OLDER LATINO OLDER LATINO IMMIGRANTS, THEIR IMMIGRANTS, THEIR HEALTH STATUS AND HEALTH STATUS AND

HEALTH CAREHEALTH CARE

Gwen Yeo, PhDGwen Yeo, PhDStanford Geriatric Education Stanford Geriatric Education

CenterCenter

Partially supported by a grant from the Bureau Partially supported by a grant from the Bureau of Health Professions,of Health Professions,

Health Resources and Services Administration Health Resources and Services Administration forfor

Geriatric Education CentersGeriatric Education Centers

The Ethnogeriatric The Ethnogeriatric Imperative Imperative Projections of Percent of Ethnic Projections of Percent of Ethnic Elders in U.S.Elders in U.S.

0

2

4

6

8

10

12

14

16

18

2000 2030 2050

African Am .

Asian /PI

Hispanic

AI/AN

Latino Latino Elders in Elders in US, 2000US, 2000

Latino/Hispanic 1,733,591Latino/Hispanic 1,733,591 Mexican Mexican 809,842 809,842

Cuban Cuban 228,677 228,677

Puerto Rican Puerto Rican 191,295 191,295

Dominican Dominican 6,648 6,648

Central American 54,151Central American 54,151

South American 76,791South American 76,791

Please review the handout on demographic characteristics of older Latinos in the U.S.

What patterns do you see? Which populations are most disadvantaged?

Cohort Analysis

Working with elders, it is important to know what historical experiences are likely to have affected their lives.

Examples?

Cuban American elders’ escape from Castro

Mexican American elders: cycles of anti-immigrant discrimination and deportation

Puerto Rican elders migration back and forth to PR

Please review the chart on disparities of health conditions.

What patterns do you see?

Mortality Crossovers Mortality Crossovers and Comparisonsand Comparisons

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Age 65 Age 75 Age 85

NH W hite

NH Black

API

Latino

AI/AN

Adapted from Hummer et al., 2004

Diabetes in Older Women Diabetes in Older Women of Colorof Color

0

5

10

15

20

25

30

35

African Am. Am.Indian M exican Am. NH W hite

Source: NIH, Women of Color Health Data Book, 1998

Percent

Prevalence of DementiaPrevalence of DementiaNorth Manhattan Study North Manhattan Study

(N=1449)(N=1449)

Gurland et al., Nat. Research Council, 1997

Effects of Education Effects of Education on Prevalence of on Prevalence of

DementiaDementia

Multivariate regression analysis included Multivariate regression analysis included age, education, income, gender, and ethno-age, education, income, gender, and ethno-racial membershipracial membership

Increased age (OR=6.1) and lower Increased age (OR=6.1) and lower education (OR=4.3) have strongest education (OR=4.3) have strongest association with risk of dementiaassociation with risk of dementia

““With age and education controlled, ethno-With age and education controlled, ethno-racial membership loses its association with racial membership loses its association with rates of dementia.”rates of dementia.”

Gurland et al., National Research Council, 1997Gurland et al., National Research Council, 1997

Reasons for Effect of Reasons for Effect of EducationEducation

on Dementia: Hypotheses?on Dementia: Hypotheses?Gurland et al. HypothesesGurland et al. Hypotheses Reduced cognitive ability in early lifeReduced cognitive ability in early life Correlates of low education: e.g., Correlates of low education: e.g.,

malnutrition, poor health care, substance malnutrition, poor health care, substance abuseabuse

Education builds robust brain structures Education builds robust brain structures that can compensate for deterioration that can compensate for deterioration

Other? Less effective assessment techniques Other? Less effective assessment techniques for low literacy, low education eldersfor low literacy, low education elders

SALSA StudySALSA StudySacramento Area Latino Study on Sacramento Area Latino Study on

AgingAging

N= 1778 aged 60+ N= 1778 aged 60+ 45% born in Mexico, 49% in US45% born in Mexico, 49% in US Mean years of education: 4.7 for Spanish Mean years of education: 4.7 for Spanish

speakers, 10.7 for Englishspeakers, 10.7 for English Overall dementia prevalence: 4.8%Overall dementia prevalence: 4.8% Risk 8x higher for those with diabetes Risk 8x higher for those with diabetes

and strokeand strokeHaan et al., 2003Haan et al., 2003

Dementia Prevalence Dementia Prevalence 85+85+

Other Important Other Important Findings:Findings:

SALSA Study:SALSA Study: Higher risk of dementia with diabetes and/or Higher risk of dementia with diabetes and/or

strokestroke Higher risk of dementia with lower folate Higher risk of dementia with lower folate

levels levels Higher risk of dementia with abdominal fat; Higher risk of dementia with abdominal fat;

Lower risk with overall obesity Lower risk with overall obesity More sleep problems, wandering, More sleep problems, wandering,

hallucinations, & combativenesshallucinations, & combativeness Earlier age at onset of dementiaEarlier age at onset of dementia Some evidence of longer survivalSome evidence of longer survival Dementia frequently seen as normal aging; Dementia frequently seen as normal aging;

sometimes as punishment from God or result of sometimes as punishment from God or result of nerviosnervios

Latino CaregiversLatino Caregivers More likely to be depressedMore likely to be depressed More depressed when care recipient exhibits More depressed when care recipient exhibits

neuropsychiatric symptomsneuropsychiatric symptoms Less likely to express burdenLess likely to express burden Frequent feelings of cultural obligation for Frequent feelings of cultural obligation for

family caregivingfamily caregiving Less and later use of nursing homesLess and later use of nursing homes Organizational religiosity related to less burden; Organizational religiosity related to less burden;

non-organizational related to poorer mental non-organizational related to poorer mental healthhealth

Less help seeking even with larger social Less help seeking even with larger social networksnetworks

Frequent primary caregiver with minimal help Frequent primary caregiver with minimal help from family membersfrom family members

Relationship of Relationship of CaregiverCaregiver

Percentage of Ethnic PatientsPercentage of Ethnic Patients

0

10

20

30

40

50

Spouse Son Daughter Other Rel. Friend

W hite Black Hispanic Asian /PI

Yeo et al, 1996 Ethnicity & Dementias

Less use of hospiceLess use of hospice

More likely to believe death depends on More likely to believe death depends on

God’s timingGod’s timing

More likely to want to maintain the More likely to want to maintain the possibility possibility

of a miracle, so prefer aggressive of a miracle, so prefer aggressive treatmenttreatment

End of Life IssuesEnd of Life Issues

RESOURCESRESOURCES Yeo & Gallagher-Thompson (Eds.) Yeo & Gallagher-Thompson (Eds.) Ethnicity and the Dementias, 2Ethnicity and the Dementias, 2ndnd Ed. Ed. New York: Routledge/Taylor & Francis. 2006New York: Routledge/Taylor & Francis. 2006

Stanford Geriatric Education Center 2009-Stanford Geriatric Education Center 2009-2010 Webinar Series: 2010 Webinar Series: Ethnicity and the Ethnicity and the Dementias. Dementias. Replays available on SGEC Replays available on SGEC website:http://sgec.stanford.edu website:http://sgec.stanford.edu

Email Gwen Yeo at Email Gwen Yeo at <gwenyeo@stanford.edu ><gwenyeo@stanford.edu >

Important Research Important Research TopicsTopics

Latino EldersLatino Elders To what extent do older immigrants To what extent do older immigrants

from Mexico return to Mexico when they from Mexico return to Mexico when they become seriously ill?become seriously ill?

Not all older Latinos have family Not all older Latinos have family caregivers; what do they do when they caregivers; what do they do when they need assistance?need assistance?