Advertisement

Limited English Proficiency in Older Adults Referred to the Cardiovascular Team

Published:February 21, 2023DOI:https://doi.org/10.1016/j.amjmed.2023.01.028

      Abstract

      Limited English proficiency (LEP) is defined as individuals in whom English is not the primary language and who have limited ability to read, speak, write, or understand the English language. Cardiovascular (CV) team members routinely encounter language barriers in their practice. These barriers have a significant impact on the quality of CV care that patients with LEP receive. Despite evidence demonstrating the negative association between language barriers and health disparities, the impact on CV care is insufficiently known. In addition, older adults with CV disease and LEP are facing increasing risk of adverse events when complex medical information is not optimally delivered. Overcoming language barriers in CV care will need a thoughtful approach. Although well recognized, the initial step will be to continue to highlight the importance of language needs identification and appropriate use of professional interpreter services. In parallel, a health system-level approach is essential that describes initiatives and key policies to ensure a high-level quality of care for a growing LEP population. This review aims to present the topic of LEP during the CV care of older adults, for continued awareness along with practical considerations for clinical use and directions for future research.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Migration Policy Institute (MPI). The limited English proficient population in the United States. July 8, 2015. Available at:https://www.migrationpolicy.org/article/limited-english-proficient-population-united-states-2013. Accessed December 31, 2022.

        • Schiaffino MK
        • Al-Amin M
        • Schumacher JR
        Predictors of language service availability in U.S. hospitals.
        Int J Health Policy Manag. 2014; 3: 259-268
        • Regalbuto R
        • Maurer MS
        • Chapel D
        • Mendez J
        • Shaffer JA
        Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?.
        J Card Fail. 2014; 20: 641-649
        • Seman M
        • Karanatsios B
        • Simons K
        • et al.
        The impact of cultural and linguistic diversity on hospital readmission in patients hospitalized with acute heart failure.
        Eur Heart J Qual Care Clin Outcomes. 2020; 6: 121-129
        • Rawal S
        • Srighanthan J
        • Vasantharoopan A
        • Hu H
        • Tomlinson G
        • Cheung AM
        Association between limited English proficiency and revisits and readmissions after hospitalization for patients with acute and chronic conditions in Toronto, Ontario, Canada.
        JAMA. 2019; 322: 1605-1607
        • Latif Z
        • Makuvire T
        • Feder SL
        • et al.
        Challenges facing heart failure patients with limited English proficiency: a qualitative analysis leveraging interpreters' perspectives.
        JACC Heart Fail. 2022; 10: 430-438
        • Nguyen P
        • Schiaffino MK
        • Lipton BJ
        Disparities in self-management outcomes by limited English proficiency among adults with heart disease.
        Prev Med Rep. 2021; 23: 10147
        • Bell SP
        • Orr NM
        • Dodson JA
        • et al.
        What to expect from the evolving field of geriatric cardiology.
        J Am Coll Cardiol. 2015; 66: 1286-1299
        • Forman DE
        • Maurer MS
        • Boyd C
        • et al.
        Multimorbidity in older adults with cardiovascular disease.
        J Am Coll Cardiol. 2018; 71: 2149-2161
        • Krishnaswami A
        • Beavers C
        • Dorsch MP
        • et al.
        Gerotechnology for older adults with cardiovascular diseases: JACC state-of-the-art review.
        J Am Coll Cardiol. 2020; 76: 2650-2670
        • Karliner LS
        • Auerbach A
        • Nápoles A
        • Schillinger D
        • Nickleach D
        • Peréz-Stable EJ
        Language barriers and understanding of hospital discharge instructions.
        Med Care. 2012; 50: 283-289
        • Diamond L
        • Izquierdo K
        • Canfield D
        • Matsoukas K
        • Gany F
        A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes.
        J Gen Intern Med. 2019; 34: 1591-1606
        • Gany F
        • Leng J
        • Shapiro E
        • et al.
        Patient satisfaction with different interpreting methods: a randomized controlled trial.
        J Gen Intern Med. 2007; 22: 312-318
        • Parker MM
        • Fernandez A
        • Moffet HH
        • Grant RW
        • Torreblanca A
        • Karter AJ
        Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes.
        JAMA Intern Med. 2017; 177: 380-387
      2. United States Department of Health and Human Services. HHS.gov. National standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care. 2017. Available at:https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf. Accessed January 21, 2023.

        • Karliner LS
        • Jacobs EA
        • Chen AH
        • Mutha S
        Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature.
        Health Serv Res. 2007; 42: 727-754
        • Lindholm M
        • Hargraves JL
        • Ferguson WJ
        • Reed G
        Professional language interpretation and inpatient length of stay and readmission rates.
        J Gen Intern Med. 2012; 27: 1294-1299
        • Hsieh E
        Not just “getting by”: factors influencing providers' choice of interpreters.
        J Gen Intern Med. 2015; 30: 75-82
        • Biswas S
        • Seman M
        • Cox N
        • et al.
        Impact of limited English proficiency on presentation and outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
        Intern Med J. 2018; 48: 457-461
        • Hyun KK
        • Redfern J
        • Woodward M
        • et al.
        Is there inequity in hospital care among patients with acute coronary syndrome who are proficient and not proficient in English language?: analysis of the SNAPSHOT ACS study.
        J Cardiovasc Nurs. 2017; 32: 288-295
        • Herbert BM
        • Johnson AE
        • Paasche-Orlow MK
        • Brooks MM
        • Magnani JW
        Disparities in reporting a history of cardiovascular disease among adults with limited English proficiency and angina.
        JAMA Netw Open. 2021; 4e2138780
        • Meischke H
        • Ike B
        • Painter I
        • et al.
        Delivering 9-1-1 CPR instructions to limited English proficient callers: a simulation experiment.
        J Immigr Minor Health. 2015; 17: 1049-1054
        • Sudore RL
        • Fried TR
        Redefining the “planning” in advance care planning: preparing for end-of-life decision making.
        Ann Intern Med. 2010; 153: 256-261
        • Sudore RL
        • Schillinger D
        • Katen MT
        • et al.
        Engaging diverse English- and Spanish-speaking older adults in advance care planning: the PREPARE randomized clinical trial.
        JAMA Intern Med. 2018; 178: 1616-1625
        • Khoong EC
        • Steinbrook E
        • Brown C
        • Fernandez A
        Assessing the use of Google Translate for Spanish and Chinese translations of emergency department discharge instructions.
        JAMA Intern Med. 2019; 179: 580-582
      3. U.S. Department of Health and Human Services (HHS). Limited English Proficiency (LEP). Available at:https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/index.html. Accessed December 31, 2022.

        • Sudore RL
        • Schillinger D
        Interventions to improve care for patients with limited health literacy.
        J Clin Outcomes Manag. 2009; 16: 20-29