among the older Hindu population. Dil udhas hona is the term for “the blues” or depression in the Hindi, Urdu, Punjabi, and Gujarati languages. Traditional older Hindus may be resistant to admitting experiencing symptoms of any mental illness such as depression.
They may refuse to believe that depression is an organic syndrome and that it can be treated with medications. In contrast, they may believe that feelings of sadness or hopelessness are a result of past karma and that the illness-associated suffering will eventually wash away the karma and, thus, should not be palliated with medications.
Health is usually related to the connectedness of the body, mind and spirit. Most older adults focus spiritually in preparing the soul for life after death. Some believe that mental illness is due to possession of the evil eye. Mental illness is seen as a stigma, so it is frequently concealed and presented to the physician as somatic complaints, such as headaches or stomach pain, instead of anxiety or depression.