Key considerations

CALD Older People Resource

Older people may be more accustomed to a paternalistic medical system in which the doctor determines the care plan and makes the decisions.
A doctor who takes charge and gives prescriptions for medications may be preferred.
Doctors are expected to make decisions and give instructions.
Doctors may be perceived as incompetent if they sound unsure.
The doctor must be viewed as trustworthy, caring and willing to help.
Some older people may feel uncomfortable with physical contact during conversations.

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.
Older adults should be treated with the utmost courtesy and respect. During the assessment interview with the older adult it is important not to forget that formality and respectfulness must be conveyed during the meeting. Providers should use a formal mode of address until given permission to use first names, if ever.
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. In conversation, extended direct eye contact can be considered rude.

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.
It is a good idea to briefly summarise the plan of care, and to ask questions so that their concerns can be addressed.

Many families have a hierarchy of decision makers in place, usually beginning with the oldest son as the primary contact and disseminator of information. However, this may change depending on the degree of acculturation.
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.
Families may be reluctant to discuss personal, emotional and financial issues with health providers.

Same-gender care providers are usually preferred. If a same-gender provider is not available, then examine a female client in the presence of another female chaperone.
Care providers should respect older women’s modesty and privacy.
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.

Most clients will prefer a family-centred approach.
Older adults and their children often prefer not to disclose negative information to clients because they may worry that the truth may take away hope and increase suffering.

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). 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.

Despite complete understanding of biological causes of illness, it is often believed that illness and disability is caused by karma.
Many Hindu older people may be using Ayurvedic medications and it is important to elicit and document this.

Religious Background. 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.