opinion: the language you speak shouldn’t impact the healthcare you receive
several studies show that patients with limited english proficiency often experience lower quality care in our healthcare system.
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as global migration continues to shape canada’s cultural and linguistic landscape, our healthcare system must be prepared to meet the needs of all our aging patients, particularly those who face linguistic barriers and disproportionate risks.
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as canadians face the coldest months of the year, hip fractures from slipping on ice and snow are a common occurrence, often requiring hospitalization and surgery. while most people recover well, some older adults are at a higher risk of complications—sometimes due to something as simple as a language barrier. picture an older woman, whose first language is cantonese, recovering from hip surgery, but unable to understand crucial instructions. without the support to receive care in her preferred language, her rehabilitation is delayed and complications arise. what should have been a quick recovery turns into a prolonged hospital stay.
in a linguistically diverse country like canada, the language you speak shouldn’t impact the care you receive. the 2021 census found that 4.6 million canadians, or 12.7 per cent of the population, speak a language other than english or french at home, a number that has steadily increased over the past 30 years as immigration levels rise.
despite this growing linguistic diversity, several studies show that patients with limited english proficiency often experience lower quality care in our healthcare system. studies show that patients with limited english proficiency who are admitted to hospital experience longer stays, more re-admissions and higher rates of emergency department visits after discharge. recent data from the canadian institute for health information shows that patients who speak neither english nor french experience a 30 per cent higher rate of harmful events compared to those who speak the official languages.
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our study, published in jama network open, focuses specifically on linguistic inequities in hip fracture care. breaking a hip is a common and often catastrophic event associated with loss of independence, disability and death. as a result of these devastating consequences, hip fractures have been identified as a priority area for health quality improvement. our study found that while wait times for hip fracture surgery were similar for english and non-english speakers, non-english speakers had a higher risk of delirium, heart attack, longer stay in hospital and were more often discharged to a nursing home after their surgery.
these findings highlight the disproportionate burden of harm faced by patients who do not speak the dominant language, in this case, english. delirium, for example, is a severe and distressing condition that can increase the risk of long-term cognitive impairment in older adults. the differences we found in delirium rates may reflect the important role of shared language and communication in delivering appropriate delirium prevention and care. similarly, returning home after a hip fracture is widely recognized as an important patient and health system goal. we found that non-english speakers who lived at home were more likely than english speakers to be placed in a nursing home after hip fracture surgery. these differences could stem from patients and care providers not speaking the same language, leading to reduced opportunity for rehabilitation and recovery.
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language barriers and communication challenges may lead to inadequate counselling, improper use of medications and missed or improper tests and procedures – all of which can lead to unnecessary days in hospital and poorer health outcomes. systemic inefficiencies like longer hospital stays and frequent readmissions also have higher healthcare costs – burdens that affect both the healthcare system and patients. these avoidable complications not only hurt patient outcomes but strain precious resources.
despite canada’s linguistic diversity, healthcare systems and staff often do not reflect the communities they serve. in cases where language barriers exist, professional interpretation services should be considered a medically necessary resource. hospitals must develop standards for language accessible care, including collecting data on patient language preference, flagging patients who require interpretation, training staff to use interpretation services effectively and providing fast and available access to professional interpretation services through multiple avenues like video, phone or in-person.
we need a healthcare system that works well for everyone. while our study focused on the hospital setting, this issue extends to all healthcare environments including in pharmacies and primary care offices. we must ensure that older patients who speak non-dominant languages receive care in their preferred language and do not experience preventable harm.
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a healthcare system that leaves patients lost in translation is a system that needs fixing. as global migration continues to shape canada’s cultural and linguistic landscape, our healthcare system must be prepared to meet the needs of all our aging patients, particularly those who face linguistic barriers and disproportionate risks. reducing these inequities will ensure that every canadian receives the care they deserve, regardless of the language they speak.
dr. christina reppas-rindlisbacher is a geriatrician at sinai health and university health network and a phd student at women’s age lab at women’s college hospital.
dr. shail rawal is a general internist and assistant professor at university health network and the university of toronto.
dr. paula rochon is a geriatrician, founding director of women’s age lab at women’s college hospital and professor at the university of toronto.
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