Instrumental activity of daily living limitations and supports in a clinic population of low-income Puerto Rican elderly adults with chronic diseases.

Latino older adults in the United States have disproportionately high rates of chronic and disabling medical conditions. Puerto Ricans have a higher prevalence of several chronic medical conditions and higher rates of functional disability than other Latinos. Earlier studies have documented that Puerto Rican older adults traditionally have relied mostly on family members for assistance with their functional needs, with low use of formal support services, but little is known about their functional help needs and caregiving practices. This study examined independent living and caregiving practices of community-dwelling Puerto Rican older adults in western New York using a mixed-methods approach with a sample of 49 individuals attending an inner-city primary care clinic. Standard instruments were used to obtain information on socioeconomic and health status and functional ability. Forty participants who needed help with any instrumental activities of daily living (IADLs) were probed qualitatively for how their needs were addressed. Participants averaged six chronic medical conditions, mean age was 76.2 ± 5.3, most reported annual household income of $15,000 or less and had low fluency in English, and all had healthcare insurance. For the most part, participants' children and spouses were primary caregivers, and few used formal support services. Nearly one-third reported having insufficient help. Qualitative findings elucidated how IADL needs were addressed. In this sample of indigent Puerto Rican older adults, most needed help with IADLs. Although family members most often helped, one-third had unmet or undermet needs. Linguistically and culturally congruent formal support services are still needed for Puerto Rican older adults and their family caregivers.

Knowledge and use of ethnomedical treatments for asthma among Puerto Ricans in an urban community.

PURPOSE: Puerto Ricans have higher lifetime and current asthma prevalence than other racial and ethnic groups in the United States. A great many Hispanics use ethnomedical therapies for asthma. This study elicited participant knowledge of ethnomedical therapies, developed a typology of the therapies, and considered whether some types are used or deemed efficacious based, in part, on information source. METHODS: Eligible participants were randomly selected from the medical records of an inner-city primary care clinic serving a predominantly Hispanic community in Buffalo, New York. Thirty adult Puerto Ricans who had asthma or were care-givers of children with asthma were interviewed in person using a semistructured instrument. Qualitative data analysis followed a content-driven immersion-crystallization approach. Outcome measures were ethnomedical treatments for asthma known to participants, whether these treatments were used or perceived effective, and the participant's information source about the treatment. RESULTS: Participants identified 75 ethnomedical treatments for asthma. Behavioral strategies were significantly more likely to be used or perceived effective compared with ingested and topical remedies (P <.001). Among information sources for ingested and topical remedies, those recommended by community members were significantly less likely to be used or perceived effective (P <.001) compared with other sources. CONCLUSIONS: This sample of Puerto Ricans with a regular source of medical care was significantly more likely to use or perceive as effective behavioral strategies compared with ingested and topical remedies. Allopathic clinicians should ask Puerto Rican patients about their use of ethnomedical therapies for asthma to better understand their health beliefs and to integrate ethnomedical therapies with allopathic medicine.