Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults

Objectives This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. Methods Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. Results African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. Discussion Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.

Age-Friendly as Tranquilo Ambiente: How Socio-Cultural Perspectives Shape Older Latinos’ Lived Environment

Researchers have increasingly considered the importance of age-friendly communities to improve the health and well-being of older adults. Studies have primarily focused on the built environment, such as community infrastructure, older adult behavior, and environmental expectations. Less attention, however, has been given to the role of cultural characteristics in shaping perceptions of age-friendly environments for Latinos. Using an ethnographic methodological approach, including participant observation in a Latino community near New York City and 72 semi-structured interviews, this study provides empirical insights into how older Latinos characterize age-friendly communities. Latino older adults described their community as age-friendly using Tranquilo Ambiente (TA), which translates to a calm or peaceful environment. According to older adults, a TA possesses the following: 1) a sense of personal safety, including protection of their body, 2) ethnic, social connectedness, including networks with other Latinos and important social and cultural events; and 3) a comparative understanding of their communities treatment of seniors versus other geographical and spatial locations. While much has been written on the role of the built and social environment in developing and implementing age-friendly communities, more research on the cultural significance and understanding of place among marginalized older adults is necessary. TA and its characteristics demonstrate that cultivating an age-friendly setting requires adapting structures and services to promote Latino older adults' social and cultural support and engagement.

The Use of Concept-Mapping to Structure the Cultural Adaptation of Educational Curricula for Latino Older Adults

Culture, embedded in language and reflected in colloquial expressions, influences behaviors and cognitive constructs that affect health. To reach Latino older adults, health promotion efforts should include congruent cultural aspects—such as relevant metaphors, values, and proverbs—that will resonate with their cognitive constructs. However, this content should also be situated within a broader social context. For community-dwelling Latino older adults, this means considering their care systems and the multiple stakeholders within. In this paper presentation, we describe an innovative, interdisciplinary collaboration to culturally and linguistically adapt existing Illinois Extension curricula to meet the needs of Latino older adults and their families living in Cook County, which includes Chicago and its neighboring suburbs. We will demonstrate how concept-mapping (CM) studies can be used to structure the cultural adaptation of educational curriculum to a Latino audience. Specifically, we describe these CM studies, which asked how multiple stakeholders and Latino older adults living in the Chicagoland area defined positive aging provided empirically-grounded direction for our 11-member steering committee, composed of investigators, service leaders, and Latino older adults. We also will describe how the current project deepens relationships in the community that facilitate dissemination efforts to Latino older adults.

Creation of a Latin-American Dementia Advance Care Planning Guide

The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia) is an advance care planning conversation guide for use within the context of dementia (Dassel et al., 2019). Considering that Latino adults have the highest risk of ADRD, a culturally sensitive and translated Spanish version of the LEAD Guide was needed. Therefore, the objective of this study was to: 1) translate the LEAD Guide into a Latin-American Spanish version (i.e., LA LEAD) and 2) assess the applicability and acceptability of the LA LEAD through focus groups with Latino older adults. First, the LEAD Guide was translated into a “neutral” Spanish version. Second, forward and backward translation was conducted to create the LA LEAD. Third, two 1.5-hour focus groups with Spanish-speaking Latino adults age 50+ who were: a) healthy adults (N=7) or b) current or previous dementia caregivers (N=7) were held. The focus groups were recorded, translated, and transcribed for descriptive analysis, which revealed three domains regarding the LA LEAD: 1) Family Dynamics: the guide could help prevent family conflict, designate a health care proxy, and reduce burden; 2) Cultural Expectations: acknowledgement of cultural nuances between LA countries, the familial responsibility of caring for family in the home, and the influence of religion on end-of-life care decisions, and 3) Health Literacy: lack of knowledge about advance care planning conversations, documentation, and dissemination. This process resulted in the creation of a validated LA LEAD Guide, which is a culturally and linguistically appropriate and acceptable advance care planning tool for Latino older adults.

Racial/Ethnic Differences in Trajectories of Dementia Onset

Racial and ethnic minority older adults—especially non-Latino Black and Latino older adults—continue to have a higher prevalence of dementia with longer delays in formal diagnosis compared to non-Latino Whites. Few studies have estimated racial/ethnic differences in trajectories of dementia onset using nationally representative data with representation from the three largest racial/ethnic groups in the U.S.: non-Latino White, non-Latino Black, and Latino older adults. Additionally, given the delays in formal diagnosis we rely on a measure of probable dementia that takes into account both formal diagnosis and cognitive function. Data from the National Health and Aging Trend Study (NHATS, 2011–2019) reveals three trajectories of dementia onset (early, late, and dementia-free) and we find that Latino and Black older adults are at greater risk for early dementia onset compared to non-Latino Whites. Our next step is to explore the role of social function for dementia disparities.

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. Methods: We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. Results: Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. Discussion: Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.

Relative Importance of Positive Aging Dimensions Among Latino Older Adults and Service Providers

The variation in Latino older adults’ conceptualizations of positive aging across studies suggests greater attention should be paid to within-group factors. The purpose of the current study was to identify which factors are important to positive aging from the perspective of Latino older adults, and whether the importance of these factors varied based on participant characteristics. A second aim of this study was to examine whether there are differences in views of successful aging between Latino older adults and service providers who support aging Latinos. The current study was conducted as part of a broader research project investigating Latino older adults’ perceptions of positive aging. Latino older adults (n = 93) and aging services providers (n = 45) rated the importance of a series of statements related to positive aging. Mixed-methods analysis of the statements identified nine distinct dimensions (Positive Outlook, Spirituality/Religion, Healthy Behaviors, Independence, Self-Care, Support for Others, Social Support, Leisure Activities, and Adaptability). Latino older adults rated Positive Outlook and Spirituality highest on importance, and ratings differed based on gender and other individual difference characteristics. For example, men placed greater relative importance on Independence and Support for Others compared to women, and younger participants rated Independence higher on importance compared to older participants. In addition, Latino older adults (vs. providers) placed greater importance on all aspects of positive aging, with greatest mean differences related to providing Support for Others and Spirituality. These findings have implications for wellness programs for Latino older adults and training for service providers.

Stakeholders’ Ideas About Positive Aging for Latinos: A Conceptual Map

Few studies explore the differences between diverse stakeholders’ understandings of what constitutes “positive aging” for Latino older adults. To address this gap, we worked with a 20-member steering committee (SC) of community stakeholders to collect concept mapping data from 38 scholars and community workers. We generated 90 statements related to positive aging from the literature and produced concept maps based on four different stakeholder groups’ ratings of them. All stakeholders prioritized “Financial Security,” but scholars marked “Spirituality” as least important whereas community workers rated it second highest. The design of programs for Latino older adults should reflect such differences.