AT&R services for Middle Eastern/African older people

Assessment

Formality of address

The concept of respect for older people is important in Middle Eastern/African communities. Providers should address clients using formal modes of address, until or unless clients give permission to use their first names.
Body Care

Modesty is a strong value for Middle Eastern and African communities, especially for women. Older adults are averse to being touched and examined. This is also true for procedures such as ECG, enemas and catheterisation. Women are wary about breast and cervical screening. Clients will strongly prefer care from the same gender if feasible. Family members may want to help in providing intimate body care to avoid care from the opposite gender.

Religion and religious practices

Many but not all Middle Eastern older adults are Muslim. The client should be asked their religion rather than making an assumption, and religious beliefs should be respected.

Older people may wear religious articles and clothing (e.g., amulets, hijab or religious caps). 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). It is preferable that nothing should be placed on top of these sacred objects.

Hand washing is considered essential before and after eating. Water for washing is needed in the same room as the toilet. Middle Eastern clients 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.

Sensitive issues

Questions about sexuality are considered to be extremely delicate and personal and therefore must be asked with extreme sensitivity. Asking widowed and divorced women about their sex life would be viewed as extremely insulting. It may be difficult to elicit intimate details such as bodily functions and sexual history when the health provider interviews the female client.

Residential aged care

Middle Eastern/African families do not consider this is a good option for older family members. It is expected that adult children are responsible for the care of ageing parents and will care for them at home. Women are customarily designated the primary caregivers. This can result in a high degree of burden when caregivers feel the traditional pressure of providing all elder care personally within the home setting.

Communication

Older adults (women in particular) may not speak English. Using a professional interpreter acceptable to the client will need to be arranged. Providing a gender-matched interpreter is important.

Treatment

Approaches to decision making

Middle Eastern families are close-knit and the family unit often makes important decisions.

Inpatient care

Hospital food

Halal and other religious dietary preferences must be provided. Foods containing pork and pork products (gelatine, etc.) are prohibited for Muslims.

Hospital dress code

Older women prefer not to change into a gown even with a same sex chaperone unless absolutely necessary.

Surgery and procedures

Some Middle Eastern older people may prefer not to have surgery during the fasting month. This is less important during emergency procedures, but is a challenge during elective procedures. It is important to explore this with the client and their family when scheduling procedures and surgery, to negotiate a solution.

Body care

Modesty is a strong Middle Eastern value, especially for women. Unnecessary touching between non-related people of the opposite sex should be avoided. Muslim clients, particularly women, may need a special gown to cover the whole body in order to avoid unnecessary exposure during physical examination.

Communication

Communication with people with limited English is challenging. Family members may insist on serving as interpreters. Using professional interpreters is strongly recommended.