FAMILY MATTERS: CULTURAL PROFICIENCY IN THE PRESENT DAY

Introduction The United States is projected to have over 78 million people over the age of 65 by the year 2035, with an increasing rise in culturally, ethnically, and racially diverse population largely driven by international immigration. An important aspect of assessment and treatment in geriatric psychiatry is the ability to include family members into evaluations and treatment plans. Cultural sensitivity about beliefs, traditions, and perceptions on aging and mental illness play an important role in understanding and treating psychiatric disorders and increases the probability of a therapeutic relationship by enhancing trust and improving communication between clinicians and patients. Although there is mention of “family” and “sociocultural” in all six ACGME core competencies, these are not explicitly expanded upon. With the changing demographics in the US in the years to come, it is imperative to recognize and incorporate more elements of family and culture into training. Methods Demonstrate, through a series of case vignettes, the impact of addressing cultural expectations and context with family members and patients to improve clinical outcomes. Personal factors of race and ethnicity, along with cultural biases, will be identified to show how these factors influence the therapeutic alliance and interventions. Results These vignettes illustrate how establishing a sense of cultural safety allowed both the families and patients to collaborate more openly with the treatment team to provide effective therapeutic outcomes for culturally diverse older adults. Recognition and understanding of how culture influences family dynamics, beliefs, and support systems allowed trainees to more comprehensively understand the cultural formulation and guide treatments that were more culturally sensitive and pertinent to various psychiatric disorders. Conclusions In depth training during psychiatry residency regarding family and culture are often lacking, especially since the ACGME requirements for training related to diversity and culture are broad and not explicitly stated. By recognizing the important role that families and culture play in the treatment of older adults, residents can more easily address sensitive issues that affect treatment outcomes. As such, training programs should have more detailed didactics and curriculum to help residents feel more comfortable sitting with and including families, as well as understanding and acknowledging how culture influences the care of diverse older adults.