1. OLDER LATINO IMMIGRANTS, THEIR HEALTH STATUS AND HEALTH CARE Gwen Yeo, PhD Stanford Geriatric Education Center Partially supported by a grant from the Bureau of Health Professions, Health Resources and Services Administration for Geriatric Education Centers

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

3. Latino Elders in US, 2000 Latino/Hispanic 1,733,591 Mexican 809,842 Cuban 228,677 Puerto Rican 191,295 Dominican 6,648 Central American 54,151 South American 76,791

4. Please review the handout on demographic characteristics of older Latinos in the U.S. What patterns do you see? Which populations are most disadvantaged?

5. 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

6. Please review the chart on disparities of health conditions. What patterns do you see?

7. Mortality Crossovers and Comparisons Adapted from Hummer et al., 2004

8. Diabetes in Older Women of Color Source: NIH, Women of Color Health Data Book, 1998 Percent

9. Prevalence of Dementia North Manhattan Study (N=1449) Gurland et al., Nat. Research Council, 1997

10. Effects of Education on Prevalence of Dementia  Multivariate regression analysis included age, education, income, gender, and ethno-racial membership  Increased age (OR=6.1) and lower education (OR=4.3) have strongest association with risk of dementia  “With age and education controlled, ethno- racial membership loses its association with rates of dementia.” Gurland et al., National Research Council, 1997

11. Reasons for Effect of Education on Dementia: Hypotheses? Gurland et al. Hypotheses Reduced cognitive ability in early life Reduced cognitive ability in early life Correlates of low education: e.g., malnutrition, poor health care, substance abuse Correlates of low education: e.g., malnutrition, poor health care, substance abuse Education builds robust brain structures that can compensate for deterioration Education builds robust brain structures that can compensate for deterioration Other? Less effective assessment techniques for low literacy, low education elders

12. SALSA Study Sacramento Area Latino Study on Aging N= 1778 aged 60+ N= 1778 aged 60+ 45% born in Mexico, 49% in US 45% born in Mexico, 49% in US Mean years of education: 4.7 for Spanish speakers, 10.7 for English Mean years of education: 4.7 for Spanish speakers, 10.7 for English Overall dementia prevalence: 4.8% Overall dementia prevalence: 4.8% Risk 8x higher for those with diabetes and stroke Risk 8x higher for those with diabetes and stroke Haan et al., 2003

13. Dementia Prevalence 85+

14. Other Important Findings: SALSA Study: SALSA Study: Higher risk of dementia with diabetes and/or stroke Higher risk of dementia with diabetes and/or stroke Higher risk of dementia with lower folate levels Higher risk of dementia with lower folate 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, hallucinations, & combativeness More sleep problems, wandering, hallucinations, & combativeness Earlier age at onset of dementia Earlier age at onset of dementia Some evidence of longer survival Some evidence of longer survival Dementia frequently seen as normal aging; sometimes as punishment from God or result of nervios Dementia frequently seen as normal aging; sometimes as punishment from God or result of nervios

15. Latino Caregivers More likely to be depressed More likely to be depressed More depressed when care recipient exhibits neuropsychiatric symptoms More depressed when care recipient exhibits neuropsychiatric symptoms Less likely to express burden Less likely to express burden Frequent feelings of cultural obligation for family caregiving Frequent feelings of cultural obligation for family caregiving Less and later use of nursing homes Less and later use of nursing homes Organizational religiosity related to less burden; non-organizational related to poorer mental health Organizational religiosity related to less burden; non-organizational related to poorer mental health Less help seeking even with larger social networks Less help seeking even with larger social networks Frequent primary caregiver with minimal help from family members Frequent primary caregiver with minimal help from family members

16. Relationship of Caregiver Percentage of Ethnic Patients Relationship of Caregiver Percentage of Ethnic Patients Yeo et al, 1996 Ethnicity & Dementias

17. Less use of hospice Less use of hospice More likely to believe death depends on More likely to believe death depends on God’s timing God’s timing More likely to want to maintain the possibility More likely to want to maintain the possibility of a miracle, so prefer aggressive treatment of a miracle, so prefer aggressive treatment End of Life Issues

18. RESOURCES Yeo & Gallagher-Thompson (Eds.) Yeo & Gallagher-Thompson (Eds.) Ethnicity and the Dementias, 2 nd Ed. Ethnicity and the Dementias, 2 nd Ed. New York: Routledge/Taylor & Francis. 2006 New York: Routledge/Taylor & Francis. 2006 Stanford Geriatric Education Center 2009- 2010 Webinar Series: Ethnicity and the Dementias. Replays available on SGEC website:http://sgec.stanford.edu Stanford Geriatric Education Center 2009- 2010 Webinar Series: Ethnicity and the Dementias. Replays available on SGEC website:http://sgec.stanford.edu Email Gwen Yeo at Email Gwen Yeo at

19. Important Research Topics Latino Elders Latino Elders To what extent do older immigrants from Mexico return to Mexico when they become seriously ill? To what extent do older immigrants from Mexico return to Mexico when they become seriously ill? Not all older Latinos have family caregivers; what do they do when they need assistance? Not all older Latinos have family caregivers; what do they do when they need assistance?