Your patients bring diverse backgrounds, customs, abilities, and experiences to their health care. Some differences are apparent, while others are not. Factors that contribute to diversity include:

• Geographic and cultural background
• Race and ethnicity
• Age
• Gender identity, gender expression, and sexual orientation
• Preferred language(s)
• Religious and family traditions
• Education and socioeconomic background
• Neurodiversity
• Cognitive, sensory, and physical abilities

Recognizing and appreciating diversity is an essential part of patient-centered care. It can lead to improved patient safety, more open communication, increased health equity, and better patient outcomes. By respecting each patient’s values and preferences, you’ll be more likely to engage them as collaborative partners in their care.

How is diversity related to health?

A patient’s culture and background will affect whether and where they seek health care, their understanding of medical information, and how they make health care decisions. Recognizing the different health issues your older patients are likely to face, as well as the factors that contribute to these differences, will help you provide the most effective care.

Many complex and interacting factors, lifelong and current, underlie disparities in health risk and disease burden. These factors include:

• Unequal access to health care services
• Availability of social support
• Neighborhood and workplace environments
• Food availability and accessibility
• Wealth and income gaps
• Racism, sexism, and other forms of discrimination

Age-related health disparities affect the health of older adults. For example:

• NIA-funded researchers have found a higher prevalence of Alzheimer’s disease among African Americans and Hispanics than among other racial and ethnic groups in the United States.
• Prostate cancer has higher incidence and mortality rates, as well as an earlier average age of onset, in non-Hispanic Black men compared with men of other backgrounds.

Scientists have also observed sex and gender differences in health and longevity. For example, women live longer than men, on average. They are also more likely to develop osteoporosis or depressive symptoms and to report functional limitations as they age. Men, on the other hand, are more likely to develop heart disease, cancer, or diabetes.

Other studies have found that lower socioeconomic status is associated with poorer health and reduced lifespan in the United States. Economic circumstances can determine whether an individual can afford quality health care and proper nutrition from early life into old age. Financial resources and health insurance often determine whether an older adult enters an assisted living facility or nursing home or stays at home to be cared for by family members.

Health care workforce diversity is important

Providers representing a variety of backgrounds and cultures can help meet the health needs of an increasingly diverse population. Some patients feel more comfortable with health care providers who share or understand their language, race, ethnicity, or other cultural characteristics. Research suggests that a diverse health care workforce may also improve patient satisfaction, patient-clinician communication, and access to care.

Communicating with a diverse patient population

Your conversational style can be a subtle but powerful way to connect with your patients. Being thoughtful about how you communicate with each individual can promote understanding, trust, and satisfaction in the patient-provider relationship.

Practical tips for effective communication include:

• Ask patients which name and other descriptive terms they prefer and use those consistently. This small effort can go a long way toward making patients feel welcome, safe, and accepted.
• Use person-first language. This language avoids defining someone by their condition or disability (e.g., people with diabetes instead of diabetics).
• Try to match your communication style to that of your patient. Conventions such as the speed and volume of speech vary across cultures. To some people, interrupting an individual who is speaking is acceptable and even expected, while it is considered rude and off-putting to others. 
• Use plain language. Avoid using medical terminology or abbreviations that your patients might not understand. Remember that certain idioms and figures of speech in English may be unfamiliar or confusing to people who have a different primary language.
• Be aware of nonverbal communication (such as hand gestures) that may have a different meaning to patients from different backgrounds. People also differ in the amount of eye contact, smiling, touching, and physical distance that are comfortable.

Tailoring how you talk with patients can help them better understand the information you are providing. Communicating in a way that makes your patients feel comfortable may help them open up about their health concerns and be more receptive to your guidance.

Providing language assistance in health care settings

Overcoming language barriers is critical for effective patient-provider communication. It allows for mutual understanding, informed decision-making, and better quality of care.

In any type of health care setting, you are likely to encounter patients with a primary language other than English. Here are several ways to support these patients:

• Identify the main languages spoken by your patient population and, whenever possible, match patients with qualified bilingual staff or have other trained medical interpretation services available.
• Start appointments by asking all new patients which language they prefer to speak and read, and whether they would like an interpreter. An “I Speak” card (PDF, 4.6M) can help patients identify their preferred language. Note preferences in their medical records.
• Provide important written materials in your patients’ preferred languages. For example, have office signage, intake and consent forms, prescription labels, and patient instructions available in multiple languages when possible. NIA provides health information for older adults in both English and Spanish as well as links to resources in other languages.
• Maintain a list of referrals to local clinicians and community service providers who speak your patients’ preferred languages, when available.

It can be logistically challenging to provide language assistance services. As a result, some clinicians rely on interpretation by patients’ family members or on bilingual staff members who are untrained in medical interpretation. However, experts strongly discourage this practice. An informal interpreter may be unable to convey medical terminology accurately, may inadvertently misinterpret information, or may be reluctant to share difficult news. Informal interpretation can also interfere with patient privacy.

Using qualified medical interpreters can improve communication, understanding, clinical outcomes, and patient satisfaction with care. Trained interpreters will help ensure that everything said during a medical appointment is relayed accurately and objectively. This checklist (PDF, 207K) provides tips for working with an interpreter.

Providing language assistance isn’t just good medical practice: In some cases, it’s also required by law. Federal policies require health care providers who receive government funds, such as Medicare and Medicaid payments, to make interpretive services and written translations of critical documents available at no cost to people with limited English proficiency. Visit LEP.gov for details about these requirements.

Some states have professional associations and foundations that may provide funding for medical interpreters. Additionally, Medicaid offers reimbursement for some medical interpretation services.

If you are looking for a qualified medical interpreter, the National Board of Certification for Medical Interpreters and the Certification Commission for Healthcare Interpreters have online registries of certified interpreters. The Registry of Interpreters for the Deaf provides a searchable list of certified interpreters in American Sign Language. Many state government websites also provide directories of interpreters and translators to help you locate services in your area.

Tips for culturally sensitive care

How can you work with your patients in a way that respects their diversity? To start, avoid making assumptions about a person’s beliefs, attitudes, or behaviors based on their culture or background. Instead, engage with patients to find out about their individual values and preferences.

Additional ideas for providing culturally sensitive care include:

• Reflect on your own background, beliefs, and values, and consider how they inform your practice. For example, think about your own feelings about aging and how they might influence your interactions with your older patients.
• Get to know the community that you serve. What are the most common racial and ethnic groups? Which languages do they speak? What health, social, and environmental issues do they face? Adapt programs and health care practices so they are appropriate to the groups you serve most often.
• Recognize that a healthy diet plan may differ among cultural traditions. Patients will have difficulty following dietary advice if it doesn’t take their food preferences and cooking methods into account. The Nutrition.gov Culture and Food page provides nutrition guidance, food options, and recipes from around the world.
• Understand that some patients may value having other family members involved in their health care decisions. Clarify how the patient sees the role of family and any specific information they want shared with relatives.
• For patients nearing the end of life, ask about their health care goals. There may be cultural or religious differences in attitudes toward end-of-life decision-making, such as creating advance directives; disclosing a terminal diagnosis to the sick person or family members; and pursuing life-prolonging treatments, such as a feeding tube.

Different beliefs about aging

People from different cultures and traditions have varied attitudes about aging. For example, in some cultures, older adults are customarily respected for their wisdom and experience. Other cultures tend to be more youth-centered, valuing the qualities of youth over those of old age.

When societies prefer youth over old age, it can lead to ageism. This often underrecognized form of discrimination comprises stereotypes and prejudices directed toward people on the basis of their age. Ageism has serious implications for the health of older people: Studies have associated age-based discrimination with poorer physical and mental health, reduced quality of life, and even earlier death.

Because ageism is so pervasive, it’s easy for well-intentioned health care providers to make assumptions about their older patients and inadvertently reinforce harmful stereotypes. For example, patients and their providers may dismiss otherwise treatable health problems as an inevitable part of aging. As a result, older patients may suffer preventable discomfort and disability.

For tips on avoiding ageism when talking with your patients, see the World Health Organization’s Quick Guide to Avoid Ageism in Communication.

Clinical research needs diversity

It is important for clinical trials and studies to include a diverse range of participants so the results will have broader applicability. Researchers need older adults from many different backgrounds to participate in research so they can learn more about how new drugs, tests, and other interventions will work in diverse populations.

Clinical research also needs scientists from diverse backgrounds, particularly from groups that have been historically underrepresented. Diversity in scientific teams can lead to more creative and innovative thinking, which can help biomedical research represent and benefit people from all backgrounds.

To learn more, please visit https://www.nia.nih.gov/health/health-care-professionals-information/providing-care-diverse-older-adult-population.

ere are many things you can do to help boost your health as you age, including making healthy food choices and not smoking. But did you know that participating in social and other activities you enjoy can also help support healthy aging?

As you grow older, you may find yourself spending more time at home alone. Being lonely or socially isolated is not good for your overall health. For example, it can increase feelings of depression or anxiety, which can have a negative impact on many other aspects of your health. If you find yourself spending a lot of time alone, try participating in activities you find meaningful — those that create a sense of purpose in your daily life. These can include hobbies, volunteer activities, or time with family and friends.

BENEFITS OF AN ACTIVE LIFESTYLE

Engaging in social and productive activities you enjoy, such as taking an art class, joining a hiking club, or becoming a volunteer in your community, may help to maintain your well-being and independence as you age. An active lifestyle is more than just getting your daily steps in. It includes doing activities that are meaningful to you and benefit your mind, spirit, and body.

Research has shown that older adults with an active lifestyle:

• Are less likely to develop certain diseases. Participating in hobbies and other social activities may lower risk for developing some health problems, including dementia, heart disease, stroke, and some types of cancer.
• Have a longer lifespan. Studies looking at people’s outlooks and how long they live show that happiness, life satisfaction, and a sense of purpose are all linked to living longer. Doing things that you enjoy may help cultivate those positive feelings.
• Are happier and less depressed. Studies suggest that older adults who participate in activities they find meaningful, such as volunteering in their communities or being physically active, say they feel happier and healthier.
• Are better prepared to cope. When people feel happier and healthier, they are more likely to be resilient, which is our ability to bounce back and recover from difficult situations. Positive emotions, optimism, physical and mental health, and a sense of purpose are all associated with resilience.
• May be able to improve their thinking abilities. Research suggests that participating in certain activities, such as those that are mentally stimulating or involve physical activity, may have a positive effect on memory — and the more variety the better. Other studies are providing new information about ways that creative activities, such as music or dance, can help older adults with memory problems or dementia.

FIND THE RIGHT BALANCE

Everyone has different limits to the amount of time they can spend on social or other activities. What is perfect for one person may be too much for another. You might start by adding one or two activities to your routine and see how you feel. You can always add more. Remember: Participating in activities you enjoy should be fun, not stressful.

ACTIVITIES TO CONSIDER

Read and share this infographic and spread the word about ways that may help foster healthy aging.

There are plenty of places to look for opportunities to engage in activities you enjoy, depending on your interests and ability. Following are ideas that might work for you. Some of these include activities that can be enjoyed even from a distance using phones, computers, and other devices. Others can be done alone. So even if you’re in a rural area or have other restrictions, you can still find ways to engage in activities you like.

CONNECT WITH FAMILY AND FRIENDS

• Play cards or other games with friends in person or online.
• Travel with a group of older adults, such as a retiree group.
• Video chat or call your friends and family members.
• Try different restaurants with your loved ones.
• Listen and share favorite music with your family.
• Join a group interested in a hobby, such as knitting, hiking, birdwatching, painting, or wood carving.
• Reconnect with old friends through your high school or college alumni association.

LEARN SOMETHING NEW

• Take a cooking, art, dance, language, or computer class. Get in touch with your local community college or library. Many offer free or discounted courses for older adults. You may even be able to find classes online.
• Form or join a book or film club
• Try yoga, tai chi, or another new physical activity
• Learn (or relearn) how to play a musical instrument
• Visit local museums. Many offer free group tours and educational programs.

BECOME MORE ACTIVE IN YOUR COMMUNITY

• Visit a community or senior center and take part in its events and activities
• Serve meals or organize clothing donations for people in need
• Run errands for people with limited mobility or access to transportation
• Join a committee or help out with an activity at your place of worship
• Volunteer at a school, library, museum, hospital, or animal shelter
• Help with gardening at a community garden or park
• Organize a park clean-up through your local recreation center or community association
• Sing in a community choral group, or play in a local band or orchestra
• Take part in a local theater troupe
• Get a local part-time job or explore opportunities online
• Teach a favorite pastime or skill, such as embroidery, photography, building models, chess, baking, woodworking, calligraphy, or quilting, to a new generation

GO OUT AND GET MOVING

• Garden (indoors or out) or do yard work
• Take an exercise class or do exercises at home
• Go dancing
• Join a sports club for older adults, like a bowling club or bocce league
• Walk or bicycle with a friend or neighbor
• Take a swimming class
• Play with your grandchildren. Teach them a game or dance you remember from childhood
• Take a stroll around the neighborhood or on nature trails

ADOPT HEALTHY STRESS-RELIEVING HABITS

• Read a good book, magazine, or newspaper
• Practice gratitude and mindfulness
• Do tai-chi or yoga
• Cook your favorite healthy meal
• Enjoy the little things, such as a cup of coffee or sunrise

To learn more, please visit https://www.nia.nih.gov/health/healthy-aging/participating-activities-you-enjoy-you-age.

Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It’s important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.

If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person’s desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.

WHAT IS PALLIATIVE CARE?

Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person’s current care by focusing on quality of life for them and their family.

WHO CAN BENEFIT FROM PALLIATIVE CARE?

Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed.

In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.

WHO MAKES UP THE PALLIATIVE CARE TEAM?

A palliative care team is made up of multiple different professionals that work with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person’s team may vary based on their needs and level of care. To begin palliative care, a person’s health care provider may refer him or her to a palliative care specialist. If he or she doesn’t suggest it, the person can ask a health care provider for a referral.

WHERE IS PALLIATIVE CARE PROVIDED?

Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.

Visit the National Hospice and Palliative Care Organization website to find palliative care near you.

In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months (see What does the hospice six-month requirement mean?). Or, the palliative care team could continue to help with increasing emphasis on comfort care.

WHAT IS HOSPICE CARE?

Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.

At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.

Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person’s illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.

It’s important for a patient to discuss hospice care options with their doctor. Sometimes, people don’t begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.

WHERE IS HOSPICE CARE PROVIDED AND WHO PROVIDES IT?

Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings — at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.

Read more about where end-of-life care can be provided.

Hospice care brings together a team of people with special skills — among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.

A member of the hospice team visits regularly, and someone is usually always available by phone — 24 hours a day, seven days a week. Hospice may be covered by Medicare and other insurance companies. Check to see if insurance will cover the person’s particular situation.

It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.

Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.

To learn more, please visit https://www.nia.nih.gov/health/hospice-and-palliative-care/what-are-palliative-care-and-hospice-care.

We are thrilled to announce the addition of Dr. Robert L. Russell, MD, MBA, to our team as our new Chief Medical Officer! Dr. Russell brings with him a wealth of experience and expertise in internal medicine and geriatric care, with a specific focus on post-acute care.

Prior to joining our team, Dr. Russell served as the former Regional Medical Director for the Midwest at CommuniCare Healthcare, where he honed his skills in long-term care. Currently, Dr. Russell holds pivotal roles in shaping geriatric healthcare in Indiana. He serves as Chairman of the Medical Advisory Committee for CICOA Aging & In-Home Solutions, the state’s largest Area Agency on Aging, where he leads strategic planning efforts and oversees the Medical Nutrition Therapy Program. 

Dr. Russell is a committed advocate for healthcare excellence, having held leadership positions in various organizations, including two terms as President of the Indiana Medical Directors Association and membership on the executive board of the Alzheimer’s Association of Greater Indiana. His collaborative efforts were recognized with the Collaborator of the Year award by CICOA Aging & In-Home Solutions in 2023. Dr. Russell is also a respected keynote speaker and panelist on topics ranging from Alzheimer’s Disease to caregiver burden and value-based care.

Beyond his professional achievements, Dr. Russell is a devoted husband and father of three. He finds joy in family time, basketball games, travel, and community service.

With his heart for healthcare and passion for making a difference, Dr. Russell’s addition will undoubtedly have a profound and lasting impact in the field of geriatric medicine. Please join us in welcoming Dr. Robert L. Russell as our Chief Medical Officer! We look forward to the invaluable contributions he will make to our organization and the community we serve.

The brain controls many aspects of thinking — remembering, planning and organizing, making decisions, and much more. These cognitive abilities affect how well we do everyday tasks and whether we can live independently.

Some changes in thinking are common as people get older. For example, older adults may:

• Be slower to find words and recall names
• Have problems with multitasking
• Experience mild decreases in the ability to pay attention

Aging may also bring positive cognitive changes. For example, many studies have shown that older adults have larger vocabularies and greater knowledge of the depth of meaning of words than younger adults. Older adults may also have learned from their many years of accumulated knowledge and experiences. Whether and how older adults apply this knowledge, and how the brain changes as a result, is an area that researchers are actively exploring.

Despite the changes in cognition that may come with age, older adults can still do many of the things they have enjoyed their whole lives. Research shows that older adults can still:

• Learn new skills
• Form new memories
• Improve vocabulary and language skills

How the brain changes as people age

As a person gets older, changes occur in all parts of the body, including the brain.

• Certain parts of the brain shrink, including those important to learning and other complex mental activities.
• In certain brain regions, communication between neurons may be less effective.
• Blood flow in the brain may decrease.
• Inflammation, which occurs when the body responds to an injury or disease, may increase.

These changes in the brain can affect mental function, even in healthy older people. For example, some older adults may find that they don’t do as well as younger individuals on complex memory or learning tests. However, if given enough time to learn a new task, they usually perform just as well. Needing that extra time is normal as people age. There is growing evidence that the brain maintains the ability to change and adapt so that people can manage new challenges and tasks as they age.

Talk with your doctor if you’re concerned about changes in your thinking and memory. They can help you determine whether those changes are normal or whether it could be something else.

The brain-body connection

There is growing scientific evidence of the brain-body connection. Not only can changes in our brain affect our thinking, but also changes in our physical health may affect our brains.

For example, an NIA-funded study of almost 3,000 older adults showed that healthy lifestyle factors — physical activity, not smoking, not drinking heavily, following the Mediterranean-style diet, and engaging in mentally stimulating activities — can have important benefits. People who engaged in four or five of these behaviors had a 60% lower risk of developing Alzheimer’s compared to those who only followed one or none. People who followed two or three of the activities had a 37% lower risk.

In another study, older adults with higher levels of physical activity showed slower rates of cognitive decline than peers who were less active. Another example of how physical health can affect brain health has to do with the heart. Observational studies have found that high blood pressure in middle age, along with other cerebrovascular risk factors, such as diabetes and smoking, increase the risk of developing dementia.

Results from observational studies such as these can’t prove cause and effect, but they point to how a combination of modifiable behaviors may affect the brain as people age and identify promising avenues to be tested further.

To learn more, please visit https://www.nia.nih.gov/health/brain-health/how-aging-brain-affects-thinking