Health professionals have a responsibility to assist older Latinos with life-limiting illnesses (LLI) and their family caregivers to make end-of-life (EOL) care decisions that are acceptable and satisfactory. Evidence shows Latinos are "low-users" of hospice services (National Hospice and Palliative Care Organization, 2018) and when they use hospice, they are less satisfied than non-Latino Whites (NLW; Agency for Healthcare Research and Quality, 2016). To investigate how much is actually known about the factors that influence the acceptability of EOL care decisions among Latinos, a review was conducted focused on studies about EOL care decisions, with data reported in the "voices" of those making EOL decisions, that is, sampling their primary data. This article presents an analysis of extant research literature on EOL decision making among Latinos of Mexican descent or Mexican Americans (MAs). This review focused on MAs because they are the largest and fastest growing Latino subgroup in the United States

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults’ gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.

Evidence suggests that men's health disparities are linked to attitudes and beliefs toward health promotion and risk reduction, participation in high-risk behaviors, and limited health care access and utilization influenced by socioeconomic challenges. However, we know less about the specific factors related to health disparities in older Mexican American males. The purpose of this study was to explore the cultural, social, environmental, and gender factors influencing health-seeking behaviors and health information gathering in older Mexican American males. Indepth interviews were conducted with 14 older Mexican American males aged 65-80 years. Based on language preference, interviews were conducted in either Spanish or English. A standardized moderator's guide was used to examine the participant's perceptions of health, maintenance of health, gender influences on health, and sources of men's health information and health promotion programs. Data were collected, organized, and analyzed following the methodology of transcendental phenomenology and the Social Ecological Model. Two major themes related to health-seeking behaviors and health information gathering emerged: 1) top external sources heeded include women, health care providers, and the Internet and 2) men regard inner prompts for self-determined self-care. Future research should consider these external sources and inner prompts when developing targeted health promotion interventions, such as physical activity programs, with older Mexican American males.

Knowledge gaps exist about how to help Mexican American (MA) families seek assistance when their capacity to assist older family members is challenged. MA families may resist confronting unpleasant but real situations with the older adult, for example, the need to access long term support services (LTSS), because of cultural and structural barriers. The purpose was to describe stakeholders’ reactions to a culturally focused graphic novela created in partnership with a community advisory council. Qualitative description with content analysis of a focus group’s reactions to the graphic novela was used. Results included positive reactions as well as suggestions for improvement and dissemination. Graphic novelas can be an effective medium for modeling conversations about older adults’ needing additional care, and demonstrating how to identify and access available LTSS or other services. Included is a description of the researchers’ process of partnering with diverse stakeholders, which is essential for creating new solutions.

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