Culturally-friendly settings can improve end-of-life for migrants

Adapting aged care environments can improve the end-of-life experience of migrant residents, an aged care expert tells Australian Ageing Agenda.

Residential aged care providers should aim to make care settings more like a migrant resident’s home to improve their end-of-life experience, an expert has told Australian Ageing Agenda.

Dr Katrin Gerber, a research fellow at National Ageing Research Institute’s Melbourne Ageing Research Collaboration said making cultural changes in an aged care setting was important.

“We know that people from culturally and linguistically diverse backgrounds have different preferences for place of care and place of death,” Dr Gerber told AAA.

“Dying is hard enough. Now imagine doing this in the multicultural context of a different country while having to navigate a potentially unfamiliar healthcare system in a different language, that’s really difficult,” she said.

Migrants often want to receive end-of-life care surrounded by their family but they also long for the country of their birth, said Dr Gerber, who has undertaken research on the end-of-life experiences of older migrants.

“This feeling of being torn between two places is relatable and I can understand how at the end-of-life this would be so much more intense and relevant now during COVID where travel is difficult,” she said.

“We now need to ask ourselves, if it’s not possible for a person who is reaching the end of their life to go home… how can we make the current care setting maybe a little bit more like home?”

Dr Katrin Gerber

Dr Gerber said aged care providers can make simple changes, such as providing culturally relevant food, pictures, music and familiar objects to improve a migrants’ end-of-life experience.

“It is powerful to create a little bit more of a homelike environment,” she said.

Aged care providers should also refrain from making assumptions based on culture and provide individualised care, which requires time, Dr Gerber said.

“We need to sit down and talk to the resident to figure out how much they want to know about their medical condition, who they want to make decisions on their behalf and what is important to them as they approach end of life.”

The need for these conversations as an essential part of end-of-life care was highlighted in Dr Gerber’s recent review of 18 international research papers addressing the end-of-life preferences, attitudes, values and beliefs of first-generation international migrants aged at least 50.

The research, published in December 2020, identified six key themes in older migrants’ experiences across the research including:

  • reluctance among families to talk about death and dying
  • difficult communication in patient-clinician relationships
  • a contrast between collectivistic and individualistic norms and its associated end-of-life preferences
  • limited health literacy
  • systemic barriers such as time pressure during consultations, inflexible services and lack of cultural sensitivity
  • the need for providers to appreciate migrants’ double home experience, which is the longing to be in two different places at once.

“We found that older migrants had a wide range of needs from how much information they wanted to receive, for example, about their prognosis, how this information was being communicated and where they wanted to die,” Dr Gerber said.

The study highlighted four areas for improvement including greater awareness of migrants’ cultural needs and the role of families, cultural training for staff, access to interpreters and translated information and involving older migrants in end-of-life policymaking and research.

“We must have communication that is specifically tailored to accommodate the unique needs of all the migrants. Healthcare services have a responsibility to offer education to their staff about cultural need, and that needs to go beyond the once a year tick the box cultural diversity training,” she said.

The study was published in BMJ Supportive and Palliative Care in 2020.

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Tags: BMJ suportive and palliative care, dr katrin gerber, end-of-life care, nari, national ageing research institute, research,

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