Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 211

Cultural differences between patient and provider can lead to misunderstandings, value conflicts, and disparate understandings of health and illness. Low health literacy leads to poor understanding and adherence and often limits access to health care. Together, low levels of health literacy and a lack of cultural sensitivity can severely impact health outcomes.¹ Dramatic shifts in population demographics may be due to migration or the natural demographic shifts of an ageing society. A dramatic example of the effects of migration on the ethnicity of a population occurred in the United Kingdom (UK). In the 1950s, Bethnal Green, an area in London, was a predominantly white, working‐class neighbourhood. In the 1990s, its name had changed to Tower Hamlet, and it had become the home of large numbers of Bangladeshi immigrants. In 2018, Tower Hamlets had the lowest life expectancy and the highest rate of heart disease in all the London boroughs.

Religion offers another measure of population diversity. Wolverhampton, in the West Midlands, UK, has significant multicultural diversity in religious preference. The population identifies as 55.5% Christian, 19.7% no religion, 9.1% Sikh, 3.7% Hindu, 3.6% Muslim, and 0.4% Buddhist. Language also plays a role in maintaining low health literacy: over 800 languages are spoken in New York City, and Mandarin is the language spoken by the largest number of people worldwide. London, Leicester, Luton, Slough, and Birmingham, UK currently have a greater than 50% ethnic minority population versus a white British majority.

Changes such as these require training programmes for health professionals in how beliefs of different cultures may impact the interactions between older people and their health care providers. These changes have resulted in the need for geriatrics health professionals to be aware of cultural differences between their patients and their varying levels of health literacy. They must also be aware of how these cultural differences and health literacy levels might impact the care that their patients receive and accept.² For example, older migrants are often non‐adherent with medications, resulting from interactions between illness perceptions, low health literacy, language barriers, and disadvantaged socioeconomic circumstances, which can sometimes restrict the ability to purchase prescribed medications.³

Geriatrics care providers’ ultimate goal is to provide the best medical care possible to all older adults. This goal is made difficult when these older adults do not possess adequate health literacy – that is, the ability to understand and manage their own health care. Good communication is critical to improving health literacy. When the cultural characteristics of both patients and providers are so different that communication is compromised, poor health literacy is likely to make it difficult for patients to receive good health care. This chapter presents ideas on how cultural context affects the provision of health care to an ageing, multiethnic population. Collaboration between providers and older adults and their caregivers⁴ is crucial. This chapter addresses barriers to accomplishing the goal of providing good health care resulting from cultural differences and provides suggestions to minimise cultural differences in clinical encounters. Because there is so much cultural diversity worldwide, this chapter serves as a reminder that the problem must be addressed rather than provide a laundry list of solutions. A list of resources at the end of the chapter will help guide practitioners in developing their own strategies to develop and maintain cultural sensitivity to improve health care to their multicultural patient base.