Diabetes in the Hispanic Elderly Population

Diabetes is prevalent among the elderly Latino community. The process of accepting and acknowledging the seriousness of having this condition can have a mental effect on the elder. There are factors that need to be taken into account that will change for the typical Latino elder living in the central valley. Since much of the Latino community in the central valley works in agriculture, income is low and adherence to medication becomes difficult. Economic factors directly affect their health. The family who is associated with the diabetes patient will suffer as well. Dietary and lifestyle changes can help prevent long term medical conditions and help an elder Latino take control of their life by controlling their diabetes.

Effects of Diabetes in Elderly Latinos
As far as humans are concerned, time only flows in one direction. From the point of conception, humans are continuously aging. Once we have reached the pinnacle of our physical size, our body and health begins to deteriorate. Although there are preventative measures to stunt our decay, no one is exempt from aging and eventual death. Some diseases however cannot be prevented, rather they can only be controlled. Diabetes type 2 is an example of such a disease. Genetics play a huge part in the prevalence of the disease and one ethnic group has a high prevalence of diabetes; Latinos. Elderly Latinos are by far the most severely impacted group within the culture. The disease has impacts throughout the entire life of the Latino’s elderly; socially, economically, and of course lifestyle. The following studies have been done based on the Latinos living in the United States.

Acceptance by the elderly that they have a life threating condition may come as a shock. Based on a study, many elderly Latinos described the disease as frightening (Coronado, page 5). They compared the disease to HIV and cancer. To become diagnosed with a disease which a person relates to incurable conditions can be a traumatic experience. Diabetes is taken extremely serious by the elderly community. In fact many of the elders did their research on what had caused the disease in the first place. Many believed it came from genetics. Others claimed the food they consumed played a large role in their development of diabetes. Only a few people however, attested exercise was a valuable asset when diagnosed with diabetes. This speaks about the culture as a whole.

This could mean that the elderly Latinos who were part of this experiment were reluctant to exercise. Exercise can improve their condition in many ways by allowing the body to use sugars in a more effective way. Acceptance could be hard; the implications of having such a disease can have a large mental impact on the elderly. By elderly Latinos accepting that they have diabetes, they are consciously accepting that they need medical attention. This medical attention can save a patient’s life and therefore it is crucial for a patient to be diagnosed early, so the healing process can begin sooner. It may not be easy for them to accept it, however they will begin to notice the symptoms and eventually succumb to medical treatment or risk suffering extreme high or low glucose levels, which in some cases could mean death.

Once the elderly Latino diabetes patient accepts that they have a dangerous medical condition, the meditation regime will begin. Depending on the type of diabetes a patient has, they can be prescribed insulin, pills or a combination of both. Adherence to medications is a huge problem with Latino Elders. Many dislike the use of insulin simply because of their dislike for needles. The fact that the patient will be on medications for the rest of their lives may result in patients assuming one dosage miss will not have a huge impact on their health. The reality is that a diabetes patient will have severe symptoms with either hyper or hypoglycemia (high or low blood sugar levels) within an extremely short time span. Constantly injecting yourself and inserting a needle in your body may be of discomfort for patients. Also, as is the case for many medications, some patients do not like taking oral medication. The burden of consuming or injecting medication on a daily basis hinders the possibility of a worry free life. Constantly taking medications for a disease can also give a sense of low self-worth. A study shows that the “prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men” (Black Page 546).

For this reason, depression is high among elderly Latino men. Diabetes patients will forever be under the mercy of their medications. This is sure to alter their lifestyle in various ways, hinder true enjoyment of their lives. Another aspect affected by diabetes in the elderly Latino community is in their diet. As Latinos we are used to a carbohydrate rich diet. Rice, beans, and a whole lot of tortillas are what the basic Latino diet consists of. As a diabetes patient many foods must be reduced as to not disturb the homeostasis of the sugar levels in their body. When a diabetes patient wishes to indulge on their favorite sugar filled snacks, they must carry the burden that they are consciously harming their own health. A change is usually recommended by physicians, they suggest less tortillas and rice, and more meats, particularly chicken. Some patients have trouble or are plain stubborn and resist any dietary changes. Some older Latino men are reluctant to change their diet, especially when a female physician suggests the changes. Older male Latinos prefer older male physicians to give them advice, this however is an entirely different subject called machismo, which we will ignore, as we can spend hours writing on machismo. To a Mexican family, food is a big part of their lifestyle. Not only is the person with diabetes affected however, but also those who care for the person.

The homemakers of the house must go out of their way to cook special meals specifically for the family member with diabetes. If an unhealthy diet is being consumed by a diabetes patient, without doubt there will have to be a change, reluctant as the patient may be. Money is a big factor in the quality of life. Based on studies done by The Measure of America, income is directly related to health. The central valley of California is primarily agriculture and many of the Latino community that lives in the central valley works those fields. California is composed of almost 40 percent Latinos, and the primary income of these Latinos is usually related to field work. An example is Congressional District 20 (CD 20), which is in California close to Fresno. 70 percent of the population is Latino and the median income for this district is around 18,000. This income is so low that CD 20 ranks second to last in the entire USA. Now since the population is 70 percent Hispanic in CD 20 and 8.5 percent of Californians suffer with diabetes and each CD has 450,000 people, this means that there are roughly 26000 people suffer with diabetes in this area.

Adjusting for people in the ages above 55 leaves gaps in the data, therefore we will assume the entire population is above this age. This many people suffering with a condition that requires intensive care and constant medication means many people will have to give up goods in order to pay for medications. With a big part of their income going into medications, the elderly are left with a low budget to work with. Granted many of the older citizens will have some type of insurance, but we cannot assume that they all will. The cost of insulin in the entire USA will continue to rise unless preventative measures are taken (Krein page 4). The cost of Diabetes is astronomical when we put together all the expenses. Insulin, various oral medication, co-pays, doctor visit charges, gas, and time are just a few examples of the total cost of diabetes. Not to mention that eating healthy is more expensive that eating junk food in today’s world, the burden of maintaining a healthy diet becomes near impossible for the elderly. Fortunately big pharmaceutical companies have taken notice of the struggles of the extremely poor and created Patient Assistance Programs (PAP) where people without insurances can apply and hopefully be accepted into programs that allow the patient to receive free medications for an entire year.

Clinics such as UCSF-Fresno Medication Management Services aid these types of patients in applying and maintaining their PAP applications. This particular pharmacy manages diabetes specifically and specializes in counseling patients on the disease and how the medications will or will not help if taken incorrectly. A large number of patients who take advantage of the program are Latino and Elderly, as witnessed by the writer. The cost is low, however time is always lost when dealing with a medical condition that is untreatable. Undoubtedly diabetes has a large cost to the patient. The Latino elders who endure diabetes have without doubt a rough time. However, the families who care for them suffer as well. Seeing as many elderly Latinos cannot hold a job and may or may not receive help from the government or from PAP programs, there is only one logical choice in who will take care of them. Latino families take care of this elders and if needed move them in to take care of them. The family must adjust their lives in order to accommodate for the elders. The elders however, are usually reluctant to let their children take complete care of them. Some become depressed and mental attitude begins to change for them. Family problems within the children of the diagnosed elderly also sadden the elders, and many more social and family problems can affect the elders.

Latino elders with low income and no form of transportation must rely on any help they can get, and usually their family will have to provide this help. Long term effects of diabetes on the elderly will be of a mixed variety depending on the time of diagnosis, adherence to medication, and lifestyle advice followed. There are many long term conditions that can arise with diabetes. The longer a person has diabetes the more likely they will have more medical conditions. Some of the most common conditions that are tied with diabetes are high cholesterol and high blood pressure (Hertz). These three conditions alone will mean an even more intense medication regime, which means higher cost. However there are more conditions that can arise with badly controlled diabetes. Long term memory loss (Malone), liver failure, and eyesight loss are common conditions that elderly diabetes patients must endure. Some Latino elderly, although this applied to all uncontrolled diabetes patients, will experience a numbness of the legs during a hyperglycemic episode. Without medication adherence this is common for some patients and hence they see nothing wrong.

However even a small cut can become infected, and since the patient is numb from that part of their body, a dangerous infection can arise and can eventually lead to an amputation which in itself creates another whole set of problems for the patient and for the families who care for them. In conclusion, diabetes affects the elderly Latino community in more ways and at a higher frequency than most other ethnic groups (Meneilliy). Acceptance that their lives will forever consist of dealing with this condition is step one of this long process. Then hopefully, the cost of the medications will not drive the Latino Elders into a desperate anxious state. The level of income will undoubtedly by related to the adherence to medications. Then finally, preventative measures to avoid long term conditions will prove to be a challenge to diabetes patients.

There is a Hispanic paradox where the immigrants who traveled to the USA in their later years are healthier than their kids. Those kids who were brought at an early age into the USA then had their own kids and as generations passed, the health of each generation deteriorated to be worse than that of their predecessor. The relationship between prevalence of diabetes, and obesity for that matter, between Latinos born here with comparison to those who immigrated at a later age shows that the western diet has risen an unhealthy community (Fitten). Perhaps the western diet is to blame for such high instances of diabetes around the world. The elderly Latino community however will continue to have a genetic predisposition to diabetes and suffer accordingly. Preventative measures should be put in place. Regular screenings for early diagnostics would prevent an array of long term diseases. Although the Elders in the Latino community are affected in great part by this disease they continue to fight and to take preventative measures. The Californian elder Hispanics have lived a long usually harsh life working agriculture in the central valley and they deserve to have their health controlled and not deal with this disease that is Diabetes.

References

“Alternative Content.” HDI Map. Measure of America, A Project of the Social Science Research Council, 2008. Web. 29 Oct. 2012. <http://measureofamerica.org/maps/>. Black, S. , Ray, L. , & Markides, K. (1999). The prevalence and health burden of self-reported

diabetes in older mexican americans: Findings from the hispanic established populations
for epidemiologic studies of the elderly. American Journal of Public Health, 89(4), 546-
552.
Coronado, Gloria D., Beti Thompson, Silvia Tejeda, and Ruby Godina. “Attitudes and Beliefs
Among Mexican Americans About Type 2 Diabetes.” Journal of Health Care for the
Poor and Underserved 15.4 (2004): 576-88. Print.
Deshpande, A. , Harris-Hayes, M. , & Schootman, M. (2008). Epidemiology of diabetes and
diabetes-related complications. Physical Therapy, 88(11), 1254-1264 Fitten, L., et al. (2008). “Depression, diabetes and metabolic-nutritional factors in elderly
Hispanics.” The Journal of Nutrition, Health & Aging 12(9): 634-640. Foote, J., et al. (2010). “Diabetes in the Elderly.” Current Cardiovascular Risk Reports 4(5): 347-
353.
Hertz, R. P., et al. (2006). “Diabetes, Hypertension, and Dyslipidemia in Mexican Americans and
Non-Hispanic Whites.” American Journal of Preventive Medicine 30(2): 103-110. Krein, S. L., et al. (2006). “Economics of Diabetes Mellitus.” Nursing Clinics of North America 41(4): 499-511.
Malone, J. I., et al. (2008). “Hyperglycemia not hypoglycemia alters neuronal dendrites and
impairs spatial memory.” Pediatric Diabetes 9(6): 531-539.
Meneilly, G. S. and D. Tessier (2001). “Diabetes in Elderly Adults.” The Journals of
Gerontology Series A: Biological Sciences and Medical Sciences 56(1): M5-M13. Permutt, M. , Wasson, J. , & Cox, N. (2005). Genetic epidemiology of diabetes. The Journal of
Clinical Investigation, 115(6), 1431-1439.
Reimann, Joachim O.F., Gregory A. Talavera, Michelle Salmon, Joseph A. Nuñez, and Roberto
J. Velasquez. “Cultural Competence among Physicians Treating Mexican Americans
Who Have Diabetes: A Structural Model.” Social Science & Medicine 59.11 (2004):
2195-205.
Skelly, A. H. (2002). “Living with Illness: Elderly Patients with Diabetes.” The American
Journal of Nursing 102(2): 15-16.