Elderly Hispanics Research Articles

Comparing Physical Activity And Fitness Among Hispanic Elders In Two Community-based Programs In Puerto Rico

Comparing physical activity and fitness among Hispanic elders in two community-based programs in Puerto Rico Community-based programs are ideal settings to promote physical activity (PA) and physical fitness (PF) among elders; therefore, improving health and quality of life. However, PA and PF in these programs are rarely documented. PURPOSE: We evaluated PA and PF among Hispanic elders in a community-based program located in two municipalities in Puerto Rico, one with (San Germán) and one without (Mayagüez) a PA program. HYPOTHESES: steps/day, time in moderate to vigorous PA (MVPA), and PF will be higher among elders in San Germán compared with Mayagüez. METHODS: Fifty-seven Hispanic elders in San Germán (n=30) and Mayagüez (n=27) wore a GT3X+ accelerometer attached to a waist band during seven consecutive days and completed PF evaluations (muscle strength with hand dynamometry, muscle endurance with squats and 3-5 lb. elbow flexion per 30 sec, flexibility with back scratch, agility with “foot up and go” test, cardiorespiratory endurance with distance covered in 6 min, and BMI). An independent t-test was used to detect differences between Centers. RESULTS: Steps/day among elders in San Germán and Mayagüez were not different (4,121±376 vs. 3,940±445 steps/day, respectively, P=0.76), but there was a tendency for MVPA to be higher in San Germán compared with Mayagüez (96.6±31.5 vs. 35.6±9.7 min/week, respectively, P=0.05). However, elders in both Centers were below the recommended PA levels. Elders in San Germán showed better results in all PF components compared with Mayagüez: muscle strength (24.9±1.4 vs. 19.5±1.4, P=0.009), muscle endurance (upper body [18.2±0.8 vs. 14.8±0.8 Kg, P=0.004], and lower body [14.1±0.7 vs. 11.6±0.7 kg, P=0.01]), flexibility (-5.2±.8 vs. -8.1±0.9, P=0.02), agility (33.7±1.5 vs. 48.2±3.5 sec, P=0.0003), and cardiorespiratory endurance (481.0±15.0 vs. 388.8±28.1 m, P=0.004). CONCLUSION: Although elders in both Centers did not comply with current PA recommendation, the PA program in San Germán could explain the tendency for higher MVPA and higher PF among its participants. These results support the integration of daily sessions of physically demanding activities for Hispanic elders in community-based programs.

Association of social isolation and health across different racial and ethnic groups of older Americans.

Social isolation is a social and public health problem that affects people of all ages, especially elders. Previous studies have found that social isolation across numerous industrialised countries is associated with negative health outcomes. However, it is unknown whether and how this association differs by race/ethnicity and age. To begin to address this gap, this study examines the association of social isolation and physical and mental health among Black, White and Hispanic elders in the United States of America. Building on Cornwell and Waite's perceived isolation and social disconnectedness dimension model of social isolation, the author used multi-stage survey data from a nationally representative sample of 3,005 community-residing adults aged 57-85 from the National Social Life, Health, and Aging Project. Tests for association were conducted on health by age, gender, marital status, education and race/ethnicity separately. Multivariate logistic regressions were used to test the association of social isolation and health exclusively and separately among these three groups. Results showed that social isolation is strongly associated with physical and mental health. Both perceived isolation and social disconnectedness had a significant negative association with physical and mental health among White elders. For Blacks, social disconnectedness is negatively associated with their physical health while perceived isolation had a negative association with mental health. Among Hispanic elders, there seemed to be no association between social isolation and physical health, but a significant negative association was found with their mental health. Despite various associated patterns, however, social isolation overall was associated with health outcomes that were similar across three elder groups. By identifying factors influencing social isolation and health among minority older Americans, this study has relevance to the development of culturally sensitive health-care practice and services, which may be applicable to minority elders in different countries.

Characterization and outcomes of renal leukocyte chemotactic factor 2-associated amyloidosis

Amyloidosis derived from leukocyte chemotactic factor 2 (ALECT2) is a recently described disease. Here, we report the characteristics and outcome of 72 patients with renal ALECT2, which included 19 who had another kidney disease on biopsy. Ninety-two percent of patients were Hispanics and over half were elderly. Three had other organ, but not cardiac, amyloidosis involvement. All patients without concurrent disease, except three, presented with chronic renal insufficiency. Proteinuria was variable and absent in a third, whereas nephrotic syndrome and hematuria were rare. After a median follow-up of 26 months, one-third developed end-stage renal disease (ESRD). The median renal survival was 62 months. Independent predictors of renal survival were serum creatinine at diagnosis, with a value of 2.0 mg/dl being the best cutoff for predicting ESRD, percentage global glomerulosclerosis, and presence of diabetes. Only four patients died and four had received chemotherapy for an erroneous diagnosis of immunoglobulin light chain-derived amyloidosis. Five patients underwent kidney transplantation; none had graft loss but one had disease recurrence. Patient survival is superior to renal immunoglobulin light chain-derived amyloidosis and reactive amyloidosis largely due to the absence of cardiac involvement. Thus, renal ALECT2 mainly affects elderly Hispanics who typically present with chronic renal insufficiency and bland urine sediment, with or without proteinuria.

Cognitive decline and cardiometabolic risk among Hispanic and non-Hispanic white adults in the San Luis Valley Health and Aging Study

Cardiometabolic risk factors, including hypertension, dyslipidemia, central obesity, insulin resistance and diabetes are linked to cognitive impairment. The Hispanic population appears to be differentially affected by both cardiometabolic risk factors and cognitive impairment. We sought to determine whether ethnic differences in cognitive impairment in long-resident southwestern US elders was explained by the presence of cardiometabolic risk factors, and to explore patterns of cognitive decline over time. We performed a secondary analysis of data collected on 378 Hispanic and 409 non-Hispanic white adult participants in a longitudinal study of community-dwelling elderly in southern Colorado. Measures of cardiometabolic risk included waist circumference, blood pressure, diagnosis of diabetes, and random blood glucose. Cognitive measures included the Mini-Mental State Exam (MMSE) and the behavioral dyscontrol scale (a measure of executive cognitive function), at baseline and after an average of 22months. Subjects were also administered the Center for Epidemiologic Studies Depression Scale, and the Coronary Artery Risk Development in Young Adults 1-Year Activity Recall. At baseline, Hispanic elders had a greater number of cardiometabolic risk factors and lower MMSE and behavioral dyscontrol scale scores than non-Hispanic whites. Hispanic ethnicity was associated with a greater likelihood of decline in general cognitive function, but not executive cognitive function, after adjusting for age and education. This differential decline was not explained by either individual or total number of baseline cardiometabolic risk factors, depression, or physical activity. A borderline increased risk of decline in general cognitive function was seen in sedentary individuals (P=0.05).

Abstract P156: Effect of Socioeconomic and Demographic Factors on Control of Cardiovascular Risk in Elderly Hispanics

Introduction: In elderly Hispanics, the causes contributing to poor control of cardiovascular risk factors (CRF) are not well understood. The purpose of this study was to assess the effect of demographic and socioeconomic factors on CRF control among non-institutionalized elderly Hispanics. Methods: A prospective cohort of 350 elderly Hispanics was studied. A face-to-face interview was conducted to obtain data on comorbidities and demographic and socioeconomic characteristics. Anthropometric and blood pressure measurements were obtained for all participants. Fasting blood samples were collected to assess levels of blood glucose, LDL, HDL and total cholesterol. Univariate and logistic regression analyses were performed to test whether socioeconomic and demographic characteristics were independently associated with adequate control of hypertension, dyslipidemia, and diabetes. Results: Most subjects (72.5%) were women. Median age was 71 (interquartile range, 64-79) years. The prevalence of hypertension, diabetes, and dyslipidemia was 68%, 65%, and 64%, respectively. Of these, 93% of hypertensive, 87% of diabetics, and 78% of dyslipidemic subjects were on pharmacologic treatment. Adequate control of the CRF was achieved in 33%, 70%, and 68% of hypertensive, diabetic, and dyslipidemic subjects, respectively. In general, 63.5% of the subjects had at least one risk factor not controlled. Univariate analyses revealed that only the level of trust in the health care system was significantly associated with adequate control of dyslipidemia ( P =0.03) but not with control of the other risk factors. Multivariate analyses revealed that level of education (odds ratio [OR], 0.92; 95% confidence interval [95%CI], 0.86-0.99; P =0.03) and understanding of information obtained from health care provider (OR, 1.48; 95% CI, 1.01-2.1; P =0.04) were independently associated with adequate control of blood pressure. No other significant associations were found. Conclusions: Despite high rates of treatment, elderly Hispanics in our cohort exhibit poor control of cardiovascular risk factors. Demographic and socioeconomic characteristics do not seem to have a strong effect on CRF control among elderly Hispanics.

Abstract P148: C-Reactive Protein (CRP) and the Prediction of Cardiovascular Death Among Mexican-Americans

Background: Addition of C-reactive protein (CRP) improves risk stratification provided by traditional Framingham risk factors (FRFs) in some populations, but findings vary by gender and by race/ethnicity. Whether CRP levels can improve risk prediction of cardiovascular mortality (CVD) among elderly Hispanics is unknown. Hypothesis: CRP will add incremental CVD risk prediction in addition to FRFs. Methods: We evaluated whether addition of baseline CRP to the Framingham risk score can improve CVD risk stratification for CVD death among 1,422 participants (536 males, 886 females) from the Sacramento Area Latino Study on Aging (SALSA). SALSA is a well-characterized, NIH funded cohort study of Mexican Americans aged > 60 followed since 1998–1999. Death was ascertained by participant contacts, obituary reviews and cause of death from death certificates. We evaluated the association of CRP levels with CVD death using Cox proportional hazards models adjusting for FRFs stratified by gender. We calculated gender stratified net reclassification improvement (NRI) in models with and without CRP to predict 10-year CVD risks using the established FRFs categories (<5%, 5–10%, 10–20%, > 20%). Results: Mean baseline age was 70.7 and mean CRP level was 5.86 ng/ml. There were 167 CVD male deaths (mortality rate 39.2 per 1,000 person years) and174 among women (mortality rate 27.8 per 1,000 person years). Higher CRP levels were significantly associated with higher CVD mortality risk in men, HR of 1.29 (95% CI 1.11 – 1.50) but not women, HR 0.94 (95% CI 0.81 – 1.08) after adjustment for covariates. Addition of CRP was useful in reclassifying CVD death risk among men defined by FRF alone, and this was due to correct reclassification of those who did not experience CVD death from the highest risk group to a lower risk category. The majority of male participants (619/745=83%) were classified as having >20%risk in the model without CRP. Mortality rate for men initially classified as having > 20% risk was 37.9 per 1,000 person years. After addition of CRP, 6% were reclassified into an intermediate risk category (NRI 7.4%, p< 0.001) and their mortality rate was 10.3 per 1,000 person years. Overall, NRI for men was 4.2% (p=0.05). In contrast, addition of CRP among women was associated with increased misclassification to a higher risk category (NRI= − 13.4%, p=0.0001). Conclusion: A risk prediction model that includes CRP improves cardiovascular risk classification among elderly Mexican-American men but not women as defined by traditional FRFs.

Race-Ethnic Differences of Sleep Symptoms in an Elderly Multi-Ethnic Cohort: The Northern Manhattan Study

Background: Sleep disorders are associated with stroke and may vary among elderly Hispanics, Blacks and Whites. We evaluated differences in sleep symptoms by race-ethnicity in an elderly population-based urban community sample. Methods: Snoring, daytime sleepiness and reported sleep duration were ascertained by standardized interviews as a part of the Northern Manhattan Study, a prospective cohort study of vascular risk factors and stroke risk in a multi-ethnic urban population. Sleep symptoms were compared amongst race-ethnic groups using logistic regression models. Results: A total of 1,964 stroke-free participants completed sleep questionnaires. The mean age was 75 ± 9 years, with 37% men, with 60% Hispanics, 21% Blacks and 19% Whites. In models adjusted for demographic and vascular risk factors, Hispanics had increased odds of frequent snoring (odds ratio, OR: 3.6, 95% confidence interval, CI: 2.3–5.8) and daytime sleepiness (OR: 2.8, 95% CI: 1.7–4.5) compared to White participants. Hispanics were more likely to report long sleep (≧9 h of sleep, OR: 1.8, 95% CI: 1.1–3.1). There was no difference in sleep symptoms between Black and White participants. Conclusion: In this cross-sectional analysis among an elderly community cohort, snoring, sleepiness and long sleep duration were more common in Hispanics. Sleep symptoms may be surrogate markers for an underlying sleep disorder which may be associated with an elevated risk of stroke and may be modified by clinical intervention.

Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction

Hispanics are the fastest growing segment of the US population and have a higher prevalence of cardiovascular risk factors than non-Hispanic whites. However, little is known about whether elderly Hispanics have higher readmission rates for heart failure (HF) and acute myocardial infarction (AMI) than whites and whether this is due to site of care. We examined hospitalizations for Medicare patients with a primary discharge diagnosis of HF and AMI in 2006 to 2008. We categorized hospitals in the top decile of proportion of Hispanic patients as "Hispanic serving" and used logistic regression to examine the relationship between patient ethnicity, hospital Hispanic-serving status, and readmissions. Hispanic patients had higher risk-adjusted readmission rates than whites for both HF (27.9% vs 25.9%, odds ratio [OR] 1.11, 95% CI 1.07-1.14, P < .001) and AMI (23.0% vs 21.0%, OR 1.12, 95% CI 1.07-1.18, P < .001). Similarly, Hispanic-serving hospitals had higher readmission rates than non-Hispanic-serving hospitals for both HF (27.4% vs 25.8%, OR 1.09, 95% CI 1.06-1.12, P < .001) and AMI (23.0% vs 20.8%, OR 1.13, 95% CI 1.09-1.18, P < .001). In analyses considering ethnicity and site of care simultaneously, both Hispanics and whites had higher readmission rates at Hispanic-serving hospitals. Elderly Hispanic patients are more likely to be readmitted for HF and AMI than whites, partly due to the hospitals where they receive care. Our findings suggest that targeting the site of care and these high-risk patients themselves will be necessary to reduce disparities in readmissions for this growing group of patients.

Disability, Health and Generation Status: How Hispanics in the US Fare in Late Life

Using prospective data from a cohort of elderly Hispanics, this study explores how first-, second- and 1.5-generation Latinos differ in their levels and trajectories of disability. The results indicate that compared to second-generation elderly Hispanics, first- and 1.5-generation Hispanics had higher levels of disability. In addition, 1.5-generation elderly Hispanics had higher average ADL and IADL limitations than second-generation Hispanics at the beginning, and over time, this difference increasingly diverged. Currently married individuals had lower levels of disability than formerly married Hispanics. Also, marriage at any point in time significantly limits variability in disability in the sample, indicating that readily available spousal support is significant in diminishing generation differences in disability. Implications from these findings for future research are discussed.

Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility

Implement a memory impairment screening procedure for elderly Hispanic primary care patients, and analyze its yield and challenges to further triage and diagnostic evaluation. Three hundred twenty nine Hispanic patients aged ≥60 years or proxy informants were enrolled from outpatient primary care clinics at an urban safety-net medical center. Patients were screened for memory impairment using the WHO-UCLA AVLT; for those without consent capacity, proxies were given the IQCODE. Bilingual research assistants conducted in-person or telephone screening. Age, gender, education, comorbidities, acculturation, overall health, access to care, and memory concerns were assessed as potential predictors of memory impairment. Based on identified implementation challenges, a multi-disciplinary stakeholder committee proposed revised approaches to increase diagnostic evaluation and sustainability. Of 677 eligible patients approached, 329 (49%) were screened, and 77 (23%) met criteria for memory impairment using the WHO-UCLA AVLT (N=60) or the IQCODE (N=17). Only male gender and higher comorbidity uniquely predicted memory impairment (ps<0.05). Few screen-positive patients declined further triage and evaluation, but a substantial proportion could not be subsequently contacted. Challenges to implementing a memory screening program included staff time and adequate clinic space for in-person screening; challenges to follow-up of positive screening results included inability to contact patients and lack of primary care continuity to facilitate further triage and referral. Nearly one-fourth of primary care Hispanic elders screened as memory-impaired, but few factors predicted positive screening. Stakeholder-guided adaptations are needed-particularly in resource-constrained settings-to overcome challenges to further diagnostic evaluation and referral.

Gender Differences in Colonoscopy Outcomes in Elderly Hispanics

Gender Differences in Colonoscopy Outcomes in Elderly Hispanics

Impact of Co-morbidities on Colorectal Cancer Screening Decision in Elderly African Americans and Hispanics

Impact of Co-morbidities on Colorectal Cancer Screening Decision in Elderly African Americans and Hispanics

Community and Individual Race/Ethnicity and Home Health Care Use among Elderly Persons in the United States

To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2006 Medical Expenditure Panel Survey (N=23,792) linked to block group-level racial/ethnic information from the 2000 Decennial Census. We estimated the likelihood of informal and formal home health care use for four racial/ethnic elderly groups (non-Hispanic [NH] whites, NH-blacks, NH-Asians, and Hispanics) living in communities with different racial/ethnic compositions. NH-Asian and Hispanic elders living in block groups with ≥25 percent of residents being NH-Asian or Hispanic, respectively, were more likely to use informal home health care than their counterparts in other block groups. No such effect was apparent for formal home health care. NH-Asian and Hispanic elders are more likely to use informal home care if they live in communities with a higher proportion of residents who share their race/ethnicity. A better understanding of how informal care is provided in different communities may inform policy makers concerned with promoting informal home care, supporting informal caregivers, or providing formal home care as a substitute or supplement to informal care.

Elderly Asian and Hispanic Foreign- and Native-Born Living Arrangements: Accounting for Differences

This study examines the relative importance of demographic, resource, and assimilation statuses in explaining the living arrangements of foreign- and native-born Asian and Hispanic elders from 11 origins in 2000 and accounting for why these groups have higher levels of extended living than native-born Whites. Drawing on the 2000 Public Use Microdata 5% Sample (PUMS) files and using logistic regression, the findings show that demographic characteristics are the major determinants of elderly extended living, followed by resource availability, assimilation, and group origin. Assimilation, on the other hand, is the major determinant of group differences between native White and Asian and Hispanic elders. While findings provide support for assimilation theory, the persistence of differentials across Asian and Hispanic groups after controlling for model covariates, and modest increases in extended living for most native-born Asian and Hispanic groups as well as native Whites in the 1990s underscores the enduring nature of ethnic diversity in living arrangements.

Differential item responses on CES-D inventory: A comparison of elderly Hispanics and non-Hispanic Whites in the United States and item usage by elderly Hispanics across time

Objectives: This study examines the differential item functioning (DIF) on both the standard 20-item scale and 10-item and 12-item subsets of the Center for Epidemiological Studies Depression (CES-D) inventory. Method: Two elderly groups in the United States are compared: one composed of Hispanics and the other of non-Hispanic Whites. We also compare item use among the elderly Hispanics over time. Survey data was analyzed from participants (N = 4499) in the Established Populations for Epidemiologic Studies of the Elderly (EPESE) with complete data on the CES-D. Partial correlation analysis was applied to test hypotheses regarding the DIF on the basis of ethnic background and among the elderly Hispanics across time points. Results: Hispanics appear to express positive affect differently than non-Hispanic Whites. On the 20-item scale, Hispanics under responded to items measuring positive affect. Item bias was also found for one positive affect question in the 10-item subset. Among the Hispanic sub-population, we also observed item response bias for the positive affect items across time. A 12-item subset tested for DIF displays an acceptable amount of item bias across ethnic groups and across time for the Hispanic sample. Conclusions: Attempts to make substantive comparisons about the relative prevalence of depression symptoms in elderly Hispanic and non-Hispanic sub-populations appears to be limited by the lack of measurement invariance in the full CES-D. Comparisons across time for elderly Hispanics also appear problematic.

Hispanic Ethnicity and Unintentional Injury Mortality in the Elderly

Unintentional injury is a leading cause of preventable mortality in elderly populations and is most often related to accidental falls and motor vehicle accidents. Hispanic ethnicity has been previously associated with decreased risk of accidental fall death as well as improved outcomes in other health states, the "Hispanic paradox." A timely analysis of national data with consideration for multiple injury types and age could provide insight into this epidemiologic phenomenon and help guide the use of prevention efforts. Search of the Center for Disease Control's WISQARS database was performed to identify the number of fatalities in the U.S. between 2003 and 2006 by age group, gender, Hispanic ethnicity, and injury type. Total U.S. population and group populations for the years examined were obtained from the U.S. Census Bureau's American Community Survey for each year. Mortality was calculated as fatalities over the total group population for the years examined. Independent of gender and age group, elderly Hispanics were at decreased risk of death from accidental fall or as an occupant in a motor vehicle accident, but increased risk of pedestrian fatality compared with white-NH. The reduced fall and occupant mortality seen in elderly Hispanic populations may come at the cost of increased pedestrian-related mortality. This is consistent with and likely reflects differences in culture, socioeconomic status, and geographic distribution for the U.S. Hispanic population. Effective targeting of injury prevention programs, especially community based, should consider the role of Hispanic ethnicity and its impact on lifestyle.

W1465: Colonoscopy for CRC Screening in Asymptomatic Elderly African Americans, Hispanics and Asian Americans

W1465: Colonoscopy for CRC Screening in Asymptomatic Elderly African Americans, Hispanics and Asian Americans

Elderly Hispanics More Likely To Reside In Poor-Quality Nursing Homes

The proportion of Hispanics age sixty-five and older who are living in nursing homes rose from 5 percent in 2000 to 6.4 percent in 2005. Although segregation in nursing homes seems to have declined slightly, elderly Hispanics are more likely than their non-Hispanic white peers to reside in nursing homes that are characterized by severe deficiencies in performance, understaffing, and poor care.

Diabetes and Obesity

Diabetes and Obesity

The Relationship of Built Environment to Perceived Social Support and Psychological Distress in Hispanic Elders: The Role of "Eyes on the Street"

Research on contextual and neighborhood effects increasingly includes the built (physical) environment's influences on health and social well-being. A population-based study examined whether architectural features of the built environment theorized to promote observations and social interactions (e.g., porches, windows) predict Hispanic elders' psychological distress. Coding of built environment features of all 3,857 lots across 403 blocks in East Little Havana, Florida, and enumeration of elders in 16,000 households was followed by assessments of perceived social support and psychological distress in a representative sample of 273 low socioeconomic status (SES) Hispanic elders. Structural-equation modeling was used to assess relationships between block-level built environment features, elders' perceived social support, and psychological distress. Architectural features of the front entrance such as porches that promote visibility from a building's exterior were positively associated with perceived social support. In contrast, architectural features such as window areas that promote visibility from a building's interior were negatively associated with perceived social support. Perceived social support in turn was associated with reduced psychological distress after controlling for demographics. Additionally, perceived social support mediated the relationship of built environment variables to psychological distress. Architectural features that facilitate direct, in-person interactions may be beneficial for Hispanic elders' mental health.