(P08) Challenges in Caring for Geriatric Ethnic Minorities with Co-Morbid Illness

Introduction: A perspective on cultural translational science with disparities and access to care for minority geriatric patients with multi-morbid illnesses within medical facilities with a focus on improving outcomes and quality of care through staff education, implicit bias training, and increasing resources for community transitions by addressing social barriers.

Case Description: 71-year-old community-dwelling, Bengali-speaking female with a past medical history significant for cirrhosis secondary to non-alcoholic fatty liver disease, portal hypertension with esophageal varices, recurring gastrointestinal bleeding, pancytopenia, hypertension, coronary artery disease, heart failure reduced ejection fraction, asthma, type 2 diabetes mellitus, chronic kidney disease stage 3, iron deficiency anemia and hypothyroidism with multiple hospitalizations was admitted to a sub-acute rehab facility after discharge from the hospital where she was admitted for hematochezia. The patient was being medically managed while undergoing physical and occupational therapies for severe deconditioning. She had limited interaction and access to her needs while admitted due to a language barrier which decelerated her recovery. Social barriers, such as being a widow, limit her ability to be safely discharged home which is what mattered to her and where she would be more comfortable. When it was determined that she could safely be discharged with a diminished risk of repeat hospital admissions, home health services were considered; however, the patient continued to require medical attention for her sequential health problems. The patient had five hospital admissions in six months as opposed to her stay in sub-acute rehab where the re-admissions were prevented. A native language (Bengali) speaking home health aid was arranged upon discharge to allow for more care and transition to the community once she was medically stable.

Discussion: When ethnic minorities are admitted to medical facilities there are numerous barriers to care including but not limited to cultural insensitivity, limited communication, and an overall sense of reduced well-being. The lack of a diverse workforce and cultural translation can compromise recovery especially when a patient has limited social support such as in this widowed patient with frequent hospitalizations. Although it might be challenging to cater to all minorities, education within the facility regarding implicit bias, and caring for different ethnic groups is a good starting point to improve the quality of care and in turn patient outcomes.