Wisdom of the Ages : Doctor Offers Advice, Cultural Understanding to Elderly Latinos

Dr. Jorge Rivero has a hard time talking his patients out of their tortillas.

But Rivero, one of only a handful of Latino gerontologists in the nation, quietly explains to his mostly Latino patients in East Los Angeles that the tortillas they have been eating for decades are too high in fat. And Rivero has found that if he listens long enough and treats his patients with respect, he can eventually win them over.

“I feel that I can understand not only their complaints, but other things that are going on in their life,” said the Peruvian-born Rivero. “I think I understand more of their problems because I know more of their cultural background.”

As with all groups, the Latino population is aging at a fast rate, creating a need for physicians who not only specialize in health care for the elderly but are attuned to their cultural needs.

The American Geriatrics Society does not keep records on the ethnicity of its members, but Rivero is believed to be one of only a few Latinos in the country who specialize in geriatric medicine. His concern is taking care of the elderly in future years, when their numbers are expected to balloon.

“More people will get into their 80s and 90s with more chronic illnesses and disabilities and need more social services,” Rivero said. “Society will have to do more for their care.”

As for the Latino elderly, doctors will have to be aware of cultural values and medical concerns affecting the population, such as the high prevalence of diabetes, Rivero said. One in eight Latinos has diabetes, the highest rate of any ethnic group except for American Indians, according to the American Diabetes Assn.

Rivero, 38, became interested in the care of the elderly when he was a medical student in Lima, Peru, and his grandfather became ill. Like many older patients, his grandfather was hard to care for because he refused to take his medicine regularly or follow his doctor’s orders.

“As a medical student, I was intimidated managing him, but I was the only one he could understand,” Rivero said.

Many of his patients remind him of his grandfather, often refusing his advice. The trick, he says, is to talk to them at length and on a regular basis.

Many times patients, especially those who are diabetic, must change long-familiar diets to improve their conditions.

“A significant number of Latinos have a diet rich in carbohydrates and fat, and it’s difficult for them to understand that they have to change that,” Rivero said.

Still, he believes that reducing the number of tortillas per meal is better than increasing their medicine.

Rivero has known most of his patients since opening his practice at the AltaMed Senior Health and Activity Center clinic on Pomona Boulevard a year ago. Most of them are Latinos who are more comfortable talking about their ailments in Spanish.

One patient, Carolina Recendez, 83, grimaces as she describes the pain in her hip. Rivero goes over her symptoms and gently checks her flexibility.

Her son, Jose, brings her in for monthly visits and talks about the difficulty of seeing his once-robust mother become frail over the three years since she was diagnosed with Parkinson’s disease.

“She started to walk in little steps, and had a fear of falling and different mood swings,” he said. “Little by little, she just couldn’t move around anymore and she started to tremble with the medication.”

Other patients talk about side effects of their medication, or about new pains they are experiencing. But as trying as their problems may be, nurses and AltaMed officials say, the patients approve of Rivero.

“The Latino elderly do not want to relate to the institution (of medicine),” said Marie S. Torres, who oversees long-term care at AltaMed. “They want to deal with the person and have a relationship with them and with confianza (confidence). He’s very friendly, has an open manner and is not abrupt with them and treats his patients with respect.”

Rivero said he enjoys hearing about his patients’ younger days and their families, and has learned from them.

“I have the feeling that when they go to the other physicians, they don’t get listened to and they are rushed,” Rivero said. “I try to find out their medical problems, but on top of that, they tell me about their families. I find that important.”

Through such conversations, he discovered that an in-home attendant was abusing one of his patients suffering from Parkinson’s disease. Another conversation led him to a new patient who had been suffering from dementia for seven years but had not been diagnosed or treated.

Common conditions among his patients include dementia, amputations, strokes, arthritis, osteoporosis and high blood pressure. Their bones are frail, their hearing weak, and many have to be coaxed into socializing with others.

Many, especially immigrants, live with their children and grandchildren, Rivero said. But he was surprised to find that many more, especially those who are first- and second-generation Americans, live independently.

“I don’t have numbers, but I believe a lot of them are living alone,” he said. “They do have contact with families and sometimes live nearby, which is different from other groups. In the Latino community, they live alone, but also live close to their children, sometimes on the same street.”

But even with family support, many Latinos of all ages have poor access to health care.

A recent study by UCLA Prof. David Hayes-Bautista found that Latinos are medically underserved, with about 40% of them lacking health insurance.

But Hayes-Bautista also found that a Latino born in 1986 is expected to live 79.4 years, compared to an Anglo (75.1) and an African-American (68.7). Asian-Americans have a life expectancy of 81.5 years.

About 3.5% of the county’s 3.3 million Latinos are 65 or older, compared to 9.6% in the general population.

“Latino elderly will be small by comparison (to Anglos) but we will live a long time,” Hayes-Bautista said. “They will require Latino geriatricians and gerontologists to understand the dynamics of the Latino population.”