Elderly Hispanics Research Articles

Race, Ethnicity, and Social Security Retirement Age in the us

This study uses the AHEAD survey to examine the effects of increasing the Social Security retirement age in the United States by modeling the labor force participation decisions of men and women over the age of 65. Separate probit analyses by gender with interaction terms indicate that race/ethnicity is only marginally important in these decisions after controlling for key factors such as health, physical and mental disabilities, education, and nonlabor income. However, detailed examination reveals highly significant differences by race and ethnicity in all of these critical factors, as well as in the distribution of previous occupations. Although elderly blacks and Hispanics have greater financial need than whites, they have significantly less ability to continue working for pay. Thus, seemingly race- and ethnicity-neutral policies such as increasing the full Social Security retirement age may have disproportionate negative effects on elderly members of minority groups in the US.

Stature Prediction Equations for Elderly Hispanics in Latin American Countries by Sex and Ethnic Background

We estimate prediction equations of stature from knee height for elderly Hispanic Blacks, Mulattos, Mestizos, Mexicans, and Whites. We test the predictive power of estimated equations, assess the magnitude of relative errors in measures of body mass index (BMI), quantify errors committed when using predicted rather that observed height, and evaluate the differences in the strength of the relation between BMI and diabetes. Using data collected in 1999-2000, we split each sex and/or ethnic group into validation and cross-validation groups, estimate equations from the validation groups, then test them on the cross-validation groups. We use robust linear regression to assess the sex- and/or ethnic-specific relation between knee height and stature. We evaluate the accuracy of classifications by obesity and of estimates of risk of diabetes when using estimated versus observed height. Our equations are slightly less accurate than those obtained from U.S. data ( 4), although ethnic-specific parameters are comparable. Classification of subpopulations by obesity has high sensitivity and specificity. The estimated measure of BMI strongly attenuates estimated effects of obesity on diabetes. Thus, although the predicted heights fall within acceptable error bounds, their utilization in modeling relations to other health outcomes may give misleading inferences. Knee height is a good surrogate for current height for elderly populations. It is always preferable to use ethnic-specific predictions, because the relation differs by ethnicity. Great care has to be exercised when classifying populations using surrogate measures of height, or in estimating relations between measures that are functions of surrogate height and health outcomes.

Treating the Hispanic Elderly

Treating the Hispanic Elderly

An Exploratory Study of the Impact of the Year of 9/11 on Older Hispanic Immigrants in New York City

Hispanics are the largest minority in the US and may be at increased risk for the mental health consequences of disasters. Elderly Hispanics are vulnerable in terms of both age and ethnicity and are the fastest growing subpopulation among the aged.We conducted an exploratory, qualitative investigation of the impact of the year of 9/11 on older Hispanic immigrants in New York City. Six focus groups were conducted with a total of 31 elderly Hispanics attending a community senior center day program. Participants reported on their psychological reactions to the traumatic events of 9/11, the crash of Flight 587, and the anthrax scare. Most subjects had recovered from their acute distress reactions to 9/11 and Flight 587 four months post-September 11, but many still experienced a wide range of psychological reactions related to these traumatic events, including anxiety, avoidance, and hypervigilance. To develop relevant interventions for this population, social workers need to learn more about the psychological impact that the events of the year of 9/11 had on older Hispanics. Such interventions are necessary, especially given the continuing preoccupation in the US over the threat of terrorist acts and the possibility of war.

Plasma C-Reactive Protein and Homocysteine Concentrations Are Related to Frequent Fruit and Vegetable Intake in Hispanic and Non-Hispanic White Elders

Elevated C-reactive protein (CRP) and plasma total homocysteine (Hcy) were recently identified as risk factors for cardiovascular disease. However, few studies have related fruit and vegetable consumption to these markers of inflammation and B vitamin deficiency, particularly in the Hispanic population. We examined the relation of fruit and vegetable intake with plasma CRP and Hcy concentrations in a cross-sectional study. Subjects were 445 Hispanic elders and 154 neighborhood-based non-Hispanic white elders living in Massachusetts. Diet was assessed with a FFQ designed for this population. There were significant inverse dose-response associations between fruit and vegetable intake and plasma CRP (P for trend = 0.010) and Hcy (P for trend = 0.033) concentrations, after adjustment for potential confounders. The prevalence of high plasma CRP (> 10 mg/L), and high Hcy (>10.4 micromol/L for women and >11.4 micromol/L for men), was significantly greater among subjects in the lowest quartile of fruit and vegetable consumption relative to those in the highest quartile, 17.9 vs. 9.1% and 58.7 vs. 44.4%, respectively. With each additional serving of fruit and vegetable intake, adjusted odd ratios for high plasma CRP and Hcy were 0.79 (95% CI: 0.65 to 0.97) and 0.83 (95% CI: 0.72 to 0.96), respectively. Greater frequency of fruit and vegetable intake was associated with significantly lower plasma CRP and Hcy concentrations. Because both of these metabolites are known risk factors for CVD, these findings contribute to the evidence that a higher intake of fruit and vegetables may reduce the risk of CVD.

Mortality among elderly Hispanics in the United States: past evidence and new results.

We used vital records and census data and Medicare and NUMIDENT records to estimate age- and sex-specific death rates for elderly non-Hispanic whites and Hispanics, including five Hispanic subgroups: persons born in Cuba, Mexico, Puerto Rico, other foreign countries, and the United States. We found that corrections for data errors in vital and census records lead to substantial changes in death rates for Hispanics and that conventionally constructed Hispanic death rates are lower than rates based on Medicare-NUMIDENT records. Both sources revealed a Hispanic mortality advantage relative to non-Hispanic whites that holds for most Hispanic subgroups. We also present a new methodology for inferring Hispanic origin from a combination of surname, given name, and county of residence.

Dietary Patterns of Hispanic Elders Are Associated with Acculturation and Obesity

The association of dietary patterns and obesity, particularly in Hispanics, is relatively poorly understood. This large U.S. population subgroup has a high prevalence of obesity and associated chronic conditions, and Hispanics are changing their dietary practices as they acculturate. Our objectives were 1) to identify dietary patterns among elderly Hispanics in Massachusetts, compared with those of non-Hispanic whites; 2) to associate dietary patterns with acculturation; and 3) to associate dietary patterns with total and central obesity. We used a representative sample of 449 Puerto Rican and 133 Dominican elders and a neighborhood-based sample of 243 non-Hispanic white elders, aged 60 to 92 y, from the cross-sectional Massachusetts Hispanic Elders Study. Obesity and central obesity were assessed with BMI (kg/m2) and waist circumference measurement, respectively. Acculturation was assessed by evaluating language use. Usual diet was assessed with a food frequency questionnaire specifically designed for use with this population. Dietary patterns were defined by cluster analysis of food group variables. We identified five clusters of individuals by dietary pattern, with proportionately greater energy intake from 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) whole milk and 5) sweets, respectively. Hispanics were less likely to follow the fruit and cereal or sweets patterns, and more likely to follow the starchy vegetables or milk patterns, than were non-Hispanic whites. Only Hispanics followed the rice pattern. Among Hispanics, acculturation was positively associated with the fruit and cereal pattern, and negatively with the rice pattern. Total and central obesity were positively associated with the rice pattern. Longitudinal studies are needed to clarify the causal nature of these associations.

Literacy and Memory Decline Among Ethnically Diverse Elders

Literacy may be a more powerful indicator of brain reserve than years of education. Literacy level may be a proxy for native intellectual capacity or life experience that can compensate for brain damage or provide brain reserve. Alternately, the experience of acquiring literacy skills may in itself change the organization of the brain and increase protection against cognitive decline. However, because people with low levels of literacy obtain poor scores on most cognitive measures, only longitudinal studies can elucidate the role of reading ability in reserve. We determined whether literacy skills could predict cognitive change in a sample of 136 English-speaking African American, Caucasian, and Hispanic elders selected from a longitudinal aging study in New York City. According to a physician’s independent examination, all participants were nondemented throughout the four longitudinal assessments. Literacy level was assessed using the WRAT-3 reading subtest. After accounting for age at baseline and years of education, GEE analyses showed that elders with low levels of literacy had a steeper decline in both immediate and delayed recall of a word list over time as compared to high literacy elders. Our findings suggest that literacy skills are protective against memory decline among nondemented elders.

Identifying and recruiting Mexican American partners and sustaining community partnerships.

In this article, how community partners were identified and recruited and how community partnerships have been sustained during a current program of study designed to eliminate health and use disparities are described. Hispanic elders use in-home community services less often than do Anglo elders. The critical social paradigm, community development theories, and participatory research methods have guided a partnership with Mexican American elders and their care-givers during five research studies. Although the process of partnering with communities evolves within specific contexts and cannot be precisely predicted, strategies can be transferred to research and transcultural nursing practice to improve preventive care and sustainability of healthful changes in vulnerable populations.

Validation of a Spanish translation of the CLOX for use in Hispanic samples: the Hispanic EPESE study.

Clock drawing tests (CDT) appear to be less vulnerable to linguistic, cultural, or educational bias than traditional dementia screening instruments. We investigated a Spanish language translation of CLOX: an executive CDT, in a community sample of Hispanic elders. In-home CLOX evaluations of 1309 Mexican-American elders were reviewed. Both CLOX1 (an executive CDT) and CLOX2 (a constructional CDT) showed good internal consistency (Chronbach's alpha; both alpha = 0.82). Cultural-demographic variables had little effect on CLOX scores. Although language had a significant effect on CLOX1 failure rates, this was not mediated by age, education, acculturation or income. These results suggest that the Spanish CLOX can be validly administered to community-based Hispanic elder samples regardless of education or acculturation.

A note on the living arrangements of elders 1970-2000, with special emphasis on hispanic subgroup differentials

Previous research suggests that Hispanic elders, as a group, have been much more likely to live with others, especially adult children, than have other, especially non-Hispanic White, elders. It has also tracked an increase in solitary and couple-only living among the latter group since the turn of the century. However, it has not tracked changed living ar- rangements among Hispanic elders. When we do so, we find little aggregate change since 1970, but noteworthy change in different directions among different Hispanic subgroups. Thus aggregate figures for a diverse minority group may be masking very real changes and makes it all the more imperative that we consider different Latino groups separately and try to better understand issues of immigration and acculturation.

Dietary and plasma lipid, lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes

There are limited data about dietary intakes and plasma lipids of elderly US Hispanics. The disparity in prevalence of type 2 diabetes among population groups underscored our need to assess dietary and plasma risk factors for cardiovascular disease. Plasma lipids and apolipoproteins and dietary intakes of macronutrients were measured in elderly subjects (60-98 y): 490 Hispanics of Caribbean origin (Puerto Ricans and Dominicans) and 163 non-Hispanic whites. Plasma values were related to ethnicity and to macronutrient intake. Differences in plasma lipids due to diabetes were assessed among the Hispanics. Intakes of carbohydrate and polyunsaturated fatty acids were higher and intakes of cholesterol and saturated and monounsaturated fatty acids were lower in Hispanics than in non-Hispanic whites. Concentrations of total cholesterol, HDL cholesterol, and apolipoprotein A-I were significantly lower among Hispanic women than among non-Hispanic white women; a similar trend was seen in men. Dyslipidemia (high triacylglycerols and low HDL cholesterol) was more prevalent among Hispanics with than without diabetes. Ethnic differences in serum lipids exist and appear to be associated with differences in dietary intakes. However, both Hispanics and non-Hispanic whites had lipid profiles indicating a high risk of cardiovascular disease. Hispanics with diabetes were at higher risk of dyslipidemia than were those without diabetes. Our data suggest that lifestyle changes, including diet modification and exercise, could be of significant benefit to both ethnic groups.

Mexican American elders' use of skilled home care nursing services.

Hispanic elders use skilled home care nursing (SHCN) services less often than Anglo elders. The purpose of this study was to identify factors that influence whether disabled Mexican American elders decide to use SHCN services. The research process included reviewing the historical context in one Mexican American community, interviewing key and primary informants, presenting a report to the community and getting feedback, and assessing whether the community perceived a need for increased use of SHCN services by their disabled elders. Seven barriers to the use of SHCN services were identified: expectations of discrimination, lack of knowledge about services, expectations embedded in familism, lack of sense of prevention, lack of health insurance, preference for traditional remedies, and neglect/abuse. A community advisory committee validated the barriers identified during interviews and the need for increased use of SHCN services. Results provide new insight into the sociopolitical and cultural complexities that influence health care utilization decisions by Mexican American elders and their families and uncover traditional, oversimplified beliefs and practices by mainstream professionals and policymakers. Interventions that decrease inequities in a southern Arizona community may be transferable to other vulnerable populations in the United States and globally.

The Elder in the Cuban American Family: Making Sense of the Real and Ideal

Much of the literature on family networks of Hispanic elders in the United States assumes that the family is the natural support network without considering the structural, cultural, and psychosocial impact of immigration, or exile, on the family. However, there has been an increasing tendency of elder Cuban immigrants in the United States to live alone. With increasing mobility and varying degrees of acculturation across generations, it is important to understand how older people make sense of their rapidly changing familial life to themselves and to others. This paper compares the results of structured interviews of 79 Cuban elders in Miami-Dade County, Florida (U.S.) and focus groups on intergenerational relations held among a subset of fifteen of these elders using content analysis. Themes covered include desired family size, actual family size and its perceived effect, reasons for family size and roles of the family. The aim was to explore the ideal verses the real of Cuban elder family life and how elders themselves make sense of it. Results indicated that the ideal is larger families, but not co-residence. Migration and related economic necessity are understood as the primary reason for smaller families, as well as changes in intergenerational exchanges. The concept of the family, however, expands beyond the nuclear unit to include extended kin in the absence of co-residence and regular exchanges with children. The ideal family relations and perceived affect of migration on this dynamic were more likely to be expressed in the focus group setting than in the individual interviews.

Low Vitamin B-12 Intake and Status Are More Prevalent in Hispanic Older Adults of Caribbean Origin Than in Neighborhood-Matched Non-Hispanic Whites

Vitamin B-12 deficiency is a recognized problem among older adults, although vitamin B-12 status among differing ethnic groups remains unclear. We examined vitamin B-12 intake and status in a representative sample of elderly Hispanics of Caribbean origin (Puerto Rican and Dominican) and non-Hispanic whites. Dietary intake and plasma values were available for 347 Puerto Ricans, 102 Dominicans and 154 non-Hispanic whites (60-93 y). Relative to non-Hispanic whites, Hispanics had significantly lower vitamin B-12 intake and plasma concentrations; 17% of Hispanics and 10% of non-Hispanic whites had concentrations < 185 pmol/L (P < 0.05). Among Hispanics, log transformed vitamin B-12 intake was significantly associated with plasma concentration (beta = 60 pmol/L per log unit vitamin B-12 intake, P < 0.002 for supplement users and beta = 74 pmol/L per log unit vitamin B-12 intake, P < 0.01 for nonsupplement users). Intake and plasma concentrations were significantly associated among non-Hispanic whites only when supplement users were included (beta = 95 pmol/L per log unit vitamin B-12 intake, P < 0.0001). Hispanic supplement users (18%) had higher plasma concentrations than did nonsupplement users (364 +/- 17 and 297 +/- 8 pmol/L, respectively, P < 0.001). For Hispanics, consumption of breakfast cereal > 4 times/wk compared to no cereal was protective against lower plasma concentrations (8 vs. 24% < 185 pmol/L, P < 0.01). Approximately 40% of both groups with plasma vitamin B-12 < 185 pmol/L had homocysteine > 14 micromol/L, relative to < 17% of those with B-12 > 185 pmol/L. The high prevalence of low vitamin B-12 status in elderly Hispanics appears largely attributed to inadequate intake. As in other populations, sources of unbound vitamin B-12 such as supplements and fortified cereal appear to be protective. Dietary intervention programs targeted to the Hispanic population should promote these vitamin B-12 sources.

Living arrangements and Supplemental Security Income use among elderly Asians and Hispanics in the United States: the role of nativity and citizenship

In this analysis we compare the living arrangements and receipt of Supplemental Security Income (SSI) among older, non-institutionalised adults in five Asian and three Hispanic-origin groups in the United States. Living arrangements and SSI serve as indicators of structural incorporation and our primary objective is to identify the role of nativity (native versus foreign-born) and citizenship status (non-citizen versus naturalised citizen) on living arrangements and SSI receipt. We are also interested in identifying differences among these eight groups. In order to do so, we employ a combined sample from the 3 per cent 1990 United States Public Use Sample (PUMS) and a 5 per cent sample of individuals over 65 (PUMS-O) to achieve adequate coverage. The data reveal great diversity among the eight groups, but also reveal substantial similarity between naturalised citizens, that is, those who are foreign-born but who have become citizens, and the native-born. Our findings suggest that the process of structural incorporation is well under way among the naturalised foreign-born, and that it is important to differentiate between citizens and non-citizens in developing immigration and welfare policy. It is also increasingly clear that in the US context we must begin to differentiate among Asian-origin groups in the same way that we do among Hispanic groups in social scientific research.

Frail Older Persons in Nutrition Supplement Programs

Home-delivered and congregate meals, funded by Title III of the Older Americans Act (OAA), target low-income, frail, isolated elders and provide them with a minimum of one third of the daily Recommended Dietary Allowances (RDAs). Despite the benefits of these programs, Asian American and Hispanic elders are underrepresented among the participants. In order to inform researchers and practitioners of more effective outreach strategies for these minority elders, this study compared sociodemographic and need characteristics of African American, Asian American, and Hispanic participants in elderly nutrition programs in a large metropolitan area in the Pacific Northwest. Findings show that being Asian American and lacking English language proficiency decreased the likelihood of participation in home-delivered meal programs, even when nutrition and health statuses were controlled for. Culturally acceptable outreach strategies are discussed.

Increased sensitivity to warfarin in elderly Hispanics.

It has been suggested that aging enhances the pharmacologic effect of warfarin, but there is little information about the effects of warfarin in aging minority populations. The authors examine the response of an aging Hispanic population to warfarin. Charts in their anticoagulation clinic were retrospectively examined for the following information: age, sex, weight, duration of anticoagulant therapy, number of medical problems, number of medications, number of minor or major bleeding episodes, prothrombin time, warfarin dose, and international normalized ratio (INR). The dose-adjusted prothrombin time ratio (PTR) and dose-adjusted INR were calculated by dividing the PTR and INR by the mean warfarin dose. Four groups were compared by age: < 50, 50 to 59, 60 to 69, and > or = 70. A total of 243 charts were reviewed: 113 female, 130 male; 90% were Hispanic. The most common indication for anticoagulation was atrial fibrillation. Elderly patients had more medical problems (3.1 vs. 2.4) and took more medications (3.4 vs. 2.4) than younger patients. The dose-adjusted PTR and dose-adjusted INR increased with aging (0.59 vs. 0.38 and 0.85 vs. 0.59, p < .05 ANOVA). In a multiple linear regression analysis, only age remained significantly associated with the anticoagulant effect. These results are consistent with previous reports on the effect of warfarin in aging patients and extend these data to the Hispanic population.

Waist circumference and weight change are associated with disability among elderly Hispanics.

Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders. We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts. After adjusting for potential confounders, men with a WC > or =109.3 cm (vs <90 cm), or with a reported weight loss of -0.32 to -0.01 kg/year, or a weight gain > or =0.55 kg/year since age 50 (vs relatively stable weight, -0.01 to +0.21 kg/year [y]) were each significantly associated with an approximately threefold higher risk for greater disability. Women with a BMI > or =35 kg/m(2) were almost four times as likely to have higher disability as those with a BMI of 20 to 25 kg/m(2). Compared with women with a WC < or =85.2 cm, those with a WC of 91.5 to 106.6 cm were two times more likely, and those with a WC > or =106.6 cm were five times more likely, to have higher disability scores. Compared with relatively stable weight (-0.05 to +0.23 kg/y), weight gain > or =0.23 kg/year was associated with a twofold higher risk of greater disability among women. When BMI and WC were included in the same model, WC, but not BMI, remained significantly associated with disability. Abdominal obesity (WC > or =109.3 cm for men, or WC > or =91.5 cm for women) and weight gain > or =0.55 kg/year after age 50 in men or > or =0.23 kg/year in women may increase the risk of disability among elderly Hispanics.

Total and Central Obesity among Elderly Hispanics and the Association with Type 2 Diabetes

To report the prevalence of total and central obesity in a representative sample of Puerto Rican and Dominican elders in Massachusetts, to compare them with a neighborhood-based group of non-Hispanic white elders, and to examine associations of obesity indices with the presence of type 2 diabetes. We examined the prevalence of overweight, obesity, and central obesity in 596 Hispanics of Caribbean origin, ages 60 to 92 years, and 239 non-Hispanic whites, and tested linear and logistic regression models to determine associations among body mass index (BMI), waist circumference (WC), and diabetes. Obesity (BMI > or = 30 kg/m(2)) was prevalent among all ethnic groups, ranging from 17% to 29% for Dominican and Puerto Rican men, respectively, and from 29% to 40% for non-Hispanic white and Dominican women, respectively. These differences were not statistically significant. Among Hispanic men and women, diabetes was prevalent across all BMI and WC categories but tended to be greatest among those with BMI of 25 to 29 kg/m(2) (41% to 43%). In contrast, diabetes was most prevalent in the obese group (36% to 45%) of non-Hispanic whites. Both BMI and WC were associated with the presence of diabetes, but the coefficients were greater for non-Hispanic whites than for Hispanics. Caribbean Hispanics and non-Hispanic whites living in the same Massachusetts localities had high prevalences of overweight and obesity. Total and central obesity exerted a differential effect on the presence of diabetes among ethnic groups; for Hispanics, diabetes was prevalent even among non-obese individuals, whereas for non-Hispanic white women, the prevalence of diabetes was strongly associated with total and central obesity. Additional research is needed to investigate the factors associated with the differential effect of obesity on the prevalence of type 2 diabetes among Hispanic and non-Hispanic white elders.