Issues relating to the ethnicity, race and cultural states of the Puerto Rican elderly people influence their behavior and work. Their health behaviors are influenced by their social conditions and health habits too. For them their family is a major force and thus, the health and social workers have to develop and maintain proper family relations to be able to care for these Puerto Rican elderly people.
Health disparities have been found in almost all of the ethnic and racial populations of USA, and so is the case with the elderly Puerto Rican people. They account for almost a fourth of the US population and have among the highest number of AIDS cases in them. Death rates due to tuberculosis and alcoholism are almost 6 times more than the others are and infant mortality rate is well above the US national average. One in every three of the Puerto Rican elderly does not receive regular health care and suffers from a high rate of kidney diseases and diabetes. The Puerto Rican elderly women are also not spared and have the lowest rates of cervical cancer treatment and screening opportunities. (Coulton, Milligan, Chow & Haug, 2006)
The health and social workers who provide help to these ethnic Puerto Rican elders have to keep in mind a number of cultural issues. As they are considered minorities, most of the technological and scientific benefits available to us are not readily accessible by them due to poverty, absence of education, language barrier, lack of health insurance, lack of community support and above all cultural differences. Thus, it is up to the social and health workers to help these Puerto Rican elderly people in order to improve their well-being and health all over the country enabling them to lead a healthy and happy lifestyle and prevent any major health issues from taking place.
Over the last decades it has been seen that the health of the Puerto Rican elderly people was significantly worse than the other Hispanic ethnic minorities. It has been found that the mortality rate of the Puerto Rican population above the age group of 65 is 0.76 for men and 0.7 for women. (Seltzer & Krauss, 2007) The following are the major causes for the death of these elderly Puerto Rican people:
Disease explicit Mortality Rates
Disease explicit mortality rates have been found to be marginally lower among the elderly Puerto Rican people than in other groups.
- Coronary Heart Disease – they have a low mortality due to heart diseases, which is around.08 for the women and 0.65 for women. Weak heart problems are mainly found in these with a family history in the same.
- Cerebrovascular Disease – it is considered the fourth largest reason causing death among the elderly. It is mainly due to the failure of the brain and blood vessels linked to it. Strokes due to low blood pressure also cause death among the elderly, especially among the men. Occurrences of hemorrhagic and cardioembolic strokes are frequent among the elderly. Stoke is also high among those suffering from diabetes and hypertension.
The comparative occurrence of a particular disease or the quality of being unhealthy is generally bad for these elderly people causing an abnormally harmful or gloomy state of the mind and sometimes resulting in their death too.
- Coronary Heart Disease or CHD – these elderly Puerto Rican people face an adverse risk due to relative atherosclerotic diseases increasing the incidence and occurrence of CHD. They also face the risk of suffering from angina pectoris, which is a heart condition resulting in chest pains due to reduction of oxygen to the heart. This is linked with a number of other factors like smoking, diabetic status, age and body mass index. However, this is a little low among the elderly women.
- Atherosclerotic or Cardiovascular Risk Factors – the Puerto Rican elderly women are more prone to hypertension, diabetes and inactive lifestyle while the elderly men have a higher risk of high HDL cholesterol, diabetes, smoking problems and abdominal obesity. Most of the cardiovascular risk factors are due to dyslipidemia, smoking, diabetes, age, adiposity, hypertension and gender.
- Dyslipidemia – is a medical condition, which arises when abnormal amount of lipids are present in the blood mainly due to unhealthy lifestyle and diet. These are also characteristic features of diabetes and thus can be related to a high prevalence of diabetes among the elderly people. They also have a high level of serum triglyceride and HDL cholesterol. However, comparatively the Puerto Rican men have high levels of serum triglyceride while the women have low levels of HDL cholesterol.
- Smoking – their low educational attainment at early ages make most of these Puerto Rican elderly people chain smokers. 21% of the women and 30% of the men are chain smokers leading to a number of heart-related problems and sometimes even cancer. (Seltzer & Krauss, 2007)
- Obesity – most of these elderly men and women suffer from obesity, some are severely obese making them disabled, and some have been diagnosed with high diabetes, which is related to their obesity issues. In addition, some of them have severe drinking problems, which is more prevalent in men than in women. Those elderly people who drink alcohol daily suffer from obesity and have an increased risk of CHD.
- Hypertension – obesity and diabetes are among the risk factors leading to hypertension. This also leads to the diastolic and systolic blood pressure levels. However, diastolic and systolic hypertension is also caused by Type 2 Diabetes Mellitus, age and relative body mass index. This is more prevalent among the women.
- Type 2 Diabetes Mellitus – diabetes is probably the highest death-causing disease among both the elderly Puerto Rican men and women. 26.1% of the Puerto Ricans suffer from high diabetes. The rate is increased among the ones with a family history of diabetes, obesity and age. There have been no signs of improvement in the increasing number of diabetic people in recent times. Increasing rate of diabetes has also resulted in slightly lower cases of coronary artery disease and amputations. (Binstock & Linda, 2001)
- Malignancies and cancer – cancer rates are relatively low among these Puerto Rican elderly people. There have been very few incidences of cancer with the exception of the cervical cancer, which is highly prevalent among the women. Cancer rates have almost doubled among the women in recent times. Other incidences were found in people suffering from cancer in their cervix, gall bladder and stomach. Cases of carcinoma in situ and invasive cancer have decreased over time. Prostate cancer among elderly men and breast cancer among elderly women are also very low. The women have a risk of suffering from uterine cervix, liver and gall bladder cancer.
- End-stage renal disease or ESRD – the Puerto Rican elderly men have a higher risk of ESRD due to diabetes. Increasing rate of diabetes has also resulted in retinopathy, proteinuria and albuminuria. Although dialysis does give them a survival option most the elderly people cannot afford the procedure. (Zimmerman, 2008)
Emotional and Cognitive Status
High levels of depression, stroke, illiteracy, age and unhappy marital status have been found to be the main indicators of severe emotional and cognitive impairment.
- Dementia and Mental Status – almost 12% of the elderly people above the age of 65, 29% above 75 and 60% above 85 suffer from dementia, i.e. mental deterioration of functional abilities. Their educational status plays a role here since proper education at younger ages lowers the rates of dementia. 38% of the elderly people were also diagnosed with vascular dementia and Alzheimer’s disease. While 20% of the population suffered from the former, 47% suffered from the latter. (Abraído-Lanza & Revenson, 2006)
- Depression and Psychological Distress – psychological distress and symptoms of depression are more prevalent among the Puerto Rican elderly women but still present among the men. Several factors affect their lives like chronic life-threatening diseases, discontent and dissatisfied social support, very low family incomes, lack of proper education and having to live alone makes life very difficult for them often leading to depression. Low levels of socialization and acculturation also cause depression among the elderly.
Almost 31% of the Puerto Rican elderly people suffer from AIDS. There is a very high rate of drug use among these people, which is the major cause of AIDS among them. Almost 16% of the HIV-infected patients die within baseline assessment.
- Tuberculosis – tuberculosis is highly prevalent among the older Puerto Rican people. Although the mortality rate has come down significantly there are still some suffering from the disease.
- Functional disability – A great number of these elderly Puerto Rican people are also physically disabled unable to perform even their daily activities. They need the assistance of the caregivers to help them in their life so that they are not vulnerable in their life. If they do not receive this basic help, they might have some life-threatening accidents.
- Pneumonia, dengue and influenza – respiratory and viral diseases are very common among these Puerto Rican elderly people as their living conditions are very poor and they have very unhealthy lifestyles. Most of them do not have any knowledge of proper health care, which further increases their chances of contracting the deadly disease. Some of them even are infected by the dengue virus getting severely ill.
- Accidental injuries – many times due to unintentional injuries, like choking, concussion of the brain, falls, mass causalities, car accidents, suicides and violence also claim a number of lives of the elderly people. While some area due to instable mental conditions of the elderly people other is due to their drinking conditions, unhealthy life styles and homicides. Some of them get hip fractures due to unavoidable falls and get bedridden worsening their mental conditions. (Zimmerman, 2008)
Apart from the above major health problems these elderly people also suffer from hearing problems, they have impaired eyesight, memory loss and some of them are not even able to speak. A number of them are bedridden as they cannot use their legs or are on wheelchairs constantly needing the help and care of others. They need to regularly exercise and eat healthy if they want to stay fit. They also need to improve their living conditions so that they do not catch deadly viruses, as they are less tolerant and more vulnerable to them. A number of these elderly people also suffer from dysphagia leading to eating disorders. As they are unable to swallow their food, they barely have any intake of nutrients, which further makes them weak. (Abraído-Lanza & Revenson, 2006)
This changes their eating habits leading to their isolation and lowers their emotions and social respect. Thus, they need the constant assistance of their family members and caregivers at each step of life to perform even the everyday tasks as simple as eating. However, if they are segregated and looked down upon, then it will only worsen their health conditions, sometimes even leading to their death. The ailing Puerto Rican elderly people should never be left alone as this increases their emotional instability making them feel lonely which only worsens their medical problems. As the number of these elderly people is constantly growing year after year, so are the responsibilities of the social and health caregivers as a result that the elderly can live a better life in the last few days of their lives.
We cannot leave out the importance of these health and social workers towards the cultural proficiency and competence present in them with the elderly Puerto Rican population. It is mainly through cultures, which bring them face to face with their worldview making them, understand the beliefs, values, behaviors, symbols, experiences, customs morals and attitudes of the elderly people they take care of and enable them to communicate with each other. These health service providers have to accept the importance placed on family, religion, spirituality, and healing and health practices of the elderly Puerto Rican people in order to help them properly. In order for the caregivers and the social and health workers to be properly able to take care of these elderly people, they should be able to communicate with them properly. Most of the elderly are not in their right state of the mind and having to suffer from chronic illness makes them highly frustrated. (Zimmerman, 2008)
Thus, the caregivers should respect them and treat them properly. Their needs should be fulfilled by the caregivers as far as possible. As most of them have very few educational opportunities, they receive almost no health education. The elderly people should be provided with better health education so that they can lead a better and healthy lifestyle. Among all the health-related issues, diabetes comes at the first position claiming more lives than the others do. Health workers need to educate the elderly on how to lower their diabetes level improving their self-care management system. These minority elderly people have very little income and no educational background. They are completely dependent on their family and on these social and health workers. They cannot afford modern health care facilities and are often isolated by the society leading to further conditions of depression and deteriorating mental health. Their families must act as their social support network and providing them with whatever care they can. (Abraído-Lanza & Revenson, 2006)
Abraído-Lanza,, A.F. & Revenson, T.A. (2006). Coping and social support resources among latinas with arthritis. Arthritis Care & Research. 9(6) 501-508.
Binstock, R. H. & Linda, K. G. (2001). Handbook of aging and the social sciences. Edition: 5. New York: Academic Press
Coulton, C.J. Milligan, S. Chow, J. Haug, M. (2006). Ethnicity, self-care, and use of medical care among the elderly with joint symptoms. Arthritis Care & Research. 3(1) 19-28.
Seltzer, M. M. & Krauss, M W. (2007). Quality of life of adults with mental retardation/developmental disabilities who live with family. Mental Retardation and Developmental Disabilities Research Reviews. 7(2), 105-114
Zimmerman, J.A. (2008). Vascular risk and depression in the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE). International Journal of Geriatric Psychiatry. 14(3) 113-119