Ethnogeriatrics and Functional Status

To the Editor: Mulrow et al. showed that Mexican Americans have lower ADL scores compared with non-Hispanic white residents.1 Their findings concur with other data about older Hispanic Americans. For example, this population characteristically manifests poor health and disability.2 However, functional status is affected by cultural, familial, and socioeconomic factors as well as by disease. I want to emphasize these factors as possible explanations of their low ADL scores. First, Mulrow et al. found that few Mexican Americans live alone before entering a nursing home. In Latin American countries overall, nursing home residents account for fewer than 1% of all older people (in Ecuador only 0.5%).3 In fact, most older people live with their families; few live alone. In Hispanic culture, the nursing home is perceived very negatively. For example, Hispanics believe that the nursing home is a place to die, not to live. Therefore, nursing home placement is the last resort and is selected only for very frail older persons. Second, Hispanic families are usually paternalistic, taking care of their older members until their last days. This results in older people being cared for at home until they are severely disabled.4 However, the Mexican American family has been unable to care for its older members. This is especially true of financial support; nearly 60% of these older adults live below the poverty line and fewer than 10% receive any financial assistance from their family.5 Other family factors that might affect the functional status of older Hispanics are acculturation problems and decreased roles of older members.6, 7 Therefore, Mexican American families may not be able to care for older family members as they once did. Mulrow et al. also found that Mexican Americans have less formal education (3.2 vs 10.1 years) and are more likely to be unskilled laborers compared with non-Hispanic whites. Importantly, education is also related to health. In addition, longitudinal studies show that higher education, higher occupational category, and higher family income are associated with high ADL scores.8, 9 In contrast, low education, low income, and less prestigious occupations are associated with low ADL scores.10 Therefore, Mexican American nursing home residents have a socioeconomic disadvantage that may affect their ADL scores. In conclusion, Mexican Americans have cultural, familial, and socioeconomic factors that may affect their functional status. Understanding all factors may help health care providers to improve health care services to older Mexican Americans.