|by Daniel Pendick
From his chair, a thin elderly man, Eugenio Ramirez, smiles
up at the young, dark-haired woman greeting him.
“Very well, thank you,” he answers in his native
Genevieve Kirk, program manager for the Latino Geriatric
Center in Milwaukee, Wisconsin, is giving me a quick tour
of the Center’s adult day care facility. Like most of
the people here this morning — watching TV, eating their
breakfast, talking — the elderly man has dementia.
This day center is the first of its kind in the United States.
It is one component of a demonstration project to create a
new model of caregiving for Hispanic elders with dementia.
Architects designed the day center’s colors and forms
to resemble homes on a street in a Latin American plaza. The
clients spend the day in three large, high-ceilinged “houses,”
each with a full kitchen, restrooms, and dining and social
The houses open onto a walkway, which leads to an indoor
plaza with a fountain. High skylights and windows flood the
space with natural light. The warm tones of yellow, orange,
and stucco in the paint say “adobe.” Balconies
rim the second-storey facility, where the clients can sit
and watch the daily ebb and flow of the neighborhood.
Center of the community
The Latino Geriatric Center, recently expanded with $2.75
million in private donations, occupies most of the second
story of the United Community Center (UCC), a comprehensive
social services agency serving Milwaukee’s thriving
Hispanic community. It includes a preschool through 8th grade
charter school, a regular senior center, and even a small
restaurant, Café El Sol.
Latinos are the fastest growing minority group in the country.
By 2050, the percentage of Latinos among people 65 and older
will triple, to 16 percent. And that means Latino elders will
participate in great numbers in the long-predicted Alzheimer’s
disease explosion set to go off in a society where people
live longer and longer.
A few years ago, the UCC noticed an increased demand for
the kind of services it provides for people with dementia.
“Within the Hispanic population,” Kirk explains,
“we are finding that symptoms of Alzheimer’s and
dementia occur a lot earlier than in the typical Caucasian
population of the state — about 6.8 years is the statistic
Latinos, like African-Americans, suffer comparatively higher
rates of high blood pressure, high cholesterol,
and diabetes. These
conditions harm the brain, making elderly people more apt
to show memory impairment
and other signs of cognitive decline at an earlier age. In
the early to middle stages of Alzheimer’s, an older
person may just need supervision during the day, when their
spouses, partners, or family members are out.
The UCC decided to enlarge the Adult Day Center’s capacity
from 30 to 75. They raised funds and completed the geriatric
center’s expansion by January 2007. The three houses
care for different populations within the day-care client
base: highly functioning, moderately impaired, and severely
impaired. The hope is to provide continuous care as people
move through the stages of dementia and delay premature institutionalization.
The geriatric center is much more than just adult day care.
UCC is building a more comprehensive program for Latino elders
with dementia. Its services now include a caregiver
support group. The UCC is also a participating site in the
Wisconsin Registry for Alzheimer’s Prevention (WRAP).
The study, headed by Wisconsin Alzheimer’s Institute
in Madison, Wisconsin, is recruiting adult children of people
with Alzheimer’s to identify risk factors for the disease.
The UCC now has the ability to medically evaluate persons
with memory loss. Like its other programs, the screening is
community based and culturally sensitive. Its clinical director,
Diana Kerwin, M.D., is an Assistant Professor at the Medical
College of Wisconsin and clinical director of the Geriatric
Memory Disorder Clinic at Froedtert Hospital in Milwaukee.
The UCC clinic benefits from being right in the community
in a fully bilingual setting. Geography, transportation, and
cultural and language differences can be barriers to medical
care for elderly Latinos. "It's geographically difficult
for people from the South Side to get to Froedtert for proper
evaluation," Kerwin says. "So we decided to put
the clinic inside the UCC to better serve the Latino population
Cultural and language issues can make patients less likely
to seek help at a big academic medical center. "There
aren't as many Hispanics and Spanish speaking staff,”
Kerwin says. “I would have to bring in a translator
specifically for that appointment. At UCC, all the staff speak
Staff members of the UCC-Latino Geriatric Center collect
all the information needed for the memory evaluation and administer
standard memory tests in Spanish. Kerwin comes in once a month
to review the cases and complete a full medical evaluation
to determine the cause of the memory loss. Then she develops
a plan of care with the Latino Geriatric Center staff in collaboration
with the patient's primary doctor in the local community.
In building the program, UCC has had to overcome attitudes
among some Latinos toward dementia. “Alzheimer’s
has a really bad reputation among Hispanics and other ethnic
groups,” Kirk says. “There’s a lot of fear
about the disease.”
As in the African-American community, many Latino elders
think of dementia screening as pointless, because there is
no cure for the disease. They also have a greater tendency
to shrug off forgetfulness and confusion in older people as
“just getting old.” Another barrier is the unwillingness
of some Latino families to relinquish caregiving to “strangers.”
Kirk says her sales pitch to Latino elders and their adult
children appeals to the importance they place on family relationships.
“Memory loss is important, not just for your health,
but also for family members that are around you,” she
says. “If you do get tested, either way, whatever the
diagnosis is, it’s better in the long run for your own
health and independence to be able to make decisions about
your health care. And it could impact your family members
if they need to take a more active care giving role.”
Copyright © 2008 Memory Loss and the Brain
United Community Center
1028 S. 9th Street
Milwaukee, WI 53204
Resources for Latinos -- Alzheimer’s Association
Wisconsin Registry for Alzheimer’s Prevention: www.medsch.wisc.edu/wai/wrap/wrap.html