The moderating role of everyday discrimination on the association between post-traumatic stress and loneliness among older Puerto Ricans.

OBJECTIVES: This study examines the relationship between post-traumatic stress and loneliness and whether this relationship varies by perceived everyday discrimination among older Puerto Ricans. METHODS: A total of 304 Puerto Ricans aged 60 and above from Wave 3 of the Boston Puerto Rican Health Study were included. Ordinary least squares regression examined the association between post-traumatic stress, perceived everyday discrimination, and loneliness. RESULTS: Post-traumatic stress was significantly associated with a higher level of loneliness (ß = 0.282; p < 0.001; 95% CI: 0.142, 0.423). The interaction effect between post-traumatic stress and perceived everyday discrimination on loneliness was statistically significant (ß = 0.083; p < 0.05; 95% CI: 0.062, 0.230). More specifically, the positive association between post-traumatic stress and loneliness becomes more robust with the increase in perceived everyday discrimination. CONCLUSION: Given an increase in population size on the U.S. mainland and migration from Puerto Rico due to natural disasters and declining economic conditions, it is essential to better understand the effect of perceived discrimination against older Puerto Ricans on the mainland United States as well as those who immigrated and stayed through older age. Outreach strategies and interventions that address perceived discrimination can help mitigate loneliness among older Puerto Ricans who experienced trauma.

Mental health care use in men with comorbid diabetes and depression: The role of age and race.

OBJECTIVES: Older adults with diabetes have double the normal average risk for depression. While women also report higher rates of depression, men are less likely than women to recognize symptoms and seek assistance for mental health treatment. Racial disparities in mental health care use among men have also been identified. While age and gender differences in mental health care use have been accounted for in adults with comorbid diabetes and depression little is known about within group differences among men. The purpose of this study was to examine the influence of age and race on mental health service use in a sample of men with comorbid diabetes and depression. METHODS: This study utilized secondary data from a large health care delivery system serving in a Midwestern urban city and included 335 Black, and non-Latino White men with comorbid type 2 diabetes and depression. RESULTS AND DISCUSSION: Findings indicate that men under the age of 55 were less likely to experience a 6-month or more delay in receiving a psychiatric medication prescription after their initial depression diagnosis. Black men over 55 years of age were significantly more likely to experience a delay of over six months to receiving psychiatric medication. More research is needed to explore preferred depression treatment methods for older Black men with type 2 diabetes, in addition to any issues with access to pharmacological medications to treat depression.

Alzheimer's Disease in the Latino Community: Intersection of Genetics and Social Determinants of Health.

Alzheimer's disease (AD) is the most common type of dementia among individuals 65 or older. There are more than 5 million diagnosed cases in the US alone and this number is expected to triple by 2050. Therefore, AD has reached epidemic proportions with significant socioeconomic implications. While aging in general is the greatest risk factor for AD, several additional demographic factors that have contributed to the rise in AD in the US are under study. One such factor is associated with the relatively fast growth of the Latino population. Several reports indicate that AD is more prevalent among blacks and Latinos. However, the reason for AD disparity among different ethnic groups is still poorly understood and highly controversial. The Latino population is composed of different groups based on nationality, namely South and Central America, Mexico, and Caribbean Hispanics. This diversity among the Latino population represents an additional challenge since there are distinct characteristics associated with AD and comorbidities. In this review, we aim to bring attention to the intersection between social determinants of health and genetic factors associated with AD within the Latino community. We argue that understanding the interplay between identified social determinants of health, co-morbidities, and genetic factors could lead to community empowerment and inclusiveness in research and healthcare services, contributing to improved diagnosis and treatment of AD patients. Lastly, we propose that inserting a neuroethics perspective could help understand key challenges that influence healthcare disparities and contribute to increased risk of AD among Latinos.

Framing Effects on End-of-Life Preferences Among Latino Elders.

This study compared how the presentation of end-of-life (EOL) choices influences responses by Latino and White older adults relative to resuscitation preferences. The authors apply prospect theory, which deals with decision making based on how choices are framed. Participants were presented with differently ordered questions framing a resuscitation scenario and asked to rate their preferences. Results show that Latino participants were significantly influenced by the framing order of treatment options with regard to resuscitation while Whites were not. Health professionals need to be aware that the ways they present EOL options are likely to affect the choices of Latino older adults. Further research is needed with Latino subgroups.

Prevalence of intimate partner violence and associated risk factors among Latinos/as: an exploratory study with three Latino subpopulations.

This study seeks to contribute to the limited literature on intimate partner violence (IPV) with Latino populations by analyzing national estimates of prevalence of and risk factors for IPV across the three largest Latino subgroups: Cuban-Origin, Mexican-Origin, and Puerto Ricans. Results showed that foreign-born Mexicans reported the highest rates of IPV compared with foreign-born Cubans and Puerto Ricans; Latinas with higher levels of education and employment reported higher levels of IPV; and foreign-born Mexicans reported a higher rate of less injurious IPV than their U.S.-born counterparts. These findings highlight the need to inform programs of varying nature of Latinas experiencing IPV.

Factors associated with mental health service use among Latino and Asian Americans.

Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.

Chronic illness intrusion: role impairment and time out of role in racially and ethnically diverse older adults.

PURPOSE OF THE STUDY: Little is known about the effects of chronic illness on social role participation among racially and ethnically diverse older adults. This study was undertaken to better understand disruptions in role among African American, black Caribbean, white, Latino, and Asian older adults with arthritis, heart disease, or diabetes. DESIGN AND METHODS: This study consisted of a cross-sectional secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys. Role disruption was operationalized using time out of role and role impairment in the past 30 days. Data from participants aged 65 and older were used in negative binomial regression analyses. RESULTS: Overall, prevalence of role impairment occurred more often than time out of role. Race and ethnicity were not associated with time out of role, but they were for role impairment. Whites experienced more role impairment than any other racial or ethnic group. Within-group analyses identified that chronic illness, role participation, and socioeconomic factors are related in different ways depending on race or ethnicity. It appears that for some racially and ethnically diverse older adults, higher income and education are protective against role disruption. IMPLICATIONS: Race and ethnicity are factors in how the social roles of older adults are affected by chronic illness, and it appears that role disruption varies with type of illness. Interventions to support older adults with chronic illness should take into account the cultural factors related to role disruption.

Brokering language and culture: can ad hoc interpreters fill the language service gap at community health centers?

The purpose of the research was to explore the ability of ad hoc interpreters to integrate into the organizational climate at a federally qualified community health clinic (CHC) and create satisfactory services for limited-English-proficiency clients. Survey and interview data were gathered from staff (n = 17) and Latino clients (n = 30). The data indicate that clients felt satisfied with interpreters. Some friction existed between the interpreters and the medical staff due to incongruent expectations. The CHC's organizational climate and the interpreters' commitment to the Latino community mediated the impact of these tensions on services and satisfaction. The study offers important insight into how ad hoc interpreters can become professional medical interpreters within a limited-resource service environment.

Culture, place of origin, and service delivery for Latino older adult immigrants: the case of Puerto Rican older adults.

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.