According to the National Health Council, nine out of every ten persons over the age of 65 have one or more chronic conditions that diminish the quality of life. The major chronic illnesses affecting the elderly include: cancer, diabetes, cardiovascular diseases, and osteoporosis.
Data from the 2000 United States census revealed that there are more than 400 thousand elderly Asians in the three major metropolitans of the United States; Los Angeles – 171,230; San Francisco – 133,032, and New York – 100,253. The more recent census of 2010 will likely show an increase in the number of elderly Asians in each area, virtually all of them suffering from at least one chronic illness.
A study of the Asian American elderly population in New York by the Asian American Federation of New York found that nearly all are immigrants, have little education, are limited in their ability to speak English, have low incomes, and are unfamiliar with western medical practices. These factors together make it difficult to provide culturally-sensitive healthcare for chronically ill Asian seniors.
The language barrier can be overcome by accessing medical personnel (doctors, nurses, physician assistants, social workers, etc.) who speak or read the patient’s language. This is particularly important because language reflects the culture. Words do not translate meanings directly, especially between Asian languages and English. In a hospital setting where no staff member speaks the patient’s language, the hospital may subscribe to a telephone interpreter service. Often, family members and friends who accompany the patient are equally challenged in speaking English.
The elderly chronically ill Asian patient usually prefers eastern medicine over western medical practices. Eastern medicine diagnosis and treatment is generally non-invasive. Western medicine uses invasive technology to diagnose and treat in ways that are offensive to many immigrant Asian patients. Common examples include drawing blood samples, injections and intravenous infusions. Elderly Asian patients often resort to western medicine and hospitals as a last resort and do not comply with prescribed treatments. This further fuels their image of western medicine as ineffective. For example, friends and family frequently provide foods that are detrimental to the patient’s illness from a western perspective such as foods high in sodium for a patient with high blood pressure. The key to good treatment of the elderly Asian patient is simple but most often overlooked, especially in a hospital setting. Begin by asking the patient:
1) What is bothering you? 2) Why are you here in the doctor’s office or hospital? 3) What do you want done for you? 4) What don’t you want done to you? Failing to evaluate the patient’s perspective through his or her eyes can lead to inappropriate and unwanted treatment. In one incident, I was able to resolve a strident confrontation between the attending physician, staff and the patient’s friends that lasted nearly 24 hours. I began my Cantonese conversation with the patient’s friends with the above questions.
There are two deeply imbedded cultural taboos in the Chinese culture that severely limit western treatment of chronically ill Asian patients: mental illness and death. Chinese immigrants associate mental illness with shame and stigma. Friends and family avoid contact with the patient who becomes socially isolated. The belief that mentioning death in the presence of the patient hastens death deprives the patient, family and friends of opportunities to say goodbye in a meaningful way.
Richard Cheu is the author of Living Well with Chronic Illness: a Practical and Spiritual Guide (2013). He is a hospital chaplain at Bellevue Hospital in New York City where he provides pastoral counseling to a diverse patient population. He also is a stress management consultant, ordained Catholic deacon, and caregiver for his wife. He formerly was a neurophysiologist and Emergency Medical Technician. He and his wife live in Manhattan. He was born in San Francisco, raised in Chinatown and graduated from Lowell High School and Stanford University. His father, Dr. Henry Cheu, was a member of the Chinese Hospital medical staff for many years and also served as Chief of Staff.