Communication and Language Issues
The assessment of older adults who do not speak or read English well and who have different world views and goals than the health care professional can be a difficult and arduous task. Although many of the communication skills required apply to our interactions with all older adults, social distance, racism, unconscious fears, and similar concerns on the behalf of patients and professionals may contribute to additional problems in assessment and diagnosis of older adults from different ethnic groups (Brangman, 1995). Early attention to building rapport will go a long way to facilitate communication.
In many cultures, such as in Mexico, rapport begins through exchange of pleasantries or chit-chat before beginning the business of medical history-taking and physical examination (Gallagher-Thompson, Talamantes, Ramirez, Valverde, 1996; Elliott, 1996). As previously mentioned, personalismo is an essential quality for providers to have when caring for this population. Personalism has been tested in a focus group methodology to evaluate Mexican Americans’ perception of culturally competent care and deemed to be a significant indicator (Warda, 2000). Older Hispanic-Americans often expect health care personnel to be warm and personal and express a strong need to be treated with dignity (Villa et al., 1993).
Suggestions for respectful communications with elders from Hispanic/Latino backgrounds include the following:
- As a sign of respect, older persons should be addressed by their last name.
- Gesturing should be avoided because seemingly benign body or hand movements may have adverse connotations in other cultures.
- Take care to evaluate whether questions or instructions have been understood, because some persons will nod “yes” but not really comprehend.
- Outright questioning of authority such as a physician is taboo in some cultures, so encourage the patient to ask questions.
- Tell the patient that you realize that some things are not normally discussed, but that it is necessary so that the best care can be planned.
If the clinician and the patient do not speak the same language, the availability and choice of interpreters is crucial to a successful interaction. . There may be clinical consequences as a result of inadequate interpretation, such as gaps in the information obtained from the patient, gaps in information relayed to the patient from the health care provider, or inadequate or incomplete patient education. Other serious concerns about inadequate interpretation are those related to providers either conducting unnecessary testing or missing important cues which would lead the provider to order other needed tests (Woloshin, Bickell, Schwartz, Gany & Welch, 1995).
The Department of Health and Human Services (DHHS) Office for Civil Rights considers inadequate interpretation as a form of discrimination (Woloshin et. al., 1995). For a discussion of advantages and disadvantages of different types of interpreters, see the Core Curriculum in Ethnogeriatrics, Module Four. A special issue in use of family members as interpreters among Spanish speaking elders has been the hesitancy of some older Latino women to talk about breast, gynecological, or sometimes gastrointestinal issues in front of younger members of their families, especially males, according to case histories.