Alicia Arbaje, MD, PhD, MPH, associate professor at Johns Hopkins School of Medicine, talks to WebMD about the health challenges of elders in America’s many Hispanic communities.
This interview was edited for length and clarity.
WebMD: What’s the best way to refer to people with Hispanic roots or identities in a medical context?
Arbaje: This is a great question. The terms are important and unfortunately many of them were put upon us by other cultures and because of a history of colonization. For example, the “Latinx” term is not well embraced by the Latino population – especially older adults. It’s also not widely used in the scientific literature or in geriatrics, though this may change over time.
We see “Latino,” “Latina,” and “Hispanic,” but there’s no great term. This can cause a problem with how data is collected for this population. The best thing to do when working with people of Latin descent is to meet people where they are and ask them to self-identify. Most people tend to identify themselves by nationality (i.e., Puerto Rican, Dominican, etc.). When you put everyone together in one bucket it can sometimes discount the rich diversity and even different health backgrounds.
[For this Q&A with Dr. Arbaje, WebMD will use the terms Hispanic and Latino to refer to anyone who may have roots in Latin America and parts of the Caribbean.]
WebMD: What are the biggest health challenges for today’s aging Hispanic population?
Arbaje: In general, they’re the same issues that happen in most aging populations: Heart disease, diabetes, cancer, respiratory disease. But some things are more common. Dementia seems to disproportionately affect Latinos compared to other groups. And more than 50% of people of Hispanic descent will have type 2 diabetes in their lifetime compared to less than 40% for the rest of the population.
In addition, Hispanic Americans are 1.2 times more likely to be obese than non-Hispanic whites and 1.5 times more likely to have kidney disease compared to other Americans. In addition, while Hispanics have a lower rate of some of the common cancers in the U.S., they have a higher rate of cancer caused by infectious agents such as liver, stomach, and cervical cancer.
The higher incidence of these diseases has a lot to do with historical marginalization versus there being something inherent in Latinos that makes them more likely to have these conditions.
WebMD: Do people in the Latino community receive a different standard of medical care because of their race or cultural background?
Arbaje: In some cases, yes. I see this play out in a variety of ways. The biggest challenge is a lack of access to care, which can lead to a delayed diagnosis. Dementia, for example, tends to be diagnosed later in Latinos.
A lack of trust in the medical community can also delay a diagnosis. This mistrust is sometimes based in disturbing history. To take one example, U.S. scientists tested the birth control pill in Puerto Rican women without their full consent.
Sometimes there are language barriers between doctors and aging patients and that can add to the problem. Unfortunately, the reality is that some in the medical community still look down on people of Latin descent who may not speak English as a first language.
WebMD: Does research data focus on unique issues and health outcomes for Hispanics?
Arbaje: People don’t often think about how data can be skewed – especially the data currently available to us. We have a long way to go as studies and some medical data don’t give enough detail and may not reflect the real makeup of the U.S. population.
One problem is a possible undercounting of Latinos. Nationally, most of the data about the older population comes from Medicare. But Medicare data isn’t great for identifying ethnicity, especially people of multiple ethnicities. As a result, many Hispanics are classified as “other” or “unknown.”
Also, in most medical record software programs people aren’t allowed to self-identify. And if they are, available options may not be accurate.
And many medical records systems may not account for the multiple last names common in many Latino cultures. As a result, some people may mistakenly have two more medical records, which can mean unsafe or incorrect medical care.
WebMD: What can someone in this population do to improve some of those health outcomes?
Arbaje: We know nutrition is critical to health. I encourage Latinos to consider their country of origin, which likely follows a plant-based diet. If you don’t have easy access to fresh fruits and vegetables, ask for help through peers, health care professionals, or even the faith community.
Of course, exercise is important for anyone as well, especially for those who are getting older.
I also say: Demand that the health care you receive is aligned with your goals. This may be uncomfortable for the older generations as they aren’t taught to question their doctors, but younger caregivers can help.
For example, if you’re a caregiver, you could say “My grandfather wants to be able to get to church on the weekends. What can we do to get that?” Or “My grandmother wants to spend more time with her grandchildren. Would these medications allow her to do this?” Present your goals clearly and directly.
WebMD: What about the emotional health impacts faced by this community?
Arbaje: Depression is a problem in older people, but can be hard to diagnose in the Latino community because there’s a stigma often around talking about things like depression that may imply weakness. Or I see patients who assume a low mood is a “normal” part of aging and won’t talk to their doctors about it.
Social isolation is a problem. It can worsen depression and hasten dementia. That’s why staying socially connected is so important as people get older. In many cases, due to immigration and migration, family support systems in Latino communities may be far away and so less able to help. Many younger people, for example, have left Puerto Rico for jobs on the U.S. mainland, leaving a lot of the aging population behind with less support.
That’s why finding, building, and nurturing a support system is so important.
WebMD: Did we learn anything about the health of Latinos during the pandemic?
Arbaje: COVID affected Latinos more than the general population – mostly younger people in the meat packing and home health care industries. And there are some long-term effects that are yet to be seen as these folks age. I think this is going to be an emerging place to watch. In some ways, COVID can accelerate some underlying diagnoses. We have yet to see what happens there.
WebMD: How can health care providers better serve the Latino community?
Arbaje: Hire them! Make it a priority to improve data about the Latino community. Approach care with cultural humility. Engage in shared decision-making and meeting people where they are instead of communicating in a way that places the full blame for health challenges on the patient.
Yes, individual responsibility is important, but good health care is a partnership.
WebMD: What’s your message to loved ones and caregivers of those in the aging community?
Arbaje: To the caregivers, I say, “You are not alone.” There are people who can help make your loved one’s life match what they want it to be as best as possible. Geriatricians in particular see it as a mission to help older adults have a better quality of life. But you can also get support from other health care and mental health professionals and from your faith community and peers.
Lastly, know you are doing noble work. Treasure this time. It is a distinct honor and privilege to usher someone through the later stations in their life. It can be challenging, but it’s important and sacred work that has real value.
Alicia I. Arbaje, MD, MPH, PhD, associate professor of medicine, Johns Hopkins University School of Medicine; director of transitional care research, Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology.
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