Doorway Thoughts: Cross-Cultural Health Care for Older Adults, two volumes, by the American Geriatrics Society (Sudbury, Mass.: Jones and Bartlett). Vol 1: (2004); paperback, 113 pages; $23.95. Vol. 2: (2006); paperback, 181 pages; $23.95.

Reviewed by Moira Fordyce

In 2004, the Ethnogeriatrics Committee of the American Geriatrics Society published the first volume of Doorway Thoughts, an easy-to-read, 113-page paperback book addressing the role that cultural diversity and ethnicity play in healthcare decision-making in America. It focuses on how clinicians can develop an understanding of various ethnic groups to care more effectively for older patients.

The chapters address cross-cultural healthcare for older adults from the following groups: American Indians and Alaska Natives, Hispanic Americans, African Americans, Vietnamese Americans, Asian Indian Americans, Japanese Americans and Chinese Americans. Each chapter is written by a clinician and educator who is either from the community discussed or who works extensively with the given ethnic or cultural group.

Influencing Patient-Provider Relationships

The “doorway thoughts” referred to in the title are key concepts that the culturally aware health practitioner reflects upon before walking into any examination, consultation or hospital room. These concepts can influence healthcare encounters and relationships for good or ill. They can affect relations with individual patients and caregivers -- and can affect the patient’s willingness or ability to understand, accept and adhere to prescribed regimens.

Each chapter covers the following key areas of culturally competent healthcare practice with the given group, and case studies illustrate applications of the concepts presented in the chapters:

• Preferred forms of address
• Nonverbal communication
• History of traumatic experiences
• History of immigration or migration
• Acculturation
• Culture-specific health risks
• Disclosure and consent
• Tradition and health beliefs
• Gender issues
• Approaches to decision making on care-intensity, end-of-life issues and other healthcare concerns
• Use of advance directives

Late last year, the Ethnogeriatrics Committee brought out a second volume of Doorway Thoughts. In developing this volume, the editorial board expanded on the first by writing about groups of older Americans whose populations are rapidly increasing, including Filipinos, Vietnamese, Koreans, Pakistanis, Haitians and those from various Arab cultures. In addition, the volume discusses groups with distinct cultural traditions in a stable, significant population base, such as Portuguese-speaking Americans and Russian-speaking Americans.

An Added Look at Homecare and Food

Overall, the second volume follows the format of the first, but a new topic heading has been added to most of the chapters: “Home Care and Food.” Since home-based care is increasing in the United States, and since palliative care is entering the mainstream of older adult care, several readers of the first volume requested this addition to help them provide optimal services to various ethnic groups and in intercultural settings.

Both volumes of Doorway Thoughts are clearly written and are full of valuable, easily accessible information. As the cultural diversity of the population of older adults in America continues to grow, clinicians must do three significant things to ensure culturally competent practice:

• Develop an understanding of the different ethnic groups represented in their practice.
• Guard against stereotyping.
• Recognize the uniqueness of each person.

The two volumes of Doorway Thoughts provide a satisfactory introduction to each of these vital concepts.

Moira Fordyce is an adjunct clinical professor at the Stanford University School of Medicine, Stanford, Calif. She is the author of Geriatric Pearls (Philadelphia: F. A. Davis, 1999).

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