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Hispanics in Milwaukee are improving services for elders with Alzheimer's disease by customizing care to cultural attitudes toward dementia and medicine.

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Remembering the Future

Caring for Culture
Hispanics in Milwaukee are improving services for elders with Alzheimer's disease by customizing care to cultural attitudes toward dementia and medicine.

by Daniel Pendick

Como está?

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 Spanish.

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 areas.

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 I’ve seen.”

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.

Comprehensive care

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 in Milwaukee."

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 Spanish."

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.

Myth-busters

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

Further Resources:

United Community Center
1028 S. 9th Street
Milwaukee, WI 53204
(414) 649-2838
www.unitedcc.org

Resources for Latinos -- Alzheimer’s Association
www.alz.org/espanol_latino_resources.asp

Wisconsin Registry for Alzheimer’s Prevention: www.medsch.wisc.edu/wai/wrap/wrap.html