Age is a period of existence. ⁸ There are obvious anatomic, physiologic, and behavioral changes at every stage of life. The health care plan needs to be based on the impact of these stages and how these will affect the patient’s response. The Joint Commission⁴ requires hospitals and health care organizations to provide ongoing education, training, and competency validation to ensure safe and effective age-specific and culturally sensitive patient care.

Staff attitudes can affect the quality of care available to the older adult. The Age Discrimination Act of 1975 is a national law that prohibits discrimination on the basis of age in any program that receives federal financial assistance. ⁷

Generational differences can explain a patient’s need for care and reaction to that care. Advancing age is commonly associated with comorbidities; infants are completely dependent on caregivers for meeting their self-care needs. The older adult may have greater expectations of common courtesy, such as expecting staff members to knock before entering and to introduce themselves. Younger adults are more likely to be involved in traumatic events. When caring for pediatric patients, there can be increased anxiety within the family and staff.

Class identifies a group of people whose members share the same attributes, such as social rank or socioeconomic status, and adhere to traditional roles and principles. ⁸ Socioeconomic status may have more to do with how individuals are judged by others than any other area of diversity. Socioeconomic status is a strong predictor of health. Race and culture are often blamed when socioeconomic status or poverty is actually the causative factor. Differences commonly seen with patients living in poverty directly affect access to care, transportation, and the ability to provide self-care when needed. Poverty is a fact of life for every racial/ethnic group. ⁶ Many people have come to the United States to escape war or long-time military rule. Poverty was the way of life in their home countries. They may arrive here with minimal resources or education.

Culture includes patterns of behavior and thinking that persons living in social groups learn and share. ¹ Culture is closely related to the identified ethnic background. Culture may affect the way a patient responds to health concerns, such as in response to crisis or grief. Negative attributes are often associated with being part of one’s culture, when actually the effects of a lower socioeconomic status cause violence and/or criminal activities.

Culture is handed down from generation to generation. You may see one age-group that follows their parents’ culture more closely than another, younger group might. Culture can also be self-identified. A patient may identify more with a culture because of an affinity for the group’s traits. Asking open-ended questions about culture, without judgment, can aid in understanding.

A person’s ethnicity can be seen as a conscious choice of his or her identity based on beliefs, values, practices, and loyalty to a certain group or groups. ¹ Ethnicity is generally related to heritage or country of origin of one’s ancestors. An individual’s ethnic identity may be an area of invisible diversity to someone not of that group. Statements such as “You don’t look like someone from that ethnic group” are perceived as ignorant and unkind. Not all people from each group look alike. All ethnic groups have variations in skin color, hair color, and the color of their eyes. Some groups have pronounced features that may or may not be easily identified. There are, of course, many people whose mother and father come from different ethnicities. Such an individual may or may not identify with either or both groups. A patient’s or staff member’s last name may not be one normally identified as part of a particular ethnic group. It is also not appropriate to tell the patient or staff member that he or she has a name that does not “fit” for the group the person identifies with. If information about ethnicity is pertinent, the health care professional should ask open-ended questions without making initial assumptions. If the health care professional finds it necessary to identify a person according to his or her ethnicity, it is most appropriate to ask the patient what he or she prefers. Table 4-1 lists terms used by certain groups that may or may not be used as identifiers by all members of those groups.

Gender is a described identity, male or female. ¹ This seems to be an easy question to answer, but it may not always be apparent. The use of a form that asks basic demographic information with a gender checkbox is helpful. Transgender patients identify with a gender other than the one that was applied to them at birth. Transgender patients may or may not have had reassignment surgery, but this does not change the fact that the patients identify their own gender. The name and gender the patient describes should be used as identifiers.

There continue to be stereotypic presentations that pertain to gender. A health care professional is less likely to expect a male sexual assault victim than a female. Heart disease can be misdiagnosed in women who do not present with the classic signs and symptoms. The health care professional needs to take into account gender issues and how they affect the care of a patient.