Alicia Arbagi, MD, PhD, MSc in public health, associate professor at Johns Hopkins School of Medicine, talks to WebMD about the health challenges of older adults in many Latin American communities.
This interview has been edited for length and clarity.
WebMD: What is the best way to refer to people with Hispanic roots or identities in a medical context?
Arbagi: This is a great question. Terms are important and unfortunately many of them have been given to us by other cultures and due to a history of colonialism. For example, the term “Latinx” is not well adopted by the Hispanic population – especially the elderly. It is also not widely used in the scientific literature or in geriatrics, although this may change over time.
We see “Latino,” “Latin,” and “Spanish,” but there’s no cool term. This can cause a problem with how data is collected for this group. The best thing to do when working with Hispanics is to meet people wherever they are and ask them to identify themselves. Most people tend to identify themselves by nationality (for example, Puerto Rican, Dominican, etc.). When you put everyone together in one bucket, rich diversity and even different health backgrounds can sometimes be ruled out.
[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 faced by the Hispanic population today?
Arbagi: In general, it’s the same problems that occur in most age groups: heart disease, diabetes, cancer, and respiratory disease. But some things are more common. Dementia appears to disproportionately affect Latinos compared to other groups. More than 50% of Hispanics will develop type 2 diabetes in their lifetime compared to less than 40% for the rest of the population.
Additionally, 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 than other Americans. Additionally, while Hispanics have a lower rate of some common cancers in the United States, the incidence of cancers caused by infectious agents such as liver, stomach, and cervix is higher.
The higher incidence of these diseases has a lot to do with historical marginalization versus having something inherent in Latinos that makes them more susceptible to these conditions.
WebMD: Do people in the Hispanic community receive a different level of medical care because of their ethnicity or cultural background?
arabic: In some cases yes. I see this playing out in a variety of ways. The biggest challenge is not getting care, which can lead to a delayed diagnosis. Dementia, for example, tends to be diagnosed later in Latinos.
Distrust of the medical community can also delay diagnosis. This mistrust is sometimes grounded in a disturbing history. To take one example, American scientists tested the birth control pill on Puerto Rican women without their full consent.
Sometimes there are language barriers between doctors and elderly patients and this can add to the problem. Unfortunately, the truth is that some in the medical community still view Hispanic people who may not speak English as their first language.
WebMD: Does the research data focus on unique issues and health outcomes for Hispanics?
Arbagi: People don’t think much about how to skew data – especially the data that is currently available to us. We have a long way to go because studies and some medical data do not provide enough detail and may not reflect the true composition of the US population.
One problem is the potential for the number of Latinos to decline. Nationally, most data about the elderly comes from Medicare. But Medicare data isn’t great for determining race, especially people of multiple races. As a result, many Hispanics are classified as “others” or “unknown.”
Also, in most medical records programs, people are not allowed to identify themselves. And if they are, the options available may not be accurate.
Many medical record systems may not take into account the multiple family names common in many Latin cultures. As a result, some people may mistakenly have two other medical records, which could mean unsafe or incorrect medical care.
WebMD: What can someone in this group do to improve some of these health outcomes?
Arbagi: We know that nutrition is critical to health. I encourage Latinos to think of their country of origin, which would likely follow a vegan diet. If you don’t have easy access to new products Fruits and vegetables, seek help through peers, healthcare professionals, or even the faith community.
Of course, exercise is important for anyone, too, especially for those who are getting older.
I also say: Demand that the health care you receive aligns with your goals. This may be inconvenient for the older generations as they have not been taught to question their doctors, but younger caregivers can help.
For example, if you are a caregiver, you might say, “My grandfather wants to be able to go to church on the weekends. What can we do to get that?” or “My grandmother wants to spend more time with her grandchildren. Would you let her Do these drugs do that?” Present your goals clearly and directly.
WebMD: What about the emotional health impacts this community faces?
Arbagi: Depression is a problem in older adults, but it can be difficult to diagnose in the Latino community because there is often a stigma around talking about things like depression that can suggest frailty. Or I see patients who assume bad moods are a “normal” part of aging and won’t talk to their doctors about it.
Social isolation is a problem. It can exacerbate depression and accelerate dementia. This is why staying in social contact is so important as people get older. In many cases, due to immigration and emigration, family support systems in Latino communities may be remote and therefore less able to help. For example, many young people have left Puerto Rico for jobs in the US mainland, leaving much of the elderly population behind with less support.
That’s why finding, building, and nurturing a support system is so important.
WebMD: Have we learned anything about the health of Latinos during the pandemic?
Arbagi: COVID has affected Latinos more than the general population — mostly young adults in the meatpacking and home health care industries. And there are some long-term effects that remain to be seen as these people age. I think this is going to be an emerging place to watch. In some ways, COVID can speed up some basic diagnoses. We still have to see what happens there.
WebMD: How can health care providers better serve the Latino community?
Arbagi: Clean them! Make it a priority to improve data about the Latino community. Treat with care with cultural humility. Engaging in shared decision-making and meeting people where they are rather than communicating in a way that puts the entire blame for health challenges on the patient.
Yes, individual responsibility is important, but quality health care is a partnership.
WebMD: What is your message to loved ones and their caregivers in the aging community?
Arbagi: I tell caregivers, “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 important to helping older adults enjoy a better quality of life. But you can also get support from other healthcare and mental health professionals, your faith community, and your peers.
Finally, I know you are doing a noble job. treasure this time. It is a distinct honor and privilege to guide someone through the later stages in their life. It can be challenging, but it is an important and sacred work that has real value.