Fighting the Swell of Latino Dementia

head-ct300With Latinos now the largest ethnic population in California, the spotlight on Latino aging is shining ever brighter, and with it exposure to a topic rarely discussed: worsening rates of cognitive decline.

Latinos suffer from dementia at rates 1.5 times higher than whites, but not because of genetic makeup. Instead, the factors that contribute to Latino dementia are largely controllable.

Latinos tend to suffer more diabetes and hypertension — conditions that left untreated can exacerbate dementia. In addition, socioeconomic factors like poverty, discrimination and limited access to quality healthcare also play a role in cognitive decline.

Together, these factors can cause an infinite loop of poor health.

These observations come from both the Alzheimer’s Association and the country’s sole research facility specializing in the intersection of Latino aging and dementia: the UC Davis Latino Aging Research Resource Center.

Dr. Ladson Hinton, the center’s co-director, says the center has two overarching goals: reduce health disparities among Latino elders, and diversify the healthcare workforce.

Besides targeting Alzheimer’s disease and other forms of dementia, the Center explores a wide variety of other critical issues that affect aging Latinos: trouble accessing care, difficulties finding culturally competent information, and shortages of Latino clinicians and researchers.

The center’s work is acutely important today as the number of older adult Latinos is rising rapidly as are “Latinos who are afflicted with Alzheimer’s disease and other dementia,” says Hinton.

Dementia takes a tremendous toll on Latino households, which often circle their support around a suffering elder, says Alexandra Castillo-Weisgerber of the Alzheimer’s Association of Northern California and Northern Nevada. Latino homes are frequently multigenerational, and then face the added burden of older adult caregiving. Because of tight familial bonds, in some cases an older Latino adult once living independently may move in with children and grandchildren.

“Typically the caregiving falls upon the wife or the daughter regardless of how large the family is,” says Castillo-Weisgerber, family care specialist for the association. “Often the caregiver quits their job, which causes further economic distress. For some families that means going hungry.

She cites estimates that the cost of a caring for an aging parent is $5,000 a year, creating “family challenges and instability in the home.”

These factors — declining health, family pressures and financial woes — produce a cascading series of problems.

“Our formal systems of care are not very well prepared to help families manage these problems,” says Hinton.

And Latinos face even more problems than their white counterparts.

While Latinos suffer higher rates of dementia, it’s often not diagnosed until after the disease has progressed much further than for white patients, says Hinton. A delayed diagnosis, he adds, means lost time in treating dementia and helping families cope with the disease.

In addition, a Center study found that Latinos were more likely than their white counterparts to be prescribed anti-psychotic medications for dementia — a trend that has been roundly criticized as ineffective since the drugs cause a number of unwanted side effects, including higher rates of mortality.

“The medications we have are not terribly effective in managing these behavioral symptoms,” says Hinton, citing anxiety, depression, anger and confusion

The fertile farmland of the Central Valley and its wealth of migrant workers is ground zero for many of these complex issues.

“One thing we definitely do know is that there are a large number of Latinos in the Central Valley who have great difficulties accessing good quality care,” says Hinton. “A lot of Latino families are subject to economic stress.”

Add to these woes the comparatively low health literacy among Latinos — and the desperate need for culturally competent care — and health disparities worsen exponentially.

Offering a glimmer of hope, Hinton praises the work of the Alzheimer’s Association in addressing Latino dementia.

In many Latino communities promatoras — Spanish-speaking health advocates — are essential in outreach efforts. Besides working with these promatoras, the association offers Spanish-language dementia workshops at senior centers and within local business networks. It also provides 24-hour telephone support in Spanish for caregivers as well as in-person Spanish-speaking support groups. It also maintains a Spanish language portal on its website.

Hinton says the best dementia treatments – for patients of all colors — are non-pharmaceutical interventions: human interaction and a team approach to medical care.

The California Culture Change Coalition has campaigned to see dementia in an entirely new light – as a time to overthrow social conventions and simply live in the present moment.

The UC Davis Latino Aging Research Resource Center is one of seven national Resource Centers for Minority Aging funded by the National Institutes of Health. It is the only one focused on Latino aging.

Finally – yet critically – Hinton says in the competitive world of high-stakes research, Latino researchers are often underrepresented, so research on Latino health often remains underfunded.

“If we have a more diverse workforce we’ll be able to better address all of these disparities.”

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