AT&R services for Chinese older people

Assessment

Formalistic conformity/deference to authority

Clients may not verbalise anxiety or doubts regarding their medical care in front of clinicians, but they may not follow through with treatments. This can be misinterpreted as client non-compliance.

This deference to authority can also be misconstrued as a lack of interest in participating in medical decision making. It is a good idea to briefly summarise the plan of care, and to ask questions so that client’s  concerns can be addressed.

Decision makers

Decision makers are traditionally expected to be the husband or oldest son. However, this may change depending on the degree of acculturation. Thus, it is a good idea to ask the client whether they would want to make their own decisions about health care, or defer to other family representatives. It is also important to clarify that the doctor cannot act as the surrogate decision maker for the client.

“Saving face”

The concept of “keeping one’s good reputation” may make it harder for older people to admit to having problems, especially mental health and family problems. Clients who do not want to lose face  with the doctor may not want to question or disagree with them directly,  resulting in the client not coming back for follow up, or not taking medications as prescribed.

Concepts of yin/yang and “chi” or “qi” (vital energy)

Traditional Chinese Medicine (TCM) is the most common form of healthcare among first generation migrants. TCM is mainly guided by a holistic concept of health that emphasises achieving balance and harmony throughout the bodily systems. Many older Chinese people use TCM and allopathic medicine in a complementary fashion (Stokes-Chen & Pan, 2010).

Treatment

Role of the health provider

In order to put the client at ease, it is important to take a little time to chat before beginning the clinical interview, to address clients with respect (Mr or Mrs) and to try to pronounce names correctly. It is appropriate to ask the client how to pronounce his/her name. The basic concept of treating clients with respect, compassion and honesty is regarded as paramount, regardless of the client’s cultural/ethnic background (Stokes-Chen & Pan, 2010).

Other considerations:

• There may be a conflict with the Western concept of the client-doctor relationship of partnership versus the doctor as authority.
• Doctors are expected to make decisions and give instructions.
• The doctor must be viewed as trustworthy, caring and willing to help.
• Clients may hesitate to make direct eye contact, or may hesitate to ask questions or voice opinions so as not to inconvenience others or appear disrespectful.
• Some older people may feel uncomfortable with physical contact during conversations.

Integration/awareness of Traditional Chinese Medical (TCM) treatments/beliefs

Many Chinese older people use TCM treatments. Therefore, a physician’s disregard or lack of respect for these beliefs may lead to distrust. Open discussion and flexibility may go a long way to achieving the best treatment outcome for the client.

Advance directive/end-of-life issues

Many Chinese older people may be reluctant to discuss these issues. However, attitudes can change according to the degree of acculturation.

Clinicians need to take care and be aware of their clients’ beliefs when approaching these issues with Chinese older people and their families. It is important to ask about whether there is an accepted family decision maker.

Medications

Many less acculturated Chinese older people believe that Western medications are too strong and may not take prescribed doses. Older Chinese people may be at risk for drug interactions due to metabolic factors which alter the metabolism of drugs, and the concurrent use of herbs and other Chinese medications (Chan et al., 2008).

Rehabilitation

It is a traditional Asian belief that resting is an important part of recovery especially after major surgery. Some Asian older people may be reluctant to do exercise or help themselves in daily activities. There may be a dilemma between western expectations of gaining independence and client and family expectations of interdependence. Increasing health professional efforts to explain