 Locale of practice - get to know the predominate
1. CULTURAL FACTORS/ETHNICITY SUCH AS REGARD
FOR ELDERS, PERCEPTION OF HEALTH PATIENTS
Culturally Diverse Patients
 Differences of any kind
 Good healthcare depends on sensitivity toward
these differences
 Every patient is unique
Culturally Diverse Patients
Key points
 Individual is the “foreground”, culture is the
“background”
 All people share common problems/situations
 Not all people identify with their ethnic cultural
background
 Every patient needs to be treated equally
Culturally Diverse Patients
 Patients have the right to self-determination
 If the patient is of legal age (18 or older, not
emancipated)
 Document what has been refused and why
 The patient, or person authorized to consent,
must sign for themselves spouses, grandparents,
older siblings, police officers cannot sign a
refusal if telephone permission is taken, witness
by 2 persons, and EMS signs and adds the name
of the person supplying permission
Culturally Diverse Patients
 Respect the integrity of cultural beliefs
 Patients may not share your explanation of
causes of ill health and not accept conventional
treatments
 Recognize your personal cultural assumptions,
prejudices and belief systems.
 Avoid letting your prejudices interfere
with patient care.
Culturally Diverse Patients
 Language barriers - your assessment and
accuracy of interpretation will be hindered when
a language barrier is present. In some cultures,
use of children is insulting to adults and seen as
too much responsibility placed on the child
Culturally Diverse Patients
cultures of your area - know resources available
in your community
Culturally Diverse Patients And Body Language
 Very important especially when a language
barrier exists
 Usually at a subconscious level
 Components of body language
eye contact
facial expressions
proximity
posture
gestures
Body Language - Eye Contact
 Can play a key role in establishing rapport
 Failure to make eye contact can be a sign of
dishonesty
 Asians may be reluctant to make eye contact
with a figure of authority
Body Language - Facial Expressions
 One of the most obvious forms of body language
 Can convey mood, attitude, understanding,
confusion, other emotions.
Smiling and Winking
 Japanese - may smile when confused or angry
 Others Asians - smile in friendly greeting
 Latin Americans - winking is romantic, sexual
 Nigerians - parents wink at children to have them
leave the room
 Chinese - winking is rude
 Hong Kong - blinking is sign of disrespect and
boredom
 Filipinos - point to objects with eyes, not fingers
 Venezuelans - finger pointing is impolite
Body Language - Proximity
 Acceptability varies widely culture to culture
 In the United States, twice the arm length is a
comfortable social distance - 4-12 feet
 Personal space is 1.5 - 4 feet
 Different messages are interpreted when
standing above, at, or below eye level.
Body Language - Posture homelessness
 Range of attitudes conveyed from interest, chronic illness with frequent hospitalizations
respect, subordination, disrespect poor personal hygiene
 Some cultures impolite to show the bottom of self-employment
the shoe because it is dirty; will not sit with a foot
resting on opposite knee Culturally Diverse Patients
 During Assessment and Management
Body Language - Gestures
 Can replace or accompany verbal Geriatrics
communication Challenges in the Geriatric Population
 In Europe, waving goodbye is raising the hand  Often suffer from concurrent illnesses
palm facing out, wiggling fingers back and forth  Chronic problems make assessment of acute
 In Nigeria, this is an insult if the hand is too close problems difficult
to another’s face  Aging affects response to illness/injury
 Social/emotional factors have great impact on
Gestures health
 In Bulgaria & Greece, head nodding means no  Depression & isolation - highest suicide rates in
 In the USA, beckoning with 1 finger means “come people over 65
here”. In some cultures it is insulting or obscene.
 Indonesia - pointing is done with a thumb 2. RISK FACTORS ASSOCIATED WITH CHRONIC
 Middle East - pointing with 1 finger is impolite ILLNESS
 “OK” sign - obscene in Germany and Bulgaria - in According to the World Health Report 2010, the major
Japan means zero or worthless risk factors include:
 Tobacco use
Cultural Diversity - Physical Contact  The harmful use of alcohol
 Eastern Europeans are comfortable with  Raised Blood Pressure (or hypertension)
touching  Physical Inactivity
 Asians prefer less physical contact  Raised Cholesterol
 Chinese are uncomfortable with physical contact  Overweight/Obesity
but will use a handshake for greeting  Unhealthy diet
 Latin Americans show affection easily and  Raised Blood Glucose
handshakes are strong & warm 
 Egypt - tend to be touch oriented A. TOBACCO USE
 Smoking is the most preventable cause of ill
Cultural Diversity - Gestures health and death in the world wide.
 Middle East - left hand reserved for hygiene.  The Philippines was the 15th largest consumer of
Don’t shake hands left-handed or accept a gift tobacco in the world in 2002 and currently has
with left hand one of the highest smoking rates in Asia, as well
 Native Americans - offensive to step on a foot - as some of the lowest cigarette prices.
apologize immediately  WHO estimates that 10 Filipinos die every hour
due to cancer, stroke, lung and heart diseases
Culturally Diverse Patients - Financially Challenged  Increases in the cost of purchasing cigarettes,
 Know your community and county resources to changes to packaging and social marketing
offer to this group of people campaigns.
 As a reminder, use your own resources wisely

Culturally Diverse Patients - Financially Challenged

 Signs of impairment
B. ALCOHOL CONSUMPTION
 The Filipinos are the second highest consumers
of alcohol in South East Asia (the Indonesians are
first), and the number one wine drinkers.
 It is estimated that 5 million Filipinos drink on a
fairly regularly basis – it is believed that 39.9% of
the population drink on an irregular basis.
 End up with incurable conditions such as liver
cirrhosis
 Dangers of this type of behaviour include:
amount of alcohol in a short period of time will be at
risk of alcohol poisoning.
Risk of developing alcoholism.
Excessive alcohol intake can lead to physical health
problems.
Drinking can seriously damage mental health
Some people behave badly when they are intoxicated.
Unproductive at work the next day.
It can be a drain on finances
C. RAISED BLOOD PRESSURE (OR HYPERTENSION)
 Hypertension is considered as the biggest single
risk factor for deaths worldwide.
 According to the World Health Organization
(WHO), hypertension causes 7 million deaths
every year while 1.5 billion people suffer due to
its complications.
The following can help prevent the disease:
• Eating nutritious, low-salt, low-fat diet
• Exercising regularly
• Maintaining a healthy weight and if overweight
or obese, try to lose weight
• Drinking alcohol in moderation
• Quitting or never smoking
• Reducing stress and practice relaxation
techniques
D. PHYSICAL INACTIVITY
 Physical inactivity is one of the four leading risk
factors for global mortality associated with non-
communicable diseases (NCDs) such as
cardiovascular diseases, cancers, diabetes and
chronic respiratory diseases
 Physical activity is not just sports or exercise.
 This includes sports, exercise, playing, walking,
doing household chores, gardening, and dancing,
among many others.
E. RAISED CHOLESTEROL
 31.4 % of Filipino adults 20 years old and over
 Risk factor that is known to contribute to the
development of chronic diseases, such as
ischaemic heart disease and stroke.
The following are some suggestions:
1. Eat fish more often than meat or poultry;
2. Limit the intake of egg yolk to two to three times a
week;
3. Remove skin of poultry. Trim fat from meat and
poultry;
4. Occasionally replace animal foods with dried beans,
peas and legumes;
5. Increase intake of fruits and vegetables to five servings
a day;
6. Roast meat on a rack to allow meat fat to drip out
during cooking and,
7. Read labels to select foods lower in cholesterol and
saturated fat.
F. OBESITY
 In 2014 recorded an obesity prevalence of 5.1
percent, with 23.6 percent of Filipino adults
being overweight and with 24 percent increase
between 2010 and 2014.
 Spike in incidence of related non-communicable
diseases such as type 2 diabetes, cancer,
cardiovascular diseases and stroke
 Eat more fruit, vegetables, nuts, and whole
grains.
 Exercise, even moderately, for at least 30
minutes a day.
 Cut down your consumption of fatty and sugary
foods.
 Use vegetable-based oils rather than animal-
based fats.
G. RAISE BLOOD SUGAR
 Worldwide, diabetes prevalence increased
fourfold, from 108 million in 1980 to 402 million
in 2014.
 In the Philippines, it is estimated that 1 in 5
Filipinos is a diabetic.
 Diabetes’ most common complications include
cardiovascular diseases, kidney diseases eye diseases
(retinopathy), nerve damage diabetic foot
There is no cure for diabetes, but it can be treated and
controlled. The goals of managing diabetes are to:
 • Keep blood glucose levels
• Maintain blood cholesterol
• Control blood pressure.
PATTERNS OF ILLNESS OF OLDER PERSONS
 Degenerative problems are becoming pre-eminent in
older age and much of health care practice falls within
the category of ‘longer-term / chronic' conditions. In
many of these conditions, by the time they manifest
themselves a successful cure is elusive. Distinguishing the
accumulation of age related disease (morbidity) from
true ageing is difficult
 Commonly seen conditions are liable to be disregarded
by the individual
 Gradual onset of alterations in voice
 Facial appearance
 Lethargy and slowing may be easily attributable to the
ageing process that myxoedema
 Postural changes
 Stiffness and restricted activity
Managing Chronic Conditions
 Managing chronic diseases is a growing part of medical
care. Advances in science, technology and
pharmaceuticals mean that many diseases considered
fatal just a few decades ago have now become chronic
treatable conditions. The elderly, in particular, are now
living with one or more chronic diseases for extended
periods of time.
 World Health Organization (WHO) ) reports that 63 per
cent of all deaths globally are due to cardiovascular
diseases, diabetes, cancers and chronic respiratory
illnesses—making chronic disease the leading cause of
death worldwide
Positive communication
 Focusing on health promotion, disease prevention and
early detection
 Open or positive communication is important
 The Canadian Medical Protective Association (CMPA)
advises physicians who are managing a chronic disease
to listen actively, show compassion and partner with
patients to achieve care goals.
 Documenting discussions with patients, treatment plans
and other clinical issues in the medical record is good
practice as it can improve continuity of care by
communicating to other physicians, nurses and health
professionals what took place during a patient meeting
and the rationale for a treatment plan..
Patient-centered approach
 Taking a patient-centred approach that is respectful of,
and responsive to, individual patient preferences, needs
and values is advisable.
 Physicians and the rest of the healthcare provider should
take steps to educate, reinforce key information their
patients about the disease and encourage proper self-
care
Mitigating risks
 steps to mitigate the risks:
 Educate patients so they can make informed decisions
and be engaged in their care.
 Familiarize yourself with relevant clinical practice
guidelines provided by specialty societies, recognizing
that strict adherence may be difficult to achieve with
patients who have multiple chronic conditions.
 Work with patients and other healthcare providers to
develop patient-centred care plans.
Undiagnosed Diseases
 Delirium
 Gait
 Instability and falls
 Urinary incontinence
 Pain
 Malnutrition
Accommodated to disease and impairment
 Holistic, problem-solving approach
 Person-centred and interdisciplinary in approach
 Focus of the care plan
 Care coordination
Limits toleration
 The presence of frailty syndrome in the elderly
represents a vulnerable health condition, as well as a low
tolerance for physical and psychological stressors, which
increases the risk of falls, functional incapability,
dependence in activities of daily living
 Low tolerance for physical and psychological stressors
may affect engagement in physical activities
 Mobility loss:
 Malnutrition:
Dependent on others
 Old age is commonly meant for dependency
 Dependency, which is related to impairment, is
frequently equated with vulnerability, inactiveness and
loss of autonomy
 Patients have the right to choose, accept or decline
information