Older Latino Adults Research Articles

Physical activity characteristics and depressive symptoms in older Latino adults

BackgroundPhysical activity (PA) has been consistently associated with fewer depressive symptoms in observational and intervention studies. Emphasis on leisure-time PA, reliance on self report measures of PA, and lack of inclusion of racial/ethnic minority populations have contributed to uncertainty regarding the minimal and optimal dose (minutes/day), intensity (i.e., light, moderate, or vigorous), bout duration (i.e., incidental vs. 10-min bouts), and domain (i.e., leisure-time, occupational, and household) of PA for reducing and preventing depressive symptoms across diverse populations. PurposeTo investigate the relationship between PA characteristics (i.e., dose, intensity, bout duration, and domain) and depressive symptoms in older Latinos using both objective and subjective measures of PA. MethodsOlder Latinos (n = 174) completed questionnaires and wore accelerometers for seven days. Accelerometer output provided daily minutes of sedentary, light, and moderate-vigorous PA (MVPA) overall and in 10-min bouts. The Community Healthy Activity Model Program for Seniors (CHAMPS) questionnaire provided daily minutes of leisure-time PA, household PA, and sedentary activities. Hierarchical linear regression analysis was used to predict Center for Epidemiological Studies Depression Scale (CES-D) score. ResultsAfter controlling for established correlates of depressive symptoms (i.e., demographics, acculturation, and health characteristics), MVPA in ≥10-min bouts independently predicted fewer depressive symptoms (β = −.231, ΔR2 = .052, p ≤ .01) and household PA greater depressive symptoms (β = .263, ΔR2 = .056, p ≤ .001). ConclusionsResults suggest that PA intensity, bout duration, and domain influence the strength and direction of the relationship between PA and depressive symptoms in older Latino adults.

Abstract P044: The Role of Self-Perceived Attributes of the Neighborhood Environment on the Association between Depressive Symptoms and Physical Activity in Older Latino Adults

Background: Physical inactivity is associated with the development of cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, obesity, and diabetes) and an increased risk for cardiac-related morbidity and mortality. The impact of depressive symptomatology on self-perceptions of the neighborhood environment may explain the low levels of physical activity (PA) among older Latino adults with depression. The aims of the current study are to examine whether individuals with depression are less likely to view their neighborhood environment as conducive for walking behavior, and to examine the role of self-perceptions of the neighborhood environment in the association between depression and PA. Methods: We analyzed baseline in-person interview and pedometer data collected from Latinos ≥60 years participating in an exercise intervention (Caminemos!) at 27 senior centers. Depression was assessed using the Geriatric Depression scale and the Neighborhood Environment Walkability Scale (NEWS) was use to capture self-perceived attributes of the neighborhood environment associated with transport and recreational walking. The NEWS includes multiple subscales capturing the presence and accessibility of sidewalks, neighborhood aesthetics, pedestrian/traffic safety, and crime safety. PA was objectively measured using pedometer data. Bivariate analyses were conducted to examine the association between depression status and measures of PA, overall neighborhood walkability and associated subscales. We followed Baron and Kenny’s four steps to conduct a mediation analysis to examine whether self-perceived attributes of the neighborhood environment served as a mediator between depressive symptoms and PA. Results: Baseline characteristics for this sample (n=572) include: mean age of 73 years; 77% female; 83% with incomes below $20,000; and 59% with less than an 8th grade education. Approximately 27.6% screened positive for depression. When using continuous pedometer data as the outcome of interest, depressed individuals were less likely to engage in walking behavior when compared to their non-depressed counterparts (p=0.004), independent of basic demographic variables. T-tests revealed that depression status was only associated with the subscale of neighborhood walkability capturing criminal activity. Older Latino adults with depressive symptoms were more likely to perceive their neighborhood as a high-crime area (p=0.01). Results from the Sobel test did not find self-perceptions of criminal activity in the neighborhood to mediate the relationship between depressive symptoms and PA (p-value=0.31). Conclusion: While depressive symptoms are linked to self-perceptions of neighborhood criminal activity in older Latino adults, perceptions of neighborhood criminal activity does not act as a mediator in the relationship between depression and PA.

Examining the Relationships Between Physical Functioning, Ethnic Identity, Acculturation, Familismo, and Depressive Symptoms for Latino Older Adults

In this study, the authors examined the contributions of physical functioning, acculturation, the Latino cultural value of familismo, and ethnic identity in predicting depressive symptoms in a community sample of Latino older adults. The participants were 98 Latino older adults, age 65 and older, from a moderately sized Midwestern city. Multiple regression analyses indicated that physical functioning, acculturation, familismo, and ethnic identity were significantly related to depressive symptoms. Due to the limited empirical research focused on ethnic identity among older adults, the construct of ethnic identity was closely examined in an effort to extend ethnic identity theory and research specific to Latino older adults. The findings are discussed within the context of ethnic identity theory and implications for research and practice.

The Longitudinal Relationship Between Depression and Walking Behavior in Older Latinos

This study sought to evaluate the relationship between baseline depression and prospective engagement in walking and exercise behavior after enrollment in an exercise intervention. The study used baseline, 1-month, 12-month, and 24-month in-person interview and pedometer data collected from Latinos aged >60 years participating in an exercise intervention (¡Caminemos!) at 27 senior centers (n = 572). After joining an exercise intervention, and when using continuous pedometer data and scores from the Yale Physical Activity Survey (YPAS) as the outcomes of interest, older adults with baseline depression exhibited comparable levels of physical activity across time when compared to their nondepressed counterparts. Significant difference in physical activity levels between the depressed and nondepressed subgroups no longer existed within one month of initiating the exercise intervention. Among sedentary older Latino adults, having depression may not delay exercise initiation nor does it appear to prevent achievement or maintenance of an exercise program.

Structuring Mental Health Within Senior Services: A Case Study of an Outpatient Mental Health Clinic Serving Latinos

The article presents a case study of an outpatient mental health clinic serving Latino older adults. The study explored staff perceptions on the clinic development and the context within an immigrant multicultural community. The study used in-depth, semistructured interviews with support staff, clinical social workers, and administrators. Interviews were analyzed using a thematic content analysis. The mental health clinic formation was perceived by staff as an ecological process stemming from the needs of the Latino immigrant senior clients. A close knit and interdependent culture allowed the clinic to adjust to diversity and changing cultural contexts.

Sociocultural influences on mental health service use by Latino older adults for emotional distress: Exploring the mediating and moderating role of informal social support

This study investigated the determinants of mental health services for emotional distress by low-income older Latinos living in Los Angeles County (United States). The functional effects of informal support on service use were tested while accounting for dimensions of support and sociocultural factors. Using data from a cross-sectional survey of older Latinos (n = 235), we preformed a secondary data analysis using path analysis with Poisson regression to assess mediation and moderation models by type of perceived support, emotional and instrumental. Data was originally collected between 1998 and 2005. Results indicated that no mediation effects were present however significant moderation effects emerged. Respondents with low levels of linguistic acculturation and informal support used fewer services. Variations by type of informal support emerged, with emotional support presenting the best model fit compared to instrumental support in the moderation model analysis. The direct effects of linguistic acculturation and age remained significant after controlling for need. Findings reveal limited informal support is a risk factor for the underutilization of mental health services by older Latinos with low levels of linguistic acculturation as they age. Integrating support resources that assist in navigating service systems and address language barriers can enhance service use by older Latino adults. Implications for service delivery and program development are discussed.

Evaluation of MyPlate mini‐poster for older Latino adults: MiPlato para Adultos Mayores

Culturally appropriate nutrition education materials are in high demand for the large and growing population of Latinos in the U.S. This study assessed older Latino adult responses to consumer messages, graphics, and foods included in the draft MyPlate for Older Adults mini‐poster for Latinos, MiPlato para Adultos Mayores (MPAM). Six focus groups (FGs) were conducted by trained moderators and a nutritionist observer with a convenience sample of 47 Latinos, 60 years or older, in 3 Florida counties. Two FGs were offered per county (one each in English and Spanish) to 35 women and 12 men, representing 9 Caribbean and Latin American countries. Discussions were tape‐recorded, transcribed, and analyzed for common themes. Participants found MPAM to be informative, appealing, and culturally appropriate. They made recommendations for additional foods including papaya and fresh fish, and reduction in size of the red meat graphic. Daily food group recommendations were found to be practical. Participants liked the variety of silhouettes depicting physically active older adults and consumer messages were found to be clear, useful, and well organized. MPAM is being incorporated into lessons and educational materials for older Latino adults. The mini‐poster can be used by nutrition educators to teach MyPlate concepts to older Latino adults in a variety of educational settings. Funding provided by IFAS Dean for Extension, UF.

Financial Strain, Negative Interaction, Coping Styles, and Mental Health Among Low-Income Latinos

This study examines the relationship between financial strain and depressive symptoms in later life, and potential psychosocial mediators of this relationship. Drawing on a sample of 214 low-income Latino older adults, we used structural equation modeling to test the direct effect of chronic financial strain on depressive symptomatology, and the indirect effects via social support, negative interaction, and coping styles. Findings indicated that financial strain increased the level of depressive symptoms among this sample. Avoidance and approach-related coping styles emerged as independent determinants of depressive symptoms albeit in opposite directions; higher levels of avoidance coping was associated with higher levels of depressive symptoms. Contrary to previous findings on the general population, findings from the current study indicate that social support and negative interaction were not directly associated with depressive symptoms. Financial strain mediated the effect of sociocultural (nativity status, years of U.S. residence) and social status factors (age, education) on depressive symptoms. This study highlights the differential impact of financial strain and coping styles on psychological well-being, and the potential psychosocial targets of interventions for older adults with chronic health care conditions.

Physical Activity of Urban Community-Dwelling Older Latino Adults.

To date, little is known about the physical activity (PA) levels and commonly reported modes of PA of older Latinos, and this information is critical to developing interventions for this population. The purpose of the current study was to examine PA assessed by self-report and accelerometer and to assess the influence of acculturation, gender, and age on the PA of urban community-dwelling older Latino adults. Participants were self-identified Latinos, primarily women (73%), and individuals aged 50 to 59 (31%), 60 to 69 (30%), and 70+ (39%). PA was measured with an accelerometer and the Community Healthy Activity Model Program for Seniors (CHAMPS) PA questionnaire. Men reported engaging in, and objectively participated in, significantly more minutes of moderate/vigorous PA than women, but women reported greater light intensity household PA. Latinos aged 50 to 59 engaged in significantly more accelerometer-assessed PA than Latinos aged 60 to 69 and 70+, respectively. The majority of participants did not meet the PA Guidelines for Americans. No differences in PA were demonstrated by acculturation level. Older Latino men and women reported walking and dancing as modes of leisure PA. These findings suggest PA interventions should be targeted toward older Latinos, taking into account gender and age.

Incidence of and Risk Factors for Change in Urinary Incontinence Status in a Prospective Cohort of Middle-Aged and Older Women: The Reproductive Risk of Incontinence Study in Kaiser

Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status. We used stratified random sampling to construct a racially and ethnically diverse, population based cohort of 2,109 women 40 to 69 years old. Data were collected by questionnaires and medical record review. A second survey approximately 5 years later was completed by 1,413 women (67%) from the original cohort. The frequency of urinary incontinence was categorized as less than weekly, weekly and daily. Change in incontinence status was defined as new onset incontinence, incontinence progression or regression between frequency categories and resolution of incontinence. Predictor variables were demographics, body mass index and other medical conditions. We used logistic regression to estimate the adjusted OR and 95% CI. Compared to white nonHispanic women, black women were less likely to have incontinence progression (OR 0.46, 95% CI 0.24-0.88). New onset incontinence was more common in women with a higher body mass index at baseline (p = 0.006) and those who experienced increased body mass index (p = 0.03) or decreased general health (p = 0.007) during the study. Participants with chronic obstructive pulmonary disorder at baseline were more likely to report incontinence progression (OR 2.64, 95% CI 1.22-5.70). Baseline incontinence type was not significantly associated with the risk of change in continence status independent of frequency. Identifying risk factors for change in incontinence status may be important to develop interventions to decrease the burden of incontinence in the general population.

Acculturation and Colorectal Cancer Screening Among Older Latino Adults: Differential Associations by National Origin

ABSTRACTBACKGROUNDAlthough modest improvements in colorectal cancer (CRC) screening utilization have occurred, rates remain low among Latinos. It is unclear whether acculturation plays a role in the utilization of CRC screening.OBJECTIVEThis study aimed to examine the relationships between acculturation and CRC screening among older Mexican, Puerto-Rican and Cuban adults.DESIGNCross-sectional observational study.SUBJECTSLatinos 50 years and older, never diagnosed with CRC, and who were surveyed in the 2000, 2003 and 2005 National Health Interview Survey (NHIS).MEASURESWe measured acculturation with US nativity and language of interview, and examined three different CRC screening outcomes: fecal occult blood test (FOBT) in the past year, up-to-date endoscopy and any up-to-date CRC screening. Logistic regression models were adjusted for predisposing, enabling and health-care need factors consistent with the behavioral model of health-care utilization.MAIN RESULTSIn adjusted analyses, US nativity was positively associated with up-to-date endoscopy among Mexicans (OR: 1.5; 95% CI: 1.1, 2.2), but negatively associated with FOBT in the past year among Puerto Ricans (OR: 0.3; 95% CI: 0.2, 0.7). In contrast to this latter finding among Puerto Ricans, English language interview was positively associated with FOBT in the past year (OR: 2.5; 95% CI: 1.1, 5.4).CONCLUSIONResults underscore the importance of stratification by national origin in studies of acculturation and cancer screening and of targeting less acculturated adults to promote CRC screening. Clinicians, however, should consider the complexity of acculturation and treat US nativity and language preference as independent dimensions among their Latino patients.

Multi‐Level Intervention to Prevent Influenza Infections in Older Low Income and Minority Adults

In this paper we describe a successful multi-level participatory intervention grounded in principles of individual and group empowerment, and guided by social construction theory. The intervention addressed known and persistent inequities in influenza vaccination among African American and Latino older adults, and associated infections, hospitalizations and mortality. It was designed to increase resident ability to make informed decisions about vaccination, and to build internal and external infrastructure to support sustainability over time. The intervention brought a group of social scientists, vaccine researchers, geriatricians, public health nurses, elder services providers and advocates together with senior housing management and activist African American and Latino residents living in public senior housing in a small east coast city. Two buildings of equal size and similar ethnic composition were randomized as intervention and control buildings. Pre and post intervention surveys were conducted in both buildings, measuring knowledge, attitudes and peer norms. Processes and outcomes were documented at four levels: Influenza Strategic Alliance (macro and exo levels), building management (meso level), building resident committee (meso level) and individual residents. The Influenza Strategic Alliance (I.S.A.) provided ongoing resources, information and vaccine; the building management provided economic and other in-kind resources and supported residents to continue flu clinics in the building. The V.I.P. Resident Committee conducted flu campaigns with flu clinics in English and Spanish. The vaccination rate in the intervention building at post test exceeded the study goal of 70% and showed a significant improvement over the control building. The intervention achieved desired outcomes at all four levels and resulted in a significant increase in influenza vaccination, and improvements in pro-vaccination knowledge, beliefs, and understanding of health consequences.

Culture, Place of Origin, and Service Delivery for Latino Older Adult Immigrants: The Case of Puerto Rican Older Adults

ABSTRACT A conceptual model for the design and implementation of effective social services for Latino older adult immigrants in the United States is proposed in this article. Built on the stage-of-migration framework (Drachman, 1992), the model presented shows how the premigration service experience of Latino older adults can be used as a basis for service design and implementation in the country of immigration. The case of Puerto Rican older adult immigrants is used to illustrate how the model can be applied to understand present service utilization and develop future programs that are useful and culturally sensitive for Latino older adult immigrants.

O4-05-06: Prevalence rates for demenita and Alzheimer's disease in elderly African Americans in Indianapolis: 1992 vs 2001

Latino 1.3; 95% CI 0.9-1.7). Conclusions: African American adults aged 65 and above were more likely to experience cognitive decline compared to White older adults after accounting for demographics, socioeconomics, comorbidity, and their baseline cognitive function. There was no difference between Latino older adults and Whites in rates of cognitive decline. Future research to identify ways to reduce cognitive decline, particularly for racially-diverse groups, are needed.

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.

Fotonovelas

The purpose of this study was to examine the feasibility and impact of a guided educational intervention centering around dementia-oriented fotonovelas on a community sample of Spanish-speaking Latino older adults with a relatively low level of prior exposure to, or knowledge of Alzheimer's disease and related disorders. Two fotonovelas, or “photo novels,” were developed and subsequently tested with 111 Spanish-speaking older adults who completed a survey following group administration of a fotonovela. After a discussion to reinforce the educational content, participants were given a second fotonovela to take home. A second assessment was conducted approximately three weeks later. The results suggest that many of the participants increased their overall knowledge of Alzheimer's disease and most reported satisfaction with the educational materials. Implications for use of fotonovelas as an acceptable and cost-effective means of providing health education to an underserved population are discussed.

Selecting an Acculturation Measure for Use With Latino Older Adults

The purpose of this article is to ascertain the degree to which acculturation measures have been validated for use with older Latino adults and to offer recommendations to assist practitioners and researchers in selecting an empirically sound acculturation measure. The authors analyzed the psycho-metric properties of 15 subjective acculturation instruments that sampled Latino older adult respondents in their development or validation. In general, the limited data suggest a tendency for lower acculturation scores among older Latinos. A number of scales suffer from methodological flaws or lack sufficient psychometric data. The effect of age on acculturation was infrequently analyzed, and no measure was designed specifically for use with older adults, although several measures appear to have promise for use with Latino older adults. Because Latinos are one of the fastest growing sectors of the older adult population, further attention to the development and validation of acculturation measures for this population is urged.

Reliability and Validity of the Self-Efficacy for Exercise and Outcome Expectations for Exercise Scales with Minority Older Adults

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 +/- 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.

Planning HIV education programs for older adults: cultural implications.

In this article the author discusses a needs assessment, through the use of discussion groups of various cultures, exploring the perceptions and attitudes of older adults about human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and HIV education. Five discussion groups (one with Latino older adults, two with African-American older adults, one with White older adults, and one with Chinese-American older adults) were conducted. Semi-structured guiding questions were used with all groups. The questions centered on three major areas: perceptions of older adults and HIV and AIDS, use of condoms for HIV and AIDS prevention, and HIV prevention programs for older adults. The group sessions were approximately 1 hour, were recorded on tape, and were transcribed. The sessions were conducted in the languages of the target population. Because the project was a needs assessment for program development, the number of participants in each cultural discussion group was small, and the nurse group leaders were not experienced in focus group methodology themes and generalizations cannot be made. However, specific findings from the group sessions and recommendations for HIV prevention are presented for further exploration.

Knowledge of Alzheimer's disease in four ethnic groups of older adults.

The present study evaluated knowledge of Alzheimer's disease (AD) in four ethnic groups of older adults. Ninety-six Anglo, 37 Latino, 30 Asian, and 30 African American older adults completed a short survey about AD. Results indicated that Anglo older adults are significantly more knowledgeable about AD than African American, Asian, and Latino older adults. Level of education partially accounted for differences in knowledge of AD between Latino to Anglo older adults. After controlling for age, number of years of speaking English was associated with knowledge of AD in Asian older adults. The results suggest that certain ethnic minority groups do not have sufficient information about AD, and this may explain the lack of AD service use by minorities. Extensive evaluation of barriers to knowledge of AD is needed in order to specifically target minority groups and educate them about AD and the importance of early intervention.