must also be included. Continuum of care for older people is very much a team endeavour. Effective collaboration from the beginning makes the transitions easier.
Spirituality/seniors
Spirituality is an often‐overlooked aspect of health care for both providers and older adults. The provider should take the lead in asking whether the older adult would like to discuss the role of their beliefs in their health care. This is particularly important for end‐of‐life care.
Understand non‐verbal cues
Communication goes beyond language and medical jargon. The use of technical terms should be minimised to ensure patient understanding. Take care to understand when common terms such as stomach may be used to refer to a different part of the abdominal area. The observation of non‐verbal cues such as pointing or guarding a body area will help locate areas of concern even when a common word cannot be found to describe the location of an illness or pain.
Use professional translators when possible
It is usually advisable to engage a professional translator or use translated written materials for patients who are not fluent in the language commonly spoken in the medical office. Although it may be tempting to ask for help from a young relative who accompanies the older adult, this is seldom advisable. Children as translators are especially problematic, especially if the medical topic is not appropriate for a child. That said, sometimes even minimal communication may be better than none at all. However, take care to understand the social contract between the child and the older adult. A particularly sensitive child may wish to protect the older adult’s dignity, not understanding that the provider–patient relationship relies strongly on honesty. Alternatively, an older adult may not be comfortable communicating through a child of the opposite gender, thus leading to more confusion and under‐reporting of symptoms. Attention to non‐verbal communication becomes particularly important when children are being used as translators.
Promote health
Good nutrition, exercise, and other lifestyle‐related changes, such as smoking cessation, are cornerstones of successful ageing for all patients. Cultural differences in the perception of what defines a good diet61‐64 or the proper amount or form of exercise28,65,66 may be difficult to address but well worth the effort. Lack of physical activity, combined with poor dietary habits, contributes to increased obesity in older people. Regular exercise and increased aerobic fitness are associated with a decrease in all‐cause mortality and morbidity and are proven to reduce disease and disability and improve quality of life in older people.
Resources
Low or inadequate health literacy is a powerful barrier to good health. Following are websites that provide resources for those who wish to better understand and address health literacy.
European Union Health Literacy (http://healthliteracycentre.eu): Provides resources on recognising, measuring, and improving health literacy and includes a special web page for health literacy in older adults: http://healthliteracycentre.eu/knowledge‐base/#topics=health‐literacy‐defined‐and‐measured.
United States Centers for Disease Control and Prevention Health Literacy (https://www.cdc.gov/healthliteracy/index.html): Provides information, tools, and links on health literacy research, practice, and evaluation for public health topics and situations. Resources available on the website include ‘Understand Your Audience’ tools and resources on ‘Older Adults Communication’ to help improve communication with older adults and address health literacy barriers, as well as ‘Plain Language’ resources, the tools and resources on ‘Visual Communication‘, and ‘Testing Messages and Materials’ to ensure that health information is accurate, accessible and actionable.
Cultural competence in health care
Cultural sensitivity is a powerful strategy that health care providers can use to help reduce the negative impact of cultural differences on health outcomes. The following is a partial list of web‐based resources that may be useful. A more complete list can be accessed through search engines using keywords such as cultural diversity, cultural competence, explanatory model, health promotion programs, and disease self‐management.
Diversity Rx (http://www.diversityrx.org/topic‐areas/cultural‐competence‐101): This portion of the www.diversityrx.org website promotes language and cultural competence to improve the quality of health care for minority, immigrant, and ethnically diverse communities. It describes how language and culture affect the delivery of quality services to ethnically diverse populations and provides resources to enable providers to learn about language and cultural competence in health care, design better programs and policies, and network with colleagues and experts. It also provides information on working with an interpreter and gives examples of model programs.
American Hospital Association (AHA) Institute for Diversity and Health Equity Disparities Toolkit (www.ifdhe.aha.org/hretdisparities.toolkit): A web‐based toolkit that provides guidance on collecting patient race, ethnicity, and primary language data. The free toolkit includes resources on collecting data from patients, training staff, and addressing legal and privacy concerns. The toolkit identifies the patient’s preferred method of communication, any potential language barriers, and the patient’s culture. With this information, the provider can enlist any outside assistance needed to ensure proper patient–provider communication. The toolkit is designed to educate and inform staff about the importance of data collection, how to implement a framework to collect race, ethnicity, and primary language data, and ultimately how to use these data to improve quality of care for all populations.
EthnoMed (http://ethnomed.org): Focuses on information about cultural beliefs, medical issues, and other related issues pertinent to the health care of recent immigrants to the United States, many of whom are refugees. Cultural profiles are provided for 16 different cultures. The website offers videos in many languages on taking basic medical histories with interpreters. Hyperlinks on this site may be useful when provider and patient languages differ. Disease‐specific patient education materials are provided in 25 different languages.
Health promotion programs
Caring for Caregivers (https://www.cdc.gov/aging/caregiving/index.htm): As the number of older adults increases, so will the number of caregivers needed to provide daily care or assistance
