Cultural Considerations for Comprehensively Assessing Foreign Born Older Adults in the United States

As demographic patterns in the United States (US) shift rapidly toward an increased prevalence of older adult residents from diverse ethnoracial backgrounds, it is especially important for healthcare practitioners to familiarize themselves with the unique attitudes, beliefs, and practices of their patients. The life stories of foreign-born older adult patients are individually unique, and they can intimately impact their bio-phyco-social profiles and needs that may not be captured in full by the traditional domains of the comprehensive geriatric assessment (CGA). This review paper attempts to describe some of the most frequently encountered themes in current literature that may potentially impact how the CGA is approached in this patient population.

Ethnoracial identity and belonging is a personal and dynamic experience, which continues throughout life and into older adulthood. CGA should explore any personal, familial, gender-specific, or community centered factors, beliefs, and cultural practices, as well as how patients individually relate to them. Effective communication involves closely collaborating with foreign language interpreters. Loneliness and isolation can be perceived even in the presence of family and are crucially impactful on healthcare practice and wellbeing. Immigrants are more likely to report serious psychological distress the longer they live in the US. Cultural considerations are now incorporated into specific diagnostic criteria for psychiatric illnesses. Screening tools for assessing cognitive impairment, delirium, social isolation, and loneliness have been validated across differing cultures.

Addressing the traditional domains of CGA are useful, though additional considerations need to be taken for the foreign-born older adult. The practice of cultural humility is superior to cultural competence, and it is rooted in curiosity, equity, receptiveness, and commitment to lifelong learning.