Health Problems of Hispanic Elders

• Elderly Hispanics are more than three times more likely to report fair or poor health than non-Hispanic Whites (NHW).

  Around 15-20% of elderly Hispanics report at least one activity limitation. The differences in health status are reduced but not removed by adjustment for education and socioeconomic factors. Degree of acculturation to USA is the strongest determinant of self-reported health status. Elderly Hispanics who feel comfortable culturally living in USA, tend to report higher levels of self-perceived health and functional status than those with low levels of acculturation.

  Information on health status in Hispanic elderly is incomplete due to problems with reporting. Concerns include

  • challenges of identifying and interviewing representative samples of Hispanic elders
  • reliability of standardized instruments (even in Spanish language versions)
  • difficulty using standard instruments due to education and/or literacy
  • cultural barriers to admitting problems or fear of being removed from the family or country if incapacitated
  • significant variations between groups and within groups.

   

• Much of the research on elderly Hispanics has been conducted on specific populations (Puerto Ricans in New York, Mexican-Americans in San Antonio and California) and may not be useful for elderly Hispanic men and women living in Wichita or Garden City.

  As a group, Hispanic elderly are three times more likely than NHW to report poor health : the highest rates of poor overall health and functioning are in elders who are poorly accultured to USA. Significant differences exist between the more than ten principal Hispanic groups - and group generalizations may not apply to individual patients and families.

• The health of elderly Hispanics presents several contradictions.

  The group apparently has a high burden of risk factors yet lower mortality and perhaps lower incidences of many common conditions. Lower rates of smoking may explain part of this paradox. The differences in smoking rates between Hispanics and NHWs are greatest in groups with the lowest educational attainment.

• About 30% of deaths in elderly Hispanics are attributed to heart disease.

  Although traditionally reported to be less common in Hispanics than NHWs, recent studies suggest that the prevalence of cardiovascular disease is significantly higher in Hispanic elderly than in NHW if carefully measured in defined populations. Elderly Mexican-Americans have more diabetes and sedentary lifestyle than NHWs. Elderly Mexican-American men have less abdominal obesity and smoking than comparable NHW men. The prevalences of obesity and diabetes appear to increase with acculturation.

• Hispanics have a relatively early age of stroke/TIA onset and higher mortalities at younger ages

  After age 65, cerebrovascular death rates are substantially lower in Hispanics than NHWs. Hemorrhagic stroke is relatively more common in Hispanics than embolic stroke compared to NHWs.

• An estimated 20-25% of Hispanic elders have hypertension.

  Some studies report higher prevalence of hypertension in elderly Hispanic women than NWH whereas others conclude that hypertension rates are not significantly increased. Elderly Hispanic men do not appear to have significantly increased hypertension rates compared to other groups. Only an estimated 35% of elderly Hispanic hypertensives are receiving treatment and fewer than 15% are controlled.

• Studies report up to 26% of elderly Hispanics have type 2 diabetes and rates are increasing "at an alarming rate"

  Age, obesity, and family history are associated with increased risk of diabetes but gender, physical activity, educational attainment, and degree of acculturation do not appear to influence risk. Low rate of diagnosis, problems with glycemic control, and the adverse effects of comorbid medical problems contribute to elderly Hispanics having higher rates of retinopathy, amputation, and end-stage renal disease than comparable NHWs.

• Cervical cancer rates are reported to be doubled in Hispanic women and some studies report increased rates of stomach, gall bladder, liver, and breast cancers

  The incidences of almost all cancers are reported to be lower in elderly Hispanics than in NHWs. Low rates of smoking are credited with low cancer rates in elderly Hispanics. One study reports that the incidences of breast and prostate cancer are increasing rapidly in elderly Hispanics but this may be due to greater rates of diagnosis. Hispanic cancer patients present at more advanced stages and have poorer survival rates than NHW patients. Cancer incidence and mortality rates change in elderly Hispanics with the degree of acculturation as diet, habits, lifestyle and use of health services for screening and treatment become more similar to NHW populations.

• Rates of depression in elderly Hispanic female groups are reported to be 25-30%.

  In elderly women, depressive symptoms are twice as common in Hispanics than in NHWs. Rates of depression in elderly Hispanic men are generally reported to be comparable to NHWs. Associated factors include chronic disease, living alone, low education, unsatisfactory social support, and low levels of acculturation. After adjustment for other factors, low acculturation remains significantly associated with depression. The diagnosis of depression may be difficult to ascertain in elderly Hispanics due to language and cultural issues as well as poorer performance of standard screening instruments such as the Geriatric Depression Scale (GDS).

Summary:
Remain alert for increased risk and impact for a few conditions, especially
type 2 diabetes and depression in elderly Hispanic women, but remember the
health concerns of an individual are determined more by personal factors than
ethnically-determined characteristics.