Improving Care at the End of Life for Latinos: A Cultural Navigator Intervention
Funded by: NIA/Beeson K 23
Project Period: 07/07 - 06/11
Summary/Abstract
Failure to address or adhere to advance directives, inadequate symptom management, and unplanned institutional
deaths are major problems in care for the dying. The elderly bear most of this burden; three quarters of
those dying in the United States are over 65 years of age. Nationally, there is an expected overall increase
of 58% in persons over 65 from 1995 to 2020, while in Colorado the increase is expected to be 100%. In
addition, the oldest old are the fastest growing population in the United States. The vast majority of
elderly will experience chronic, disabling illness in the last years of their life. The goal to improve
care at the end of life for all persons must be a national priority as costs of care skyrocket and the
burdens of technologic interventions to prolong quantity over quality of life take their toll.
Yet as efforts are made to improve end-of-life care for all persons, we must recognize that cultural
values have a major impact on care preferences at the end of life for many ethnic minorities. A
one-size-fits-all approach will not be sufficient and will likely widen the gap of cultural differences
and health disparities in end-of-life care. Current studies suggest that older Latinos are more likely
to die in an institution, less likely to receive adequate pain control, and rarely receive hospice
services. Latinos are now the largest ethnic minority in the United States and expected to grow by
188% over the next 50 years. Thus, as this large ethnic group ages, we must meet the goal of improved
end-of-life care, addressing their unique needs.
Community-based culturally tailored interventions, often utilizing community health workers or navigators,
are gaining support. However, no published work exists on a culturally tailored approach to specifically
improve end-of-life care.
The overall goal of this project is to improve end-of-life care for seriously ill older Latinos
through a cultural navigator, or guia, delivering a culturally tailored intervention. The first step
of the project is to develop, through a multi-step process involving community members and experts in
the field, the materials needed for the intervention and to train the guia. The next phase of the project
is a vanguard randomized controlled trial of the cultural navigator intervention, targeting seriously ill
older Latinos. The intervention is designed to assess the feasibility of conducting a fully powered
randomized controlled trial of the intervention by determining withdraw rates, and estimating rates of
Advance Care Planning, improved pain management, and utilization of hospice care. Proving that a cultural
navigator intervention can improve end-of-life care is critical for future funding and support of this kind
of intervention.
Key Staff: Stacy Fischer, Linda Martinez
v