Culturally based differences in attitudes toward medication that can influence adherence:
- Belief that prescription drugs are too strong, leading to taking less than the amount prescribed (e.g. some Chinese and Southeast Asian elders) (Pham, Rosenthal & Diamond, 1999).
- Belief that medications administered by injection are the most effective ones, leading to expectation that if the provider is competent, a shot will be given (e.g., some Cambodian and Vietnamese elders) (Roundtable Summaries in Llorens, 1988).
- Cultural values relating to effectiveness of specific medications (e.g. belief that Chinese herbs are more effective than Western medicines for hypertension by some Chinese elders) (Li et al., 2007).
Physiological effects of the medications
Differences in response to some medications:
Lin, Poland, & Nakasaki, (1993), found smaller doses of tricyclic antidepressants, benzodaizepines, and haloperidol than usual in the U.S. were effective in some Asian patients, which they attributed to slower metabolism. Thiazide diuretics and calcium channel blockers were found in earlier studies to be more effective than beta blockers in treating hypertension in some African Americans (Francis, 1990, Moser 1990). In 2005, there was great controversy when BiDil, a combination drug, was the first pharmaceutical to be approved for a single race, in this case for Black/African Americans for the treatment of congestive heart failure (Brody & Hunt, 2006).
Effect of combining pharmaceuticals with culturally based herbal medications:
It is common for elders from cultures with strong traditions of herbal medication use to take Western based prescription and/or over the counter medications at the same time they are taking herbal medication.
Social and Economic Issues
- Financial inability to buy medication.
- Practice of importing medications from other countries.
Techniques to minimize misunderstanding
- Discuss patient’s and provider’s explanatory models for condition being treated (See Assessment).
- Investigate meaning of condition in the culture (e.g., is it hidden?, is there a word in the language for the condition?).
- Assess literacy level, then give culturally appropriate written information in appropriate reading level.
- Prescribe for elder’s individual characteristics, using geriatric prescription guidelines “start low and go slow”.
- Assess attitudes to taking prescribed amount while being careful not to give the impression of provider incompetence.
- Careful follow-up with elders about ability to take prescribed amount and response to medication.