Una escala psicométrica breve para evaluar el estado cognitivo de hispanoparlantes de edad mayor / A short psychometric scale to evaluate the cognitive status of aged Spanish speakers

During the last ten years there has been an interest for determining the prevalence and incidence of dementia among older adults and for cognitive tests that do to discriminate by level of education. This article revolves around the validation of a minimental exam, the Cabán minimental, to measure the cognitive capacity of Spanish-speaking adults 60 years of age and older; a test that is not affected by level of education. The factors measured in the Cabán minimental are: orientation, visual and motor coordination, learning, recent memory and abstraction. The validation process underwent two phases. During the first one, the Cabán test was subjected to construct validation and internal and predictive consistency tests. The second stage comprised a comparison between the Cabán and Folstein minimentals. The Cabán showed a statistically significant difference to discriminate for subjects with dementia. Results also suggest that the Cabán is not as much affected as the Folstein by differences in education.

Factores relacionados con el uso del mamograma de cernimiento en mujeres de edad mediana en Puerto Rico / Factors related with the use of screening mammogram in middle age women in Puerto Rico

Mammography for low-income women is an important intervention issue as it is still under utilized in these sectors. Despite evidence in favor of breast cancer screening with mammograms, research indicates that mammogram compliance among low-income females and women over 50 years of age has been slow. This article revolves around the factors that affect compliance with screening mammograms among low-income women ages 40 to 64 in Puerto Rico once they receive a referral from a physician. Although the multivariate analysis demonstrated that only age, work outside of the home and performing breast self-exams significantly increased the probability for middle-aged, low-income women in Puerto Rico to comply with referrals and have mammograms, this research illustrated that certain factors such as knowledge about the disease and screening practices, a satisfactory perception of the patient-physician relationship, and the performance of a clinical breast exam by a physician influence mammogram compliance.

Knowledge and beliefs of breast cancer among elderly women in Puerto Rico.

This is the first national study of breast-cancer knowledge, beliefs, and early detection practices among elderly women (65+) in Puerto Rico. Cancer breast examination (CBE) was the most common early detection practice, followed by the mammogram, with breast self exam (BSE) a distant third. The primary reasons most often cited for never having a mammogram related to both personal and external factors: not having symptoms, negligence or forgetfulness, and not having a physician's referral. No statistically significant difference (p < 0.05) was found between knowledge and early detection practices. Conversely, beliefs had an impact on preventive behavior. Those who had less misconceptions were most likely to have had a CBE or a mammogram. Bivariate analysis demonstrated that age was associated with performing a BSE once or twice monthly, ever having a mammogram, and having a mammogram in the past two years. A higher socioeconomic status was associated to performing BSE and ever having had a mammogram. Education correlated positively to ever having a mammogram or having a mammogram in the two years prior to the interview. Factors that explained compliance with a mammogram in the last two years included referral from a physician, owning a car, and receiving information after menopause on breast cancer from a health care provider. A gynecological visit increased the probability of having had a mammogram during the last two years. Logistic regression determined that a referral from a physician was the most important factor for mammogram compliance when a combination of variables were considered.

[Contributions of anthropology to an ethical approach to aging]. / Contribuciones de la antropología a un acercamiento ético a la vejez.

This article summarizes a presentation on the meanings and implications that crossing the old-age threshold has on the self-perception of the older adult. It draws from anthropological studies on the meaning of old age and sickness in old age that emphasize that meaning in old age for the older adult is the outcome of his/her considerations on aging in terms of individual experiences and the continuity of identity amidst the social and biological changes associated with old age. Implications for decision-making about medical treatment, the right to privacy, and the right to receive care in the less-restrictive possible environment for patient autonomy as well as interpretations about self-respect and self-determination are discussed.

[Elderly women in Puerto Rico: a brief summary of gerontological research activities]. / La mujer de edad mayor en Puerto Rico breve resumen de actividades de investigación gerontológica.

Elderly women are a forgotten topic in women's research and in feminist issues. This article presents a concise summary of gerontological research on women's issues in Puerto Rico. Research is divided in two main categories: demographic and health and social issues. A brief account of needed research areas is included. A demographic and health profile of older women in Puerto Rico and their informal support systems is presented. The article concludes with thoughts pertinent to the relevance of conducting research from the perspective of elderly women themselves and not merely that of researchers.

Knowledge and beliefs of breast cancer among elderly Puerto Rican women: validation process of scales.

This paper presents the results of the validation process to determine the concepts for knowledge and beliefs about breast cancer early detection practices among Puerto Rican elderly women. An initial questionnaire was designed based on the scientific literature review and focus group experiences. To determine its reliability and validity, 50 elderly women, stratified by type of profession and place of residence, were interviewed twice. Consistency of the questionnaire was analyzed using binomial test, matched t-test, Pearson correlation coefficient, and Cronbach's coefficient effect. Factor analysis (FA) was the statistical technique used to analyze the grouping of the knowledge and beliefs statements. FA indicated that three scales for knowledge and one for beliefs can be constructed. The purpose of the scales was to identify differences among groups, according to breast cancer early detection practices. Construct validity was performed to determine the number of statistical associations between the scales and these practices. The results showed that beliefs scales was associated with practice of mammogram (p < 0.05), and visit to the gynecologist (p < 0.05) while the knowledge scale for early-detection was associated with the clinical breast examination (p < 0.05). The beliefs scale had better consistency than the knowledge scale. The Cronbach's alpha was 0.75 for the beliefs' scale and 0.30, 0.41 and 0.43 for each defined knowledge scale, respectively.

The effects of the cultural context of health care on treatment of and response to chronic pain and illness.

Qualitative data from two studies in Puerto Rico and New England are used to show how cultural values, standards and beliefs in different health care contexts affect (1) health care professionals' responses to patients' problems, (2) the relationships between providers and patients, and (3) the patients' responses to chronic pain and illness. Influencing elements in the care setting include the world view of the relationship of mind and body in illness processes, the dominant values and standards regarding pain and illness behaviors and the degree of cooperation between the providers and other agencies the patient depends on for compensation, rehabilitation and health insurance. In the New England study, the biomedical world view of mind-body dualism was shared by providers and most patients, but this shared belief often contributed to substantial patient stress and alienation. In contrast, in the Puerto Rican study providers and patients often shared a view of mind-body integration in illness and valued treatments which addressed chronic pain as a biopsychosocial experience. In this setting, shared views and values contributed to more supportive patient-provider relationships, and patients thus experienced less treatment-related stress.

A cross-cultural comparison of adaptation to chronic pain among Anglo-Americans and native Puerto Ricans.

Using quantitative and qualitative data from studies in New England and Puerto Rico, we compare the chronic pain experiences of Anglo-Americans and native Puerto Ricans. We also compare adaptation to chronic pain between and within these two groups. Positive adaptation is defined as the process of adjustment in behavior and attitudes which facilitates resumption and continuation of a life defined by the subject as meaningful and worthwhile. Our case studies and quantitative analyses demonstrate that successful adaptation is associated with a reduction in depression, tension, and worry; and the realistic continuation of family, social, and work roles. Our analyses also demonstrate that the factors most often associated with adaptation are cultural (meanings and standards), psychosocial (social support, age, socioeconomic status, psychological coping style), the cultural context of care (providers' world views), and the political and economic circumstances under which compensation and rehabilitation are sought. Our quantitative analyses show significant inter- and intra-cultural group differences in pain intensity and emotional responses to the pain. However, despite higher pain intensity and more emotional responses among Puerto Ricans, there was no significant difference between the two groups regarding interference in daily activities. The two groups simply appear to experience chronic pain differently. We propose that the difference is not positive or negative in itself--it is simply a different reality which should be evaluated from an emic perspective and not through the cultural lens of the outside provider or researcher. Intra-group analyses are essential because they provide insight into the standards, norms, and variations within specific cultural groups.

[Relevance of health promotion programs for the elederly]. / La relevancia de los programas de promoción de la salud para las personas de mayor edad.

The rising number and proportion of elderly adults have implications for health promotion. The concept of wellness and not just health should be incorporated in these programs due to its holistic connotations. Life-style is another essential component in this conceptual framework. Wellness promotion programs for the aged must consider physical, biological, psychological and sociocultural characteristics of individuals from a longitudinal/historical perspective as well as specific health problems. Programs geared to the adoption of new life-styles by the aged must recognize their capability and right to assume responsibility for their well-being.

[Elderly population of Puerto Rico: Implications for health services]. / La poblacion de edad avanzada de Puerto Rico: Implicaciones para los servicios de salud.

This article presents an overview of the major sociodemographic health characteristics and patterns of health services utilization of older Puerto Rican adults. Comparisons between men and women are established. The elderly present and impoverished sector, have lower educational status and suffer from more chronic illnesses than the rest of the population. Women fare lower than men in terms of these variables. Implications of the challenge that the aged represent for health service delivery in Puerto Rico are discussed centered upon the fact that most elderly reside in the community and their families constitute their principal source of support.

[Informal support systems for Puerto Rican elderly women: implications for the health care delivery system]. / Los sistemas informales de apoyo de la mujer puertorriqueña de edad avanzada: implicaciones para el sistema de prestación de servicios de salud.

This article presents a qualitative analysis of the informal networks of support of older Puerto Rican women. It focuses on the support offered by adult children to their aged mothers. Cultural definitions about female and male roles affect the types of exchange that occur within the family. The elderly mothers expect and receive more help from their daughters than their sons. The daughters feel pleased by the fact that they are able to assist their mothers yet, many indicated that in certain occasions they feel stress.

Puerto Rican elderly women: the cultural dimension of social support networks.

This ethnographic study of elderly Puerto Rican women living in Boston explored the influence of cultural meanings on patterns of social interaction and support. Women's roles and social relations were found to reflect the importance of motherhood and domestic responsibilities. With aging, women expect and value respect from their children and younger persons and regard this as even more important than affection. These cultural factors affect friendship selection, family interdependence and exchanges as well as relations with the formal health care system.