Older Patients—Knowing Where They’re Coming From

The population of first-generation ethnic minorities is aging just as rapidly as the general population

The quality of any encounter between a clinician and a patient from a different ethnic or cultural background depends on the clinician’s skill and sensitivity.1

If the current Elder Boom doesn’t do for geriatrics what the Baby Boom did for pediatrics, it will be a surprise to everyone. For EMS, a booming elderly population requires a rethinking of the system, not only for the increased importance of Medicare reimbursement, but also for the increase in patients with multiple medical problems.

Now there’s another concern gaining ground in the geriatric field and that’s the fact that the population of first-generation ethnic minorities is aging just as rapidly as the general population. According to Hosam Kamel, MD, FACP, director of Geriatrics and Extended Care at St. Joseph’s Mercy Health Center in Hot Springs, AR, and co-editor of Doorway Thoughts: Cross-Cultural Health Care for Older Adults, “This segment is rapidly growing. EMS will be dealing with older people from minority groups more and more often.” The sub-group, expected to grow 9% over the next 25 years, is giving rise to the newer field of “ethnogeriatrics.”2

Implications for EMS

According to the authors and editors of Doorway Thoughts, a publication by the Ethnogeriatric Committee of the American Geriatrics Society, there are several issues to keep in mind, including varying levels of “acculturation” or assimilation to Western cultural lifestyles and mindset. The less acculturated, the more it will affect interactions between patient and provider, different expectations regarding behavior toward an elderly person, variations in trust in the treatment offered, cultural and religious interpretations for symptoms, as well as misunderstandings due to changes in language and literacy skills.

Kamel describes an older patient of his from Poland, who had been fluent in English for decades. “Then she got dementia and forgot all of it. Polish is suddenly the only language she speaks. When the recent memory goes,” a common condition in Alzheimer’s and other age-related brain disorders, “so does the second language.”

When does someone become “an elder”? Kamel says elderly is largely a political definition—some countries define their elderly as 60 years old, but here in the U.S., most healthcare systems place the line at 65, when Medicare starts paying benefits.

Still, health and cultural factors are more accurate signs to use when approaching an older adult with a different cultural background. Kamel warns providers not to make assumptions. “Start by being aware that there is diversity,” says Kamel. “Being aware that different people from different cultures might think differently from you is the key.”

Kamel urges EMS to incorporate “diversity training” into the system in order to better serve the changing communities EMS agencies serve. “When responders lack training,” he says, they report “feeling uncomfortable when going into the homes of minorities. Because they are concerned and they don’t want to hurt the feelings of their patients—they want to do the appropriate thing, but nobody’s told them what it is.” For better or worse, he says, it is not so much about your medical knowledge, but how you interact as a human being.

That’s why EMS should encourage diversity in their responders, he says. “It’s important to hire and train people from different cultures and backgrounds, people who can speak the different languages—because they know the community you serve.”

Knowing what cultural diversity might look like in an elderly patient, what different cultures might believe in and how their traditions affect the way they interface with typical North American medical practice is what Doorway Thoughts lays out. Issues to be aware of include:

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