Helping Elderly Hispanics Manage Health Problems

• Stereotypes are dangerous and unfair but it is reported that elderly Hispanic patients tend to be fatalistic about health problems.

  Fatalismo can be given spiritual meaning such as earning salvation by suffering, or can lead to patients regarding preventive interventions as futile, or undermining confidence in treatments. It can become part of a positive treatment strategy if divine purpose is found in the circumstances of the diagnosis and the involvement of the medical team. A stronger emphasis on the present than the future (presentismo) is reported to be pervasive in elderly Hispanics.

  Familismo: Collective loyalty to the family outranks the wishes/needs of an individual in most Hispanic groups. "Family" for many Hispanics includes extended family members plus godparents and other "fictive kin" - individuals who are given family roles and responsibilities but are not members of the biological or marriage/legal family. Strong family support systems can be a great resource in caring for elderly Hispanic patients but often complicate communication, confidentiality, and decision-making. Discussions and decisions about health are frequently conducted by the extended family. The matriarch often has the greatest influence in health decisions for the family. If she is the patient, family members may have difficulty making decisions for her or contravening her wishes. Families perceive great obligation to care for one another. For the elderly, this means that nursing homes are frequently not an acceptable strategy and that caregivers may not feel able to express stress or burnout. Distrust of government agencies and other social factors may further complicate caretaker stress by hampering recourse to assistance from outside the family or church community.

  Personalismo refers to a warm person relationship with appropriate displays of mutual respect and genuine efforts to build trust. Patients expect an individual and personal relationship with the physician and evidence (such as handshake/body language and use of appropriate names) that the physician is concerned out them as an individual. In many groups, exchange of social pleasantries and personal news is expected before focusing on the medical problem. Impersonal "routine" mailings from the physician's office or transmitting information through a nurse (without formally validating her important role) may undermine personalismo. All interactions are expected to reflect simpatia - a conspicuous display of politeness and pleasantness. This is more than avoidance of confrontation; a neutral or even a briskly "businesslike" approach may be perceived negatively by an elderly Hispanic patient.

  Jerarquismo (respect for formal structures and hierarchies) and respecto (respect for authority figures) result in physicians being generally accorded great respect by elderly Hispanics. Physicians may be expected to be directive and patients relatively passive. This complicates disagreeing with physicians, revealing that a treatment has not been taken (or has been unsuccessful or had side-effects), or even answering open-ended questions. Elderly Hispanic patients or family members may seek to avoid contradicting or embarrassing the physician or themselves by guessing the correct answer, being untruthful, avoiding providing information or just disappearing from care.

  Espiritismo is the belief that good or evil spirits can influence daily activities, including health, The term can also be used to refer to the spirit of a dead person.

• Traditional Folk Illnesses

  In some groups, the heart is considered the source of life so the concepts of “brain death” and cardiac surgery/transplantation are difficult.

  Some groups consider illnesses to be “hot” or “cold” so therapy has to include attention to the temperature of fluids and instructions about cooling or warming the patient.

  Specific conditions that may be encountered include:

  Susto “fright” can refer to a particularly stressful event that triggered an illness such as diabetes or to a specific nervous condition with symptoms such as anorexia, insomnia, diarrhea, and muscle tics. Susto, and its most severe form espanto, are triggered by a traumatic event, associated with significant suffering and increased mortality, and can be addressed by a sweeping ceremony (barrida).

  Nervios “nerves” is an anxiety state with associate physical complaints especially headache, musculoskeletal pain, insomnia, and anorexia. It is especially associated with stressful interpersonal relationship problems.

  Other conditions such as empacho (gastrointestinal obstruction due to food sticking to the wall of the gut) and empacho (evil eye) are most commonly associated with children.

• The extent to which traditional healers and/or remedies are used varies greatly –estimates range from four to over 80%

  A wide variety of traditional healers have developed in different Hispanic groups including curandero/curandeas (Mexican) santguadores/santguadoras (Puerto Rican), sobadores (massagers and bone setters), espiritistas (spiritual healers) yerberos/yerberas or senoras (herbalists).

  Researchers indicate that Hispanic patients tend to use CAM practitioners and materials in addition to conventional medicine or when conventional medicine has not been successful for most condition like diabetes but CAM may be the preferred approach to specific conditions such as susto or empacho.

  Herbal preparations (often brewed as teas) are commonly used for pain and fever (bosweilia) and diabetes (cactus/nopal, or loquat leaves/nispero).

  Prayer is an important component of treatment regardless of medicines or CAM use.

  In addition to CAM, many Hispanics obtain medications from Mexico because of cost and ability to obtain medications without prescription. Antibiotics, analgesics, and steroids are popular purchases. Always ask about imported medicines in addition to US prescribed, non-prescription, and CAM medications.

  Be alert for differences in the perception of symptoms and their significance in elderly Hispanic patients and aware of the significance attached to the personal interaction with the physician. Without stereotyping individuals, ask about their perception of their condition, its cause and the best way to manage it as well as about who helps them make decisions and their use of CAM (see ETHNICS nmenonic – link to it)

• Final Thought

  Many groups and organizations provide patient education materials and other resources in Spanish and materials specific to the needs of elderly Hispanic patients. Patients and families appreciate your thoughtfulness in having these available in your office. Local diabetes, heart, Alzheimer’s and other groups provide materials and help targeting Hispanics. The best overall single resource for health issues is

  The National Alliance for Hispanic Health
  1501 Sixteenth Street, NW
  Washington, DC 20036
  tel. 202-387-5000
  www.hispanichealth.org

Minority: Elderly Minorities | Minority Groups | Significance | ETHNICS | Factors | Beyond the Words...
Hispanic: Health Care for Elders | Health Problems | Managing Health Problems | Aspects of Dementia
African-American: Health Care for Elders | Managing Health Problems | Aspects of Dementia