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White ethnocentrism places lesser value on Spanish-speaking whites in society. Contrary to the evidence, this set of biased values assumes that Latino cultures are characterized by ignorant and simplistic views of health care. As a consequence, health providers may develop an impaired relationship with Latino males and their families, who in turn may be less inclined to trust the providers and accept their decisions. This impaired relationship may also make the providers inclined to avoid communicating with Latino males and their families as much as possible. Ethnocentrism among health providers may engender discrimination against older Latino males and decrease the likelihood that they will receive needed services, resulting in increased morbidity and mortality. A secondary data analysis of the relationship of social position to distress and depression using the 1994 National Population Health Survey found that, as with younger adults, mental health in late-life is affected by age, gender, marital status, education, and ethnocultural factors. The authors posit that the life experiences connected to social position are responsible for these effects. Social position shapes both the stressors encountered throughout life and the resources available to cope with those stressors (Cairney and Krause 2005). Specific stressors affecting Latino elders were identified in the HEPESE. Being a woman and having lower income, decreased income, chronic financial strain, and health problems were associated with increased depression symptoms (Chiriboga et al. 2002). Social exclusion can result in increased suicide rates due to increased isolation associated with depression. Language Language is a significant barrier to good doctor-patient relationships between older Latino males and their health care providers. The inability of the health care provider to accurately ascertain basic health information may incorrectly lead the provider to misinterpret symptomatology and lead to misdiagnosis and inappropriate therapy. Furthermore, older Latino males, as opposed to younger Latinos, have less command of the written Spanish language. Therefore, the older Latino male may be unable to communicate clearly with the health care provider. The language problem is compounded when untrained translators are used. Family members and friends, who frequently serve as translators, are often ill prepared to deal with the complexities of the medical evaluation. These translators frequently have variable translation skills and are often embarrassed to admit this to either the provider or their elder loved one. This frequently results in poor paraphrasing, translator-elder conflict, and reporting bias. Mental Health of Elderly Latino Males 257 Health Care Access and Transportation In this age group, affordability relates to issues beyond health insurance costs. While Medicare A is universal, a significant proportion of the Mexican origin population lacks this basic coverage. They have not been able to apply due to communication barriers or are not eligible because they are not American citizens . Likewise, elders who lack Part B either do not qualify or have not applied to have premiums deducted from their monthly social security entitlement. Medicare and secondary insurance use is unusual in this population. The intergenerational disparity myth posits that the older generation has more resources than the younger generations to devote to mental health care. In fact, if you delete the entitlements, which have strict criteria limiting long-term care options, then the older generation has fewer services available. This is further compounded by the problems associated with social inclusion and exclusion. While the Medicare Prescription Drug, Improvement and Modernization Act offers some relief in this area, the rules are complex. The renaming of MedicareChoice programs to Medicare Advantage programs is no doubt confusing , as is medication coverage under both Part C prescription plans and Part D (Espino et al. 2004). This causes extreme confusion for both older Latino males and their care providers, with many at risk for choosing the least advantageous plan. Ethnic-appropriate, quality health care remains a major barrier. Providers that are truly bicultural and have an interest in caring for frail elders, as well as the ability to shoulder the financial strain of caring for a Medicare population, are rare. Medicare reimbursements to physicians are unreasonably low for the time and effort required to care for a frail older Latino male (Elon 2003). Those bicultural providers willing to care for frail elders are able to pick and choose which patients they care for, leaving families to care for elders with multiple complex, interacting illnesses and limited options for quality care. The disparity in absolute numbers between elder men and women predisposes public policy, research, and health care communities to focus on mental health...

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