The Racial Gap in Healthcare Among Older Adults

Healthy living should be equally accessible to all individuals. Unfortunately, there seems to be a consistent, problematic trend in the health outcomes for people in different racial or ethnic groups. This racial disparity in healthcare is prevalent among people of all age groups, but especially for those who are in greater need of healthcare and are most vulnerable to the COVID-19 pandemic: individuals over the age of 65. Although most of the older population is typically satisfied with their healthcare, there are several exceptions, including older adults with “multiple comorbid conditions, physical limitations, and cognitive impairment” [8]. Unfortunately, such conditions are more prevalent among the older black population. Older black adults, compared to older white adults, are more likely to have higher levels of blood pressure, cholesterol, and glycated hemoglobin, which means they are at a greater risk of diseases such as hypertension, cardiovascular diseases, and diabetes [1]. This is a result of a lack of access to resources for both a healthy lifestyle and in medical care. Thus, it is clear that race may be a determining factor in the health outcome among older populations.


One of the main issues that contribute to this health disparity is historically racist policies that have decreased the availability of health resources to older black adults. Housing policies such as redlining have limited the neighborhoods in which they could reside, and the poor living conditions of the available houses made them vulnerable to the development of different health complications. Even after these policies were banned in 1968 with the Fair Housing Act, their limited housing and neighborhood choices in the 1930s still affect the older black adults today due to systemic racism, also known as institutional racism [4]. The neighborhoods they were living in as a result of discriminatory policies are still largely inhabited by black people, especially older black adults. These areas experience high rates of poverty, and with poverty comes terrible living conditions and a lack of necessary resources to promote a healthy lifestyle. It is harder for them to buy healthy foods such as fresh produce and to exercise due to the lack of a safe environment and infrastructure such as parks. Not only does poverty lead to poor physical health outcomes, but it can also impact mental health, as “expenditure disparities reflect differences in the number of resources provided to African-Americans and Latinos compared with non-Latino Caucasians” [5]. Mental health is very important for maintaining the quality of life, especially during a pandemic. The older population is more likely to be in isolation due to their lack of mobility, vulnerability to COVID-19, or other health-related issues. Living in isolation causes several health outcomes that decrease one’s quality of life. These poor health outcomes include “mortality, depression, and cognitive decline” [6]. It has a negative effect not only on their mental health but also their cognitive abilities. With the lack of resources to cope with these issues, older black adults are more prone to multiple comorbidities with various physical health and mental health conditions.


The problem does not stop there. Racial minorities have to live with these health inequities through the end of their lives, as shown by their lack of access to both nursing homes and hospices. In a cross-sectional study by Dr. Zheng and her colleagues, nursing homes residents in New York State were made up of 90.77% white residents and only 9.23% black residents, and other minority groups “were not included as they represent <2% of the total nursing home population” [11]. This data plainly shows that older adults in racial minority groups do not have access to facilities that support quality of life. Access to high-quality facilities not only helps older adults to receive professional care but also benefits their loved ones by reducing the level of caregiver burden. In addition, the study found a higher mortality rate for older black adults compared to older white adults because they only have access to long-term care facilities with poorer conditions and qualities. In summary, older adults in racial minority groups have to face discrimination in healthcare even towards the end of their lives.


It definitely is a challenge to change systematically racist policies and laws, but that does not mean inaction is permitted. Even if it takes time, the change should happen step-by-step, beginning with providing more resources in the neighborhoods predominantly inhabited by older adults in racial minority groups. This would be a great first step on the path towards reducing the racial gap in health care among the older population.


References:

  1. Ayanian, J. Z., Landon, B. E., Newhouse, J. P., & Zaslavsky, A. M. (2014). Racial and ethnic disparities among enrollees in medicare advantage plans. New England Journal of Medicine, 371(24), 2288–2297. https://doi.org/10.1056/NEJMsa1407273

  2. Census. (2015-2019). Percent Black or African American Population [Map]. PolicyMap. https://cornell.policymap.com/maps

  3. Frahm, K. A., Brown, L. M., & Hyer, K. (2015). Racial disparities in receipt of hospice services among nursing home residents. American Journal of Hospice & Palliative Medicine, 32(2), 233–237. https://doi.org/10.1177/1049909113511144

  4. Hoffman, J.S., Shandas, V., & Pendleton, N. (2020). The Effects of Historical Housing Policies on Resident Exposure to Intra-Urban Heat: A Study of 108 US Urban Areas. Climate, 8(1), 12. https://doi.org/10.3390/cli8010012

  5. Jimenez, D. E., Schmidt, A. C., Kim, G., & Le Cook, B. (2017). Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults. INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 32(8), 909–921. https://doi.org/10.1002/gps.4546

  6. Medvene, L. J., Nilsen, K. M., Smith, R., Ofei-Dodoo, S., DiLollo, A., Webster, N., Graham, A., & Nance, A. (2015). Social networks and links to isolation and loneliness among elderly HCBS clients. Aging and Mental Health, 20(5), 485–493. https://doi.org/10.1080/13607863.2015.1021751

  7. Pinheiro, L. C., Wheeler, S. B., Reeve, B. B., Lyons, J. C., Chen, R. C., & Mayer, D. K. (2015). The effects of cancer and racial disparities in health-related quality of life among older Americans: A case-control, population-based study. Cancer, 121(8), 1312–1320. https://doi.org/10.1002/cncr.29205

  8. Thomas, K. M., Patel, A. R., Swails, J. L., & Kwak, M. J. (2021). Primary care experience among older adults in the United States: a retrospective cross-sectional study. Archives of Gerontology and Geriatrics, 95. https://doi.org/10.1016/j.archger.2021.104396

  9. University of Richmond, University of Maryland, Virginia Tech, and Johns Hopkins University. (1935-1940). Home Owners’ Loan Corporation Risk Maps [Map]. PolicyMap. https://cornell.policymap.com/maps

  10. Yue Li, Glance, L. G., Jun Yin, & Murkamel, D. B. (2011). Racial Disparities in Rehospitalization Among Medicare Patients in Skilled Nursing Facilities. American Journal of Public Health, 101(5), 875–882.

  11. Zheng, N.T., Mukamel, D.B., Caprio, T., Cai, S., & Temkin-Greener, H. (2011). Racial Disparities in In-hospital Death and Hospice Use Among Nursing Home Residents at the End of Life. Medical Care, 49(11), 992–998. https://doi.org/10.1097/MLR.0b013e318236384e

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