LATIN@ ELDERS: Securing Healthy Aging Inspite of Health and Mental Health Disparities

Age-friendly as Tranquilo Ambiente: How Socio-Cultural Perspectives Shape the Lived Environment of Latinx Older Adults

BACKGROUND AND OBJECTIVES

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 is known about the role of cultural characteristics in shaping perceptions of age-friendly environments, especially among racial and ethnic minorities.

RESEARCH DESIGN AND METHODS

Using an ethnographic methodological approach, including participant observation in a Latinx community near New York City and 72 semi-structured interviews, this study examines how older Latinxs characterize age-friendly communities.

RESULTS

Latinx older adults described their community as age-friendly by way of the concept Tranquilo Ambiente, translated as calm or peaceful environment. More specifically, TA includes: 1) a sense of perceived personal safety, 2) ethnic and social connectedness, and 3) spatial and cultural accessibility.

DISCUSSION AND IMPLICATIONS

This study extends prior research that has largely considered structural or economic components to show how culture may also influence the well-being of older Latinxs, even if living in an under-resourced area. The concept of Tranquilo Ambiente demonstrates that both structural and cultural environmental factors influence older Latinxs understandings of age-friendly communities. By utilizing a socio-cultural lens, this research highlights how Latinx older adults benefit from an environment that supports their physical (e.g., well-lit and newly paved streets), social (e.g., city hall senior center), and cultural (e.g., events and programs that promote cultural heritage) needs.

Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention

Advance care planning (ACP) does not readily occur in medical settings and often gets missed. Older Latinos need ACP information to encourage advance directive (AD) completion indicating preferences for end-of-life (EOL) care.

Objective:

To explore the experiences with counseling using motivational interviewing (MI) techniques and social workers to encourage ACP communication among older Latinos with advance chronic diseases. This study describes stages of readiness to plan for EOL care.

Design:

We conducted a qualitative study with older Latinos who participated in a community-based intervention in Southern New Mexico.

Methods:

Participants in the intervention were selected because they received ACP education plus counseling involving MI to address resistance to ACP. Motivational interviewing counseling involved the following: (1) engaging in structured dialogue about ACP, (2) using and completing AD documentation, (3) encouraging ACP communication with providers and families, and (4) applying AD information into actionable behavior. We utilized a constant comparative method and thematic analysis to explore the meaning of older Latinos’ experiences with MI counseling and stages of change.

Results:

Participants (n = 32) were mostly women (74.3%), half born in the United States and half from Mexico in the United States on average for 31.75 (standard deviation 16.22) years. Many had less than sixth grade education (31.3%) or had not completed high school (21.9%). Key themes indicate the following stages of change: (1) precontemplation, (2) contemplation, (3) preparation, (4) ACP action, and (5) maintenance.

Conclusion:

This study contributes to the literature by identifying areas for adaption to enhance understanding and increase information to ultimately achieve the completion of ACP among Latinos.

Implementing an Advance Care Planning Intervention in Community Settings with Older Latinos: A Feasibility Study

BACKGROUND

Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs).

OBJECTIVE

To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (≥50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS).

DESIGN

We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods.

SETTING/SUBJECTS

Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico.

METHODS

All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigation for resource access, all of which included interactive ACP treatment decisional support and involved motivational interview (MI) methods. Purposive sampling was guided by a sociocultural framework to recruit Latino participants from community-based settings in Southern New Mexico. Feasibility of sample recruitment, implementation, and retention was assessed by examining the following: recruitment strategies, trial enrollment, retention rates, duration of MI counseling, type of visit (home vs. telephone), and satisfaction with the program.

RESULTS

We contacted 104 patients, enrolled 74 randomized to usual care 39 (UC) and treatment 35 (TX) groups. Six dropped out before the post-test survey, three from TX before the post-test survey because of sickness (n = 1) or could not be located (n = 2), and the same happened for UC. Completion rates were 91.4% UC and 92.3% TX groups. All participants were Latino/Hispanic, born in the United States (48%) or Mexico (51.4%) on average in the United States for 25 years; majority were female, 76.5%; 48.6% preferred Spanish; and 31.4% had less than sixth-grade education. Qualitative data indicate satisfaction with the ACP-I Plan intervention.

CONCLUSIONS

Based on enrollment and intervention completion rates, time to completion tests, and feedback from qualitative post-study, follow-up interviews, the ACP-I Plan was demonstrated to be feasible and perceived as extremely helpful.