BY Neil Gonzales,
Chief Correspondent, Northern California
SAN FRANCISCO -- Betty de Guzman takes her ailments in stride.
The gracefully dressed, pixie-haired 78-year-old has been a breast-cancer survivor the past 16 years. “When I got diagnosed, I said so be it,” she said. “But I’m thankful to
God for saving my life.”
She has also been battling diabetes. “I control my food and take my medicine,” she said while hanging out with friends at the Pilipino Senior Resource Center in San Francisco. “I eat a small amount of rice and more protein, vegetables and
Health and other concerns pertaining to older Filipino Americans such as de Guzman are expected only to heighten as this population along with the number of other aging
minorities is projected to increase significantly in the decades to come.
However, today’s society is ill-equipped to handle this projected surge in the population of Filipino American seniors, let alone the overall number of elderly minorities.
There remains a lack of services addressing not just health but wellness, recreational, social and other needs particular to Filipino American elders.
“We have a lot more work to do to really help older Asian American Pacific Islander (AAPI) adults, who are the most vulnerable,” said Wesley Lum, president of the Seattle-based
advocacy group National Asian Pacific Center on Aging (NAPCA). “A lot more readiness has to happen.”
That readiness becomes imperative as the number of Americans age 65 or older is projected to double to
nearly 84 million by 2050 from the 43 million in 2012, according to Steve Wallace, a director with the UCLA-based Resource Centers for Minority Aging Research, a national initiative to improve the health of older minorities.
Much of that overall geriatric growth is expected to burst out of Filipino and other minority communities. By 2050, according to Wallace, the number of Asian elders will
rise some fourfold from 1.6 percent to 6 percent of all older Americans while it will jump five times for elderly Latinos from 3.1 percent to 15.4 percent.
Filipinos already are the second largest Asian American population behind the Chinese. In 2010, Filipinos numbered 3.4 million while the Chinese 4 million, according to the US
Correspondingly, Filipino seniors in 2010 represented the second largest AAPI elder population behind their Chinese counterparts – 20 percent and 26 percent, respectively,
according to NAPCA.
Filipino elders accounted for 10 percent of the total population of that ethnic group, according to the Stanford University geriatrics report “Health and Health Care of Filipino American Older Adults” by Drs. VJ Periyakoil and Mark Dela Cruz in 2010.
Key health concerns
Among the key health issues facing elderly Filipinos in particular are diabetes, hypertension and cancer.
A study published in the Canadian Journal of Public Health
in April found that non-obese Filipino Americans age 50 and over have a higher prevalence of diabetes than their Caucasian counterparts (7.6 percent vs. 4.3 percent). One in every 15 non-obese older Filipino Americans suffers from
diabetes, the study added.
Filipinos’ traditionally high-cholesterol, salty diet is a factor behind the likelihood for developing diabetes and hypertension, Periyakoil said.
“Organ meats such as tripe, pork blood, pork and chicken intestines, and poultry liver are well-liked,” Periyakoil’s report said. “The typical diet uses high-sodium condiments such as fish sauce (patis), shrimp paste (bagoong), soy sauce (toyo), anchovies and anchovy paste.”
Filipinos also enjoy pastries, rice cakes and other desserts high in concentrated sugar, the report said.
Filipino American women – including the elderly - have the second highest incidence and highest mortality rate for breast cancer compared to other Asian American groups while the men follow suit in regards to lung cancer, the report said.
Contributing to a rise in lung-cancer cases is the Filipino social norm for smoking, Periyakoil said.
“Increased prevalence of smoking among foreign-born Asians compared to their US-born Asian counterparts may partially explain increased rates of lung cancer,” added Heather
Chun, NAPCA’s director of technical assistance.
“Other risk factors that may explain increased rates of cancers, diabetes and hypertension” include obesity, the adoption of fatty American diets and physical inactivity, Chun
Cultural beliefs and behaviors can prove barriers to addressing these health concerns.
“Filipinos, especially those who migrated late in life (to the US), have the tendency to self-diagnose, self-medicate and seek alternative therapies,” Periyakoil’s report said. “This practice causes great concern to most health-care providers
since these older adults only seek medical care when their illness is already very serious or in an advanced stage, leading to missed opportunities for optimal treatment.”
Elderly Filipinos also tend to weigh how much they might become a “financial and emotional burden to the family” before considering professional help, the report said.
“Filipino American elders are very family-centered,” Periyakoil said. “They don’t want to be a burden to their children.”
At the same time, filial responsibility can come into play as well. Filipino culture values extended families and places great importance on grown children caring for their elderly parents at home. “Although acculturation (to American society) makes families more accepting of formal support, they are still reluctant and may be less likely to seek professional caregivers, respite, long-term services
and supports, and long-term care,” Chun said.
Another roadblock is the Filipino attitude of “bahala na,”
or leaving something to fate or God. “Completion rates of advanced health-care directives with Filipino older adults are low,” Chun said. “This is likely due to their fatalistic belief that illness is destined or inevitable, thus rendering advanced health-care directives pointless.”
In a similar vein, Filipinos’ deep sense of religion or spirituality can sway the elderly from taking advantage of medical treatment or long-term institutional care.
“In a small qualitative research study of elderly female Filipino immigrants in Vallejo, Calif., most of the participants believed that certain illnesses that cannot be treated by modern medicine can be treated through divine intercession,” Periyakoil’s report said.
Other hurdles to accessing formal care, health insurance and other services include a lack of mobility and limited English proficiency among many Filipino seniors – especially recently arrived immigrants, the report said.
To counter these health problems and barriers, experts agree that culturally and linguistically appropriate efforts encouraging nutritious eating and physical activity need to
be improved upon or increased.
Elderly Filipinos “need culturally sensitive support,” Periyakoil said. Such support addresses, for example, their need for a group approach in which they can talk with their family first before making decisions about their advanced-care planning.
Filipino American seniors also need more health screenings, transportation help in making doctor’s appointments and community-based services that involve their children,
In addition, they can benefit from more programs led by other seniors that allow them to socialize and network or participate in meaningful activities such as dancing and tai chi - which studies have shown can delay the onset of dementia, she said.
Another example of being culturally appropriate is offering healthy ethnic meals such as those featuring vegetables or fish in community-based senior nutrition programs, Lum
The Canadian Journal of Public Health study recommends “promoting the consumption of brown rice rather than white rice (as) a simple yet very promising intervention for the Filipino population.”
Research indicate that substituting a mere 50 grams of white rice with brown rice per day lowers the risk of diabetes by 16 percent, the study said.
Raising awareness of the link between lack of sleep and diabetes onset is a potential strategy of particular salience to Filipino Americans, the study added. That’s because a
third of Asian Americans sleep less than seven hours a night – a significantly higher proportion compared to Caucasians who report insufficient sleep.
On the linguistic side, Lum said, having a professional home-based caregiver who can speak to the elderly immigrant client in his or her native tongue helps provide the best
quality support. That can be especially helpful for elderly Filipino Americans who suffer from dementia and revert back to their younger years.
Besides improving or increasing services, collecting and analyzing data and other information about elderly Filipino Americans will become critical. “What we need to do next is to be able to provide data,” Lum said. “Data tells the story. It tells us what actually is needed” be it housing, health care, funding or other resource.
Efforts under way
Although much still needs to be done for the AAPI elder population, a number of programs and efforts have sprouted out over the years to tackle the growing challenges.
Established in 2006, the Pilipino Senior Resource Center in San Francisco offers an array of culturally accommodating services to elderly Filipino Americans. In partnership
with other groups, the center brings seniors such services as free blood-pressure screenings, breast-cancer support, educational classes and translation assistance.
“But it’s not just the seniors we serve but the whole family,” said Cecile Ascalon, the center’s executive director. That’s because in Filipino culture it’s important to consider the extended family.
The center also sees seniors who don’t have a family or live independently - giving them a place where they feel a sense of belonging, she said.
“We have movies, bingo and field trips,” she added. “Our seniors are always on the go, hyper and energetic.”
Francisco Viray, 92, enjoys the company at the center. “I go here to be happy and meet up with people I know,” he said during a free lunch program featuring chicken and salad.
The field trips and other activities offered by the center also augment his need for daily exercise. “My doctor told me to exercise and walk so I don’t weaken,” he said. “So every day, I go outside.”
Last year, NAPCA in conjunction with other organizations launched the nationwide program “Healthy Eating Healthy Aging” funded by a $484,000 grant from the Walmart Foundation.
This effort targeting the Filipino, Chinese and other AAPI elder communities came about after “we couldn’t find much healthy-eating education” in immigrant communities and their languages - especially with the older population, said Eun Jeong Lee, national director for NAPCA’s Senior Community Service Employment Program.
So the program has been holding workshops in immigrant languages such as Tagalog, Mandarin and Samoan in cities across the country, including San Francisco, Seattle and New
York, to encourage participants to bump up their vegetable and fruit consumption while reducing their salt intake.
The program also seeks to increase participants’ reading and understanding of nutrition labels on food products. “Seniors love the program because they enjoy being able to read the labels” and learning about nutrition, calories and fat, Lee said.
Steven Raga, who works on older-adult outreach for the senior-advocacy organization AARP in Washington, D.C., said he has been seeing a steady amount of programs being established over the years to address the Filipino American elder population.
There seems to be a groundswell of programs such as those addressing hypertension in areas with, not surprisingly, a large Filipino American community – including San Francisco, San Diego and New York, he said.
He noted that AARP offers resources aimed at elder Filipino Americans, including information on long-term health-care planning and caregiving.
“We really have to meet the elderly and Filipino American seniors where they are in the community or online,” Raga added. AARP is “always participating with Filipino organizations and businesses to let seniors know what our services are.”
As the number of elder Americans has increased, Periyakoil said, “awareness is becoming a little better” regarding geriatric issues.
“But have we done everything we can?” she asked rhetorically. “Absolutely not.”
This article was written with the support of a journalism fellowship from New America Media, the Gerontological Society of America and AARP.
ElderlyFilAm: Cecile Ascalon (center), executive director of the Pilipino Senior Resource Center in San Francisco, look over pictures on an iPhone following activities serving elderly Filipino Americans. The center provides an array of recreational, educational and health services for Filipino seniors. Photo
by Neil Gonzales.
ElderlyFilAm2: Elisa Benedicto (far left) leads a bingo game at the Pilipino Senior Resource Center in San Francisco. Bingo is just part of the many activities and programs that the center offers elderly Filipino Americans and their families. Photo by Neil Gonzales.