Annals of Long Term Care

Hispanic elderly are the fastest growing older population segment, and they will outpace all other ethnic elder groups during the 21st century.1 The term Hispanic can be misleading, suggesting connections to Spain when the majority of Hispanics in the United States are from Latin America. The Spanish language is a common denominator of many Hispanic elderly persons, while the culture, life experiences, socioeconomic status, and the dialect of Spanish can be vastly different among Hispanic elderly individuals. Many Hispanics are U.S. immigrants, while others, such as New Mexico Hispanics, arrived in what is now New Mexico prior to 1600. Caribbean immigrants may be of African and Spanish ancestry, utilizing a rapid dialect of Spanish. Other Hispanic elderly may have personally survived physical torture and/or witnessed family death in Latin American countries undergoing political strife. Others may identify predominantly with European ancestry, while still others may speak indigenous Indian languages.

Epidemiology of Depression in Hispanic Elderly
Research on the prevalence of depression in Hispanic elderly is limited in quantity, and the results are mixed. Studies of non-immigrant Hispanics have demonstrated a higher incidence of depressive symptoms in Hispanic women, but no differences in men.2 Another report states that immigrant Hispanics are more at risk than non-immigrants.3 Some reports suggest lower rates of depression in immigrant Hispanics as compared to Hispanics who have lived longer in the United States. The prevalence of depression in Hispanic immigrants as compared to Hispanic non-immigrants may also depend on the region or community. In one study in Fresno, California, depression was less likely in immigrants from Mexico as compared to U.S.-born Mexicans.4 Another study in the Lower Rio Grande Valley of Texas demonstrated increased risk of depression in immigrant Mexicans.5 A single study that examined antidepressant use in elderly Mexican Americans found that this group was less likely to be prescribed the antidepressants, and 50% of the time they were prescribed tricyclic antidepressants, which pose serious risks.6

Major depression and dysthmia (milder, but chronic depression) occur in 5% to 10% of all elderly persons seen in primary care clinics.7 In a Sacramento study of Mexican elderly, it was found that depressive symptoms were present in 32% of elderly Mexican women and 16% of elderly Mexican men.3 A study of New Mexico elderly persons found a depression rate higher in Hispanic elderly than non-Hispanic white elderly, with the highest rate noted in elderly Hispanic women.8

Contributory Factors
A number of economic, political, and health issues should be considered in treating depression in Hispanic elderly individuals. Socioeconomic issues such as family income, limited education, and inability to speak English all limit the availability of healthcare resources, as well as the ability to negotiate large healthcare centers. The majority of older Hispanics are Spanish-dominant, have a low income, and have less than a high school education.9 Some understanding of the political experiences of immigrant elderly may help to understand mood difficulties. Immigrants from Guatemala, El Salvador, Chile, Argentina, Cuba, and other countries where political violence has occurred may have experienced torture, or family death or brutality. These individuals are at high risk for developing post-traumatic stress disorder, with patients experiencing nightmares, intrusive memories of the traumatic event, and fearfulness, as well as depression.

All chronic medical conditions often can contribute to a secondary depression. Chronic pain, immobility, or impending death can all cause secondary depression.