Culturally Appropriate Geriatric Care: Assessment

Important Cultural Issues

Old age is respected in Pakistan. Older adults should be treated with utmost courtesy and respect. During the medical interview with the Pakistani older adult it is important not to forget that formality and respectfulness must be conveyed during the meeting. Appearance is emphasized, and it is also important to sit up straight in meetings and, when standing, to avoid putting one’s hands into one’s pockets. In conversation, extended direct eye contact can be considered rude.

Same-sex care providers are usually preferred. If a same-sex provider is not available, then examine a female patient in the presence of another female (chaperone) or a female relative (except in medical emergencies).
Care providers should respect elderly female modesty and privacy. Muslim patients, particularly women, may need a special gown to cover the whole body in order to avoid unnecessary exposure during physical examination. Some examinations may be done over the gown.

Allow patients’ Imams (religious teachers) to visit them and pray for them. Priests of other faith traditions can pray for or with Muslim patients with patients’ permission, using non-denominational words like God.

Nursing homes are not considered a good option because Pakistani cultural values emphasize on caring for elderly parents at home. Also, factors like the level of caregiver’s adherence to Asian cultural norms and the older adult patient’s marital status play an important role in placing an older adult Pakistani in a nursing home. Older women who have male caregivers at home prefer nursing home care by females.

Older adults may not speak English (especially the women) and may be able to converse only in Urdu or Punjabi. Usually they are accompanied by younger relatives who can serve as translators. However, periodically, it would behoove the clinician to use professional interpreters just to make sure that all of the elders concerns are being addressed. This is especially true for elderly women who are brought by their male relatives and out of modesty may not share intimate personal details. Same-sex professional interpreters would be ideal when dealing with elderly women.

Direct eye contact is considered rude and should be avoided, as should unnecessary touch between nonrelated people of the opposite sex.

Older Pakistanis may wear religious paraphernalia e.g.: taawiz (amulet) or topi (religious cap). These should not be removed without the permission of the owner.

The prayer rug and the Koran must not be touched by anyone ritually unclean (e.g., with blood or urine on the hands), and it is preferable that nothing should be placed on top of these sacred objects.

Pakistani food varies from region to region, but most of it is curry-based and spicy. It is similar to North Indian food served in many Indian or Pakistani restaurants in North America. Dietary staples include meat- and vegetable-based curry and basmati rice or chapatti (unleavened whole wheat bread). Pakistani food has a high salt and fat content. Most Pakistani American older adults will find the U.S. hospital food bland and tasteless, and may ask family members to
bring food from home.

Hand washing is considered essential before and after eating. Water for washing is needed in the same room as the toilet; Pakistani patients should be provided with bowls or jugs of water in the toilet. If a bedpan has to be used, bowls or jugs of water should also be provided at the bedside.