Do Older Mexican Americans With Dementia Benefit From Living Closer to the Border? Evidence From the HEPESE

This paper explores disparities in health outcomes among Hispanic older adults living near the United States (U.S.)-Mexico border. Hispanic older adults face significant barriers to healthcare access, stemming from multiple factors: limited income, high medical costs, elevated rates of chronic disease and dementia, and greater reliance on public insurance programs, relative to other racial, ethnic, and age groups. Likewise, Hispanic older adults diagnosed with dementia near the U.S.-Mexico border face documented barriers to healthcare, including higher costs, fewer adult day care centers, and a lack of health insurance. We use a health disparities and dementia care conceptual framework to explore the interactions of these social determinants of health for the older Hispanic American population. Using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, waves 8–9, 2012–2013 and 2016), complemented by the American Community Survey (ACS, 2011–2022), we conduct descriptive and regression model analyses to explore the relationship between living in U.S. counties and states that border Mexico and health outcomes such as mobility difficulties, self-care, self-reported health, and issues with activities of daily living (ADL) and instrumental activities of daily living (iADL). We control for demographic, health, and social support characteristics to account for individual level differences. We also examine how proximity to the border and caregiver and community resources affect outcomes for Mexican American older adults aged 80 and older—a growing demographic with limited data and a higher risk of health disparities. Our findings show that Hispanic older adults who reside closer to the border rely more on caregivers for instrumental and emotional support, report worse self-reported health, experience more difficulty paying bills, report lower independence in both ADL and iADL measures, and face an increased risk of dementia diagnosis, relative to their counterparts further from the border. Our findings suggest the urgency for better policies to address the needs of older Hispanic Americans with dementia in the border region. These policies require a focus on primary care, benefits counseling, and assistance in locating and accessing community services. The long-term focus should be to support flexible caregiving arrangements that increase the autonomy of both the care recipient and caregiver, community support, culturally competent caregiving, infrastructural improvements, and in-home support services for families coping with a dementia patient.