by Neil Gonzalez. This article originally appeared on New America Media.

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 fruits.”

Lack of Service for Surge of Elders
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, according to Steven Wallace, director of the Resource Centers for Minority Aging Research, a national initiative based at the University of California, Los Angeles, to improve the health of ethnic elders.

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 quadruple to six percent and jump five times for older Latinos to 15.4 percent of all older Americans.

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 U.S. Census Bureau. In the AAPI population, 26 percent of seniors are Chinese and 20 percent are Filipino, according to NAPCA.

Key Health Concerns 
Among Filipinos, elders accounted for 10 percent of the population, according to a 2010 Stanford University geriatrics report “Health and Health Care of Filipino American Older Adults” by physicians V.J. Periyakoil and Mark Dela Cruz.

Among the key health issues facing older Filipinos are diabetes, hypertension and cancer. Filipinos’ traditionally high-cholesterol, salty diet is a factor behind the likelihood for developing diabetes and hypertension, said the Stanford study.

“Organ meats, such as tripe, pork blood, pork and chicken intestines and poultry liver are well-liked.” Periyakoil and Dela Cruz add, “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 elders — have the second highest incidence and highest mortality rate for breast cancer compared to other Asian American groups.

Meanwhile, the men follow have especially high lung cancer, the report said, Which Periyakoil attributed partly to their Filipino social norm of smoking.

“Increased prevalence of smoking among foreign-born Asians compared to their U.S.-born Asian counterparts may partially explain increased rates of lung cancer,” added Heather Chun, NAPCA’s director of technical assistance. She said “Other risk factors that may explain increased rates of cancers, diabetes and hypertension” include obesity, the adoption of fatty American diets and physical inactivity.

Barriers
Cultural beliefs and behaviors can prove barriers to addressing these health concerns.

“Filipinos, especially those who migrated late in life, have the tendency to self-diagnose, self-medicate and seek alternative therapies,” states the Stanford report. “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 and Dela Cruz said. “They don’t want to be a burden to their children.”

At the same time, filial responsibility can come into play. Filipino culture values extended families and places great importance on grown children caring for their elderly parents at home.

Chun observed, “Although acculturation 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.”

Another roadblock is the Filipino attitude of “bahala na,” or leaving something to fate or God. One result, Chun said, is their “fatalistic belief that illness is destined or inevitable, thus rendering advanced health care directives pointless” as a tool for stating one’s preferred medical treatment at the end of life.

In a similar vein, Filipinos’ deep sense of religion or spirituality can sway older adults from taking advantage of medical treatment or long-term institutional care. The Stanford report included information on their small qualitative research study of elderly female Filipino immigrants in Vallejo, Calif. They found that “most of the participants believed that certain illnesses that cannot be treated by modern medicine can be treated through divine intercession.”

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, said the Stanford study.

Culture, Language and Other Strategies
To counter these health problems, experts agree that culturally and linguistically sensitive efforts encouraging nutritious eating and physical activity need to be improved or increased. 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 to anticipate serious or terminal illness before a crisis.

Filipino American seniors also need more health screenings, transportation help in making doctor’s appointments and community-based services that involve their children, she said.

They can also 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.

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 said.

A report in the Canadian Journal of Public Health 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.

Heightening awareness of the link between lack of sleep and diabetes onset is also a potential strategy of particular salience to Filipino Americans, according to the Canadian journal study. That’s because a third of Asian Americans sleep less than seven hours a night – a significantly higher proportion compared to whites who report insufficient sleep.

Another concern, Lum said, is that having professional home-based caregivers who can speak to older immigrants in their native tongue helps provide the best quality of 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.

Model Programs For AAPI Elders
Although much still needs to be done for the Asian American/Pacific Islander (AAPI) elder population, a number of programs and efforts have sprouted 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 older 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, because in Filipino culture it’s important to consider the extended family. The center also sees seniors who don’t have a family or who live independently, she said.

Francisco Viray, 92, veteran and former painter, said, “I go here to be happy and meet up with people I know.” said Viray. The center’s field trips and other activities also augment his need for daily exercise.

Last year, National Asian Pacific Center on Aging (NAPCA), in conjunction with other organizations, launched the nationwide program called Healthy Eating, Healthy Aging, funded by a $484,000 grant from the Walmart Foundation, according to Eun Jeong Lee, national director for NAPCA’s Senior Community Service Employment Program.

The program has held workshops in languages, such as Tagalog, Mandarin and Samoan in cities across the country to encourage participants to bump up their vegetable and fruit consumption while reducing their salt intake. Program sessions also help participants understanding nutrition labels on food products better, such as the facts about calories and fat, Lee said.

Steven Raga, who works on older-adult outreach for AARP in Washington, D.C., said he has seen numerous programs established over the years to address concerns, such as on hypertension, for older Filipino Americans. He said AARP offers resources for them, for example, 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.

Neil Gonzalez wrote this article for Philippine News supported by a journalism fellowship from New America Media, the Gerontological Society of America and AARP.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.