Tip Sheet: Arab-American Older Adults: A Guide to Managing Your Health

Diabetes has recently become more common in many Arab countries because of economic growth, cultural changes with easier access to fast food, less active lifestyles and people living longer. Diabetes is a disease that happens when our bodies are not able to produce enough insulin or if we cannot use it properly. Insulin is a substance our bodies produces to control the amount of sugar in the blood.

When there is not enough insulin, it leads to a high level of blood sugar, and you can become very ill. Having diabetes for a long time often leads to other health problems. These problems include heart and kidney disease, blindness, and frequent infections. Obesity, little or no exercise, and unhealthy eating habits can make diabetes worse. As an Arab-American, the longer you live in the US, the more likely you are to develop diabetes.

Ask your healthcare provider about exercise, medications, and how to eat a healthier diet. Your healthcare provider will check your blood pressure, cholesterol level and your kidney function regularly to prevent complications. You should have your eyes checked every 1 to 2 years. Getting shots to prevent pneumonia and flu can help stop serious infections.

Eating more than your body needs results in these extra calories being turned into fat. This fat leads to weight gain. Obesity is bad for your health. Lack of exercise, family history, and certain medical conditions make obesity more likely.

Obesity is common in older Arab-Americans. The traditional Arab diet is mostly healthy and includes chickpeas, hummus, eggplant, yogurt, olives and less meat. The Western diet is more likely to cause obesity. This diet has more sweets, chips, breads, red meat, and sodas. It also has fewer fresh fruits and vegetables. Obesity can lead to diabetes, high blood pressure, high cholesterol, stroke, heart disease, and even cancer. It can also cause arthritis of your hips and knees, which makes it harder to walk.

Ask your healthcare provider for advice to help you lose weight, and improve your fitness and quality of life. A dietitian will look at your food habits and suggest a healthier diet. A physical therapist will create a safe exercise plan with you. A Mediterranean style diet which includes eating a few servings of fruits, colored vegetables, whole grains, healthy oils (like nuts and olive oils) is helpful in reducing weight and living a healthy lifestyle.

Cigarette smoking is common among Arabs. Tobacco use in some Arab countries can be as high as 77% for men and 35% for women. Offering a cigarette is often considered a sign of hospitality. However, we now know that nicotine and other harmful chemicals in tobacco cause heart and lung disease, as well as many types of cancer.

Hookah Use: Smoking hookah (also known as shisha, gozza, water pipe or boori) and chewing tobacco are common in Arab communities. Despite their traditional use, both habits are as dangerous as cigarettes. These habits increase exposure to deadly chemicals, and can lead to infections like TB (tuberculosis), mouth ulcers, and cancer. Sharing mouth pieces, not changing hookah pipe water frequently, and using moist tobacco can cause even more harm.

Even if you have used tobacco for many years, stopping now is still very helpful. Talk to your healthcare provider about ways and medications to help you quit using tobacco.

Cancers of the liver, thyroid, brain, kidney and bladder, as well as leukemia, are more common among Arabs in the US. One possible reason is eating an unhealthy diet. Smoking and other tobacco products also increase the risk of cancer. Talk to your healthcare provider about preventing cancer. A low salt, low fat diet, and regular exercise can decrease your chance of getting cancer. It is possible to continue eating many of the foods you and your family love but preparing them in healthier ways.

Some Arab-Americans have low life satisfaction and depression. Depression is different than normal life sadness. It is a disease that changes certain chemicals in your brain and may lead to other health problems. Feelings of being left out and not being part of the American culture are linked to family conflict and depression. You or your family may or may not understand depression, and may be uncomfortable talking to your healthcare providers about it for cultural reasons. Unfortunately, this silence can lead to more hardship and delay in getting help.

If you are depressed or have thoughts of hurting yourself, tell someone right now - a family member, a friend, a religious leader, or a healthcare provider. There are many good treatments for depression for older adults.

Religion and culture affect our healthcare decisions and habits. For cultural reasons, you may think preventive care (vaccines, cancer screening, and medications) is less important. You may prefer family members rather than paid caregivers to provide your personal and supportive care. You may also prefer family members to make your healthcare decisions. You may not be comfortable talking about withdrawing or withholding life-sustaining treatments if your loved one becomes seriously ill. Discuss these health-related decisions with your family, as well as your provider.

• Come to appointments 20 minutes before the scheduled time.
• If you cannot come to your appointment, please tell us as soon as possible. This helps all patients get good care.

• Tell us if you do not speak, understand, or read English well.
• Please bring a family member with you, if you would like them to be there with you.
• Otherwise before the visit, your family member can write a note in English for you to bring with you.
• Tell us before your appointment if you need a medical interpreter who speaks your language. We encourage your family to come to the visits and we will also provide a medical interpreter to give you the best care.
• Ask for written information in your language.

• Let us know if you fast during Ramadan or holy days. We can adjust your medications.
• You may request a male or female healthcare provider.
• Let us know if you prefer no direct eye contact, not to shake hands, or anything else that would make you feel more comfortable.
• You may wish to discuss your medical conditions with a religious leader.
• Tell us if you follow a religious diet.

• Bring all your medications to every appointment so we know exactly what you are taking.
• If you wish to avoid pork products or alcohol found in some medications, let us know. We can prescribe different medications for you.
• About your medications, tell us:
  • Why you take them
  • How you take them
  • If they help you or not
  • If you have side effects
  • If you have stopped or forget to take them
  • If you cannot afford them
  • If you have any allergies

• Tell us if you use traditional treatments such as cupping, herbs, or supplements. Sometimes they can affect other treatments we have prescribed.

• Problems with memory, bowel movements, urination, sleep, and sexual function are common in older adults. Discuss these issues with us so we can help you as they can often improve with treatment.
• Ask us to explain things you don’t understand.
• Bring a friend or family member to the appointment, if possible.

• An advance directive is a legal document that lets the provider know your wishes. It will tell us how you want to be treated when you have a serious illness or are dying.
• You can name a family member or close friend to make decisions for you during these times.
• So we can always give you the care you want, even if you are very sick, have these discussions with us while you are well.

• Some older adults may feel lonely and isolated. If you feel this way, let us know.
• Sometimes, older adults are at risk for physical or verbal abuse, even by people close to them. No one has the right to do this to you!
• People may misuse your money, property, and medications.
• Sometimes you might not be to afford your health care.
• Ask to speak to a social worker about community resources for any of these concerns.

• Knowing as much as you can about your medical conditions and treatments is important.
• Before you leave, ask:
  • “What is my main problem?”
  • “What do I need to do?”
  • “Why is it important for me to do this?”
  • “Are there other options or choices I can make?”