RESUMO
BACKGROUND AND AIMS: Use of percutaneous endoscopic gastrostomy (PEG) tubes in older adults remains controversial. This cross-sectional study examines community-dwelling Mexican American older adults' attitudes toward PEG tube placement in the hypothetical event of a terminal illness. METHODS: Interviews were conducted with 100 community-dwelling Mexican American (MA's) adults, age 60 and over, in San Antonio, Texas. Subjects were screened for cognitive competence using Folstein's mini-mental examination. This was followed by an evaluation of socioeconomic status, depressive symptoms, religiosity, health status and attitudes toward end-of-life care, including PEG tube feeding. RESULTS: Higher income MA's, professionals, those without a living will, those who saw religious belief as not important and those who attended church less than once a month were more likely to agree with PEG placement (all P < 0.05). Logistic regression analysis revealed that higher income (OR = 3.16, CI = 1.13-8.83), lack of a living will (OR = 3.34, CI = 1.03-20.87) and low importance of religious beliefs (OR = 7.14, CI = 1.25-41.67) were all independently associated with the desire for insertion of a PEG tube at the end of life. CONCLUSIONS: This is the first community-based study to describe older Mexican American's attitudes toward PEG tube placement at the end of life. Older community-dwelling Mexican Americans with higher incomes, lack of a living will or low religious involvement might be more likely to choose PEG tube placement even in the context of a terminal condition.
Assuntos
Gastrostomia/psicologia , Assistência Terminal/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , Projetos PilotoRESUMO
PURPOSE: To determine the factors that are associated with Mexican Americans' preference for ventilator support, given a supposed terminal diagnosis. METHODS: 100 Mexican Americans, aged 60-89, were recruited and screened for MMSE scores above 18. Eligible subjects answered a questionnaire in their preferred language (English/Spanish) concerning ventilator use during terminal illness. Mediator variables examined included demographics, generation, religiosity, occupation, self-reported depression, self-reported health, and activities of daily living. RESULTS: Being first or second generation American (OR = 0.18, CI = 0.05-0.66) with no IADL disability (OR = 0.11, CI = 0.02-0.59) and having depressive symptoms (OR = 1.43, CI = 1.08-1.89) were associated with preference for ventilator support. IMPLICATIONS: First and second generation older Mexican Americans and those functionally independent are more likely to prefer end-of-life ventilation support. Although depressive symptoms were inversely associated with ventilator use at the end of life, scores may more accurately reflect psychological stress associated with enduring the scenario. Further studies are needed to determine these factors' generalizability to the larger Mexican American community.
Assuntos
Atitude Frente a Saúde , Americanos Mexicanos/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Assistência Terminal/estatística & dados numéricos , Ventiladores Mecânicos/estatística & dados numéricos , População Branca/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Texas/epidemiologiaRESUMO
Little is known about attitudes toward physician-assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non-Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non-Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community-based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity. Older Mexican Americans (52.7%) reported stronger agreement than non-Hispanic whites (33.7%) with PAS. Male sex (odds ratio (OR)=2.62, 95% confidence interval (CI)=1.09-6.35) predicted agreement with legalization in Mexican Americans, whereas lower religiosity scores (OR=0.84, 95% CI=0.75-0.94) were predictive of agreement in older non-Hispanic whites. This study is the first to find positive attitudes among community-dwelling older Mexican Americans toward PAS that are higher than those of older non-Hispanic white adults. Sex and religious views were important determinants of positive attitudes toward PAS. Larger, more-generalizable studies should be conducted to confirm the attitudinal patterns that have been identified in this study.