|
COPYRIGHT 2000 JAI Press, Inc.
INTRODUCTION
The Hispanics [nursing home residents] that we do take in ... they are not the 70- and 80-year-olds. We're seeing them come in at 90+ years of age. And it's because their needs just can't be met [at home] anymore, or a spouse has a problem and needs medical care, and so then the surviving or helping individual has to make a choice. "Do I take care of mom or do I take care of my spouse?" ... It's a hard choice.... "I can't take care of both of them in the home, so I'll have to take care of one or the other ... who needs me more right now?" (from interview with nursing home care provider)
Hispanics are the fastest growing minority group in the United States. During the 1980s, a 39 percent increase was observed in the Hispanic population, compared to less than 8 percent in the non-Hispanic population. In 1990, approximately 22 million Hispanic people lived in the United States, representing 9 percent of the population (Marin and Marin 1991). Varied immigration histories have led to diversity in the Hispanic population ranging from early Spanish and Mexican residents in the American Southwest to later agricultural labor immigration bringing Mexicans, and more recent immigration from Puerto Rico, Cuba, Central and South America. The aging of the more recent immigrants and those who were young upon arrival, and elders whose families have been here several generations are all factors leading to major growth of the Hispanic elderly population in the next century (Siegel 1999).
Hispanics are a young population as a whole, with only 4 to 5 percent of Mexican Americans, Puerto Ricans, and Hispanics of South American and Central American origin (and 21% of Cuban Americans) being over age 65 (Siegel 1999). However, in many parts of rural America such as the Southwest, a higher percentage of the older adult population is Hispanic. The Hispanic older population is projected to increase from 1.5 million in 1995 to 7.8 million in 2030, and to 13.8 million in 2050. The most rapid growth will occur in those over age 80 (AARP 1997; Siegel 1999).
Older age is a time of vulnerability to chronic illness and multiple complex health problems. The minority older population in the future, continuing a current trend, will include a disproportionate share of the most needy persons, especially those of extreme old age or living alone. This group will continue to require a disproportionate share of support (Siegel 1999). Rural elders have higher poverty rates, lower levels of education, more limited transportation, and poorer health status than their urban counterparts (Coward et al. 1994). These characteristics are especially common among rural-dwelling Hispanic elders who are more likely to be marginally literate in either Spanish or English and of lower socioeconomic status than non-Hispanic whites of the same age (Espino and Sotomayor 1992; Siegel 1999; Zambrana 1995).
As a group, many Hispanic people are poor and an estimated one in four Hispanic families live below the poverty level (COSSMHO 1990). An analysis of U.S. Census data by Bull and Bane (1993) showed that 35.6 percent of nonmetropolitan Hispanics over age 65 lived below the poverty level in 1990, compared to 13.6 percent of their white non-Hispanic urban counterparts. Only 60 percent of Hispanic persons complete high school, compared to 89 percent of non-Hispanics (U.S. Bureau of Census 1991). Further, approximately 25 to 33 percent of Hispanics have no medical insurance, the highest rate for any group of ethnic minorities (COSSMHO 1990; Gallo 1993). These limitations in resources affect many aspects of health and health care (Ginzberg 1991).
Most comparisons of functional status have shown that Hispanic elders are at a disadvantage compared to others in the United States (Villa et al. 1993). Hispanics experience higher levels of disabilities in activities of daily living and in instrumental activities of daily living than non-Hispanic whites. The leading causes of death among older Hispanics are heart disease and cancer (U.S. Department of Health and Human Services Public Health Service 1992). In addition, the major chronic health problems of older Hispanics include diabetes, obesity, chronic liver disease, pneumonia, influenza, cervical cancer, and HIV infection (U.S. Department of Health and Human Services 1990; Markides and Wallace 1996). Hispanic elders are said to have low self-ratings of health, but this assessment may be prone to cultural and ethnic variation in the definition of "good health" (Shetterly et al. 1996).
Many majority rural Americans find access to health care a serious problem because of distance and lack of transportation, maldistribution of health care providers and facilities, and lack of other resources. For ethnic minority rural populations, such as Hispanic older adults, barriers such as language and limited sensitivity of health care providers to cultural nuances compound the problem. For example, Hispanic elders were found to have a greater need for long-term care services than did the population at large; however, research by Villa et al. (1993) suggested that Hispanic elders are underutilizing these services. Angel et al. (1996) conducted a secondary analysis of a large epidemiological database on Mexican American Hispanics in the southwestern U.S. They found that the majority of Hispanic elders preferred to live with their spouse, live alone, or live with family members, rather than electing nursing home or other institutional care. This preference was especially true among more traditionally focused elders. Older Hispanics rely on family support as long as possible and begin to use formal long-term care services at higher levels of disability or when children are unable to meet caregiving needs (Dilworth-Anderson and Burton 1999; Espino 1993; Wallace et al. 1999).
Rural elders possess a strong sense of independence (see Figure 1). They are resistant to outside help, are self-reliant, desire to age in place, and often depend on informal care of family and friends to help meet their health care needs (Congdon and Magilvy 1998a, 1998b; Magilvy, Congdon, and Martinez 1994; Schneider and Greenberg 1992; Yawn, Bushy, and Yawn 1994). Family and church are important to many Hispanic elders (Averill 1997; Martinez 1999). Family closeness among Mexican American Hispanics is characterized by frequent visits from nuclear and extended family, and the sharing of everyday joys and sorrows (COSSMHO 1990; Keefe 1984; Martinez 1999). Holding medical, mental health, or other problems close to the family is a norm, leading to a reluctance to fully use available health care resources.
[Figure 1 ILLUSTRATION OMITTED]
Nursing home use is increasing among ethnic elders as a result of changing cultural norms, economic adversity, decreasing discrimination, and decreasing community supports (Mui and Burnette 1994). One study of frail Hispanic elders found that 3.8 percent had used a nursing home within the past 6 months (Mui and Burnette 1994). However, Congdon and Magilvy (1998a) found that although rural nursing homes were sometimes used as an alternative housing option for some elders, many rural counties have no nursing home or assisted living facilities.
Research on health care transitions for rural older adults is very limited. In a longitudinal ethnography focused on health care transitions for rural older adults, a disturbing lack of care management and coordination was found (Congdon and Magilvy 1998b; Magilvy and Congdon 1999). In addition, many transitions from hospital to home or hospital to nursing home were made in crisis. Decision-making was hasty and both older adults and their families became frustrated and bewildered at the rapidity with which admission and discharge decisions were made (Congdon and Magilvy 1998b; Magilvy and Congdon 1999).
Much of the research on older Hispanic persons has been conducted in urban areas; we have little knowledge of rural-dwelling Hispanic elders and their health care experiences and needs (Cuellar 1990; U.S. Department of Health and Human Services Public Health Service 1990). Clearly, research is needed to provide a basis for planning culturally congruent care for this vulnerable rural population. The purpose of this article is to explicate common themes in the health care experience of older rural-dwelling Hispanics based on a major rural longitudinal ethnography and three companion focused ethnographies conducted by the authors.
METHODS
Over the past 10 years, four federally funded studies have been conducted by the authors in two areas of rural Colorado, the southern Colorado San Luis Valley and the northeastern plains area of the state. The San Luis Valley is a beautiful and expansive high mountain park surrounded by two mountain ranges. Over 40 percent of the population...
Read the full article for free courtesy of your local library.
|
Bookmark this article
Print this article
Link to this article
Email this article
Digg It!
Add to del.icio.us
RSS
