Healthcare challenges for increasingly diverse aging Americans

Diversity of Aging Population -- Innovative Healthcare

Over the past several decades there has been an avalanche of research and scholarly narratives focusing on the aging of millions of Americans -- among them the "baby boomers" that were born between 1946 and 1964 -- including their numbers and their health vis-a-vis the impact on the sometimes struggling healthcare system. But there has been a dearth of research on how American healthcare services will respond -- and is currently responding -- to an increasingly diverse older population when it comes to racial, cultural and ethnic identities. This paper points to the numerous issues and challenges that not only face an increasingly diverse older American population when it comes to healthcare, but also the challenges that the healthcare system itself faces as these Americans move into the twilight of their lives.

What should be the Vision and Mission of Healthcare Professionals in the U.S.

Goals and objectives in healthcare settings are necessary and informative to the public that the healthcare system serves. To that end, the Centers for Disease Control and Prevention posits that the goals of healthcare services in the United States -- with specific reference to aging Americans -- should extend well beyond the idea of helping people live longer. Indeed, the goal for older people should also be to assure that they are "living well" (CDC, 2007). Hence, the major public health challenges for America -- with reference to the increasingly diverse over-65 population -- include: living longer; living "high-quality, productive and independent lives"; providing care with leading edge technologies; eschewing bias based on culture, sexual preference or ethnicity; and reducing those behaviors "that contribute to premature death and disability" (CDC, III).

The vision and mission of the healthcare industry should include the prevention of "cognitive decline" in the elderly, and the prevention of "…end-of-life suffering" (CDC, V). The healthcare professionals' goal certainly should be to ensure that baby boomers and the aged population in general have an opportunity to enjoy the so-called "golden years"; but for the 360,000 to 480,000 adults over 65 that sustain "fall-related" fractures each year in the U.S. there is nothing golden at all about moving on in advanced years. Hence, the healthcare industry has as a goal to help the elderly avoid those falls, which are "…the leading cause of injury deaths" and the most common reason that older people are admitted to hospitals (CDC, V).

Zeroing in on older people and their inability to balance themselves, a fair question should be posed. To wit, how can healthcare professionals help prevent the diverse population of older people from the "suffering" that results from falls -- accidents which result in "significant mortality, disability, loss of independence, and early admission to nursing homes"? The CDC asserts that falls are preventable: a) if elderly persons' medications are monitored adequately; b) if vision problems are addressed properly; and c) if risk factors (hazards that cause tripping) are removed and handrails are installed (CDC, V).

As this diverse population copes with advancing years, in addition to the moral and ethical issues linked to taking care of the elderly, the American nation has a "strong economic incentive" as well, according to the CDC (III). The cost of providing healthcare for Americans over 65 is "…three to five times greater" than for those younger than 65 years; and moreover, those costs can be significantly lowered when steps are taken to "address health disparities among older adults, particularly in racial and ethnic minority populations" (CDC, V).

Indeed, the survey referenced by the CDC reveals that about 40% of Caucasian adults over 65 report "very good or excellent" health but just 24% of African-Americans and 29% of Latinos report "very good or excellent" health (III). Granted, this article is ten years old, but because there is continuing relevance within the data, these facts should cause every healthcare professional in every component of the healthcare field to sit up, take notice, and roll up sleeves in order to be part of the solution.

Elderly Latino-Americans today -- how will they fare in the Future?

"Gerontologists who are educators, policy makers, and practitioners can join in developing a new language and a new vision that sees diversity as a positive, energizing force for understanding the aged and aging in this country…" (Stanford, et al., 1991).

Understanding diverse populations -- and engaging in research related to the healthcare needs and realities of diverse Americans over the age of 65 -- has not always been at the top of the agenda for scholars and researchers. In a 1991 article published in the peer-reviewed journal, Generations, the authors, while no doubt well-intentioned, asserted that "Acknowledging diversity can also cause us to be overwhelmed with differences and discourage us from seeing the progress or lack of progress" toward improving the quality of life for all older people (Stanford, et al., 1991). The article also suggested that comparing older African-Americans with older Caucasians implies that minorities "need to 'catch up' to whites" -- which has negative implications for this much-needed research. Still, the authors acknowledge that studying the diversity of the aged population provides a "…opportunity to expand the tools and models" that will help healthcare professionals to fully grasp the "…major economic, social, and political issues in gerontology today" (Stanford, p. 4).

Meanwhile, in a much more recent Generations research article, eight out of ten in the over-65 population in American are listed as Caucasian; African-Americans comprise 8.5% of that elderly population, Latinos make up 6.8% and 3.3% are said to be of Asian ethnicity (Treas, et al., 2010, 38). That seems to go against recent demographic reports which continually list Latinos as the fastest-growing and most influential minority group, which is true for those younger than 65. To wit, Treas reports that 17% of the population that is younger than 65 is Latino and 13% is African-American.

But for the future, "…much of the growth in the old population" will involve Latinos and Asians, populations that currently are expected to more than double by the year 2050, and every alert person in the healthcare field should be thinking about how these minority populations will be served in the coming years (Treas, 39). Older Latinos are expected to become 19.5% of "all older Americans" by 2050, and older Asians could make up 8.4% of the over-65 population by 2050 (Treas, 39). As for African-Americans, they will make up 11.8% of the older population by 2050, Treas continues (39).

A peer-reviewed article in the Journal of Aging and Social Policy offers data showing that according to the 2000 U.S. Census, Latinos made up 10% of the 80 million baby boomers, and that about a third of Latino baby boomers (37%) were either born in the U.S. Or born in a territory to an American parent (Gassoumis, et al., 2010). About 6% of Latino baby boomers were born in a U.S. territory; 21% were naturalized citizens; and 36% were non-citizens (illegally living in the United States) (Gassoumis).

Looking briefly at where the older Latino population resides, Treas explains (p. 40) that 70% of Latinos over the age of 65 live in four states: California (27%); Texas (19%); Florida (16%); and New York (9%) (Treas, 40).

Many older Mexican-Americans are "…disproportionately poor and are at a disadvantage when the costs of health services are increasing…especially along the Texas-Mexican border," where several counties report half of the population lives below federal poverty standards, according to Jacqueline Angel, sociologist at the University of Texas (Gomez, 2013). Notwithstanding the struggles that elderly Latinos go through to receive healthcare in Texas, the governor, Rick Perry recently rejected federal Medicaid funding, which would have been helpful to older Texas Latinos (Latinos make up 37.6% of the entire population of Texas).

The conservative governor said, "I will not be party to socializing healthcare and bankrupting [Texas] in direct contradiction to [the] Constitution and [the] founding principles of limited government" (Chadwick, K, 2012). Perry's refusal to accept federal money for healthcare that would be beneficial to low-income residents -- in particular, elderly Latinos -- in his state means that he was willing to leave "…$79 billion of federal money on the table" because of his conservative ideology (Fuquay, 2013).

Meanwhile, the Latino baby boomers are "disadvantaged relative to [Caucasians] for all socioeconomic status and several health outcomes" (Villa, et al., 2012). In fact Latino baby boomers are "disadvantaged" for "diabetes, obesity, and fair/poor self-related health," Villa explains in the peer-reviewed journal Gerontologist. As the Latino baby boomers move into very old age, the "cumulative disadvantage of existing disparities are likely to result in continued or worse health disparities" (Villa).

Elderly African-Americans today -- how will they fare in the Future?

While it is clear from the data that elderly Latinos have struggled to maintain the dignity that comes with good health, African-Americans have also had their own struggles, albeit language does not present barriers for black people as it often does for Latinos. First, this paper will provide basic statistics on older African-Americans, followed by specific issues that this population deals with. There were an estimated 3.3 million African-Americans over 65 in 2010, according to the Administration on Aging (AoA). By 2050, it is expected that the elderly population of African-Americans will account for about 11% of the 65-and-older population in the United States (AoA).

And although African-Americans are living longer, the majority of those over 65 years of age have had "at least one chronic health condition and many have multiple conditions" (AoA). The AoA provides a breakdown into the most frequent chronic conditions that afflicted older black people between the years 2005 and 2007.

Topping the list is hypertension, with 84% of elderly African-Americans reporting this medical problem. The following medical ailments are listed with percentages of black elderly people in parentheses: a) diagnosed arthritis (53%); b) "all types of heart disease" (27%); c) sinusitis (15%); d) diabetes (29%); and e) cancer (13%) (AoA).

Statistics provided by the Administration on Aging reflect that at age 65, a black male can expect to live to 80.3 years of age and a black woman at 65 may live to age 83.7. In 2009, surveys of elderly African-Americans showed that 47% had both Medicare and supplemental private health insurance, which is close to the average of "all elderly people" (54% had Medicare and a supplemental policy) (AoA).

Since such a high percentage of African-Americans have been diagnosed with hypertension, it seems worthy to note a qualitative descriptive study of elderly black people's ability to "self-care" with reference to their struggles with hypertension. After all, learning to not just cope with but to actually help provide treatment for their maladies is the theme of any "self-care" program. The authors of the study report that they worked with ten African-Americans in a Midwest city -- all of whom had hypertension and also had "…some difficulties in cognitive functions" (Klymko, et al., 2011).

The results of the research -- during which healthcare professionals taught these individuals practices in better diet, physical activity, and the importance of self-care -- showed that even cognitively challenged elders can improve their lives with help and encouragement.

Shortage of Key Healthcare Professionals - Geriatricians

It is a joyous thought to imagine a diversity of elderly people living in a non-planned, non-institutional but strategically ideal neighborhood, as the NORC environment offers. Still, these older people need healthcare wherever they reside, and that portends problems because of the acute shortage of geriatricians. Doctors apparently are avoiding the specialization of gerontology; and according to an article by the Associated Press, nationwide, by 2030, there will be just one geriatrician for every 3,800 older Americans. This is very unfortunate because many general practitioners "…aren't train to care for seniors, whose biology is different from younger adults" (Sedensky, 2012). The salaries of geriatricians are generally lower than other medical specialists, Sedensky reports. On fact, the geriatrician's median salary of about $183,523 is puny compared to other specialists' earnings, which are "…two or three times more" (Sedensky, p. 2).

Clearly the dearth of geriatricians is not a new issue, and it's somewhat surprising that this shortage of skilled physicians who understand the health needs of the elderly has been ongoing for nearly twenty years. In a 1996 peer-reviewed article (Lancet) the author reports that the number of practicing (and teaching) geriatricians in the U.S. "…remains woefully inadequate" (Firshein, 1996).

Moreover, in 1996 there were "less than a quarter of the number of academic physicians that were needed…" in order to train future doctors in the field of geriatrics; this fact, expressed 18 years ago, may well explain the dire shortage of geriatricians in 2014 (Firshein, p. 1). Echoing the report by the Associated Press in previous paragraphs, Firshein points to poor compensation offered to geriatricians as a possible reason more doctors decide not to specialize in geriatrics. Since most patients of geriatricians are over 65 and "often frail or chronically ill," the geriatrician is often dependent upon Medicare for reimbursement, which is "…limited and does not cover the added cost of resources" that frail older people require which the geriatrician "must coordinate while overseeing their care" (Firshein, p. 1).

Ethical Concerns Regarding Innovative Technologies in Healthcare

In addition to the shortage of geriatricians in the healthcare field, there are other serious concerns when the subject of diversity within the aging population in the United States. One of those involves ethics, and it comes into focus because of the emerging emphasis on home care for elderly people. The NORC style of living for older Americans -- reviewed in great detail earlier in this paper -- may not be appropriate in many instances for home healthcare services, but when home care involves monitoring devices, including sensors, data recorders, and communication networks, serious concerns may arise.

Those technologies also include portable wearable devices that are attached to the person so a healthcare giver in another place can monitor the patient's activities (Kang, 2010). These monitoring devices can offer "…continuous physiological data" and may be worn like "pendants" that monitor heart rate, sleep patterns, and more. However, as Kang explains on page 1583, these devices "…may intrude on a person's free choice, decision-making, privacy and autonomy." Those elderly persons surveyed reported serious objections to being monitored, especially by video technologies; hence, while these technologies may be appropriate in some situations, the ethical concerns must be addressed and resolved.

Conclusion

The goal of the Centers for Disease Control and Prevention, as mentioned in the beginning of this paper, should be the goal for all those involved in healthcare services today: that is, all older people -- in particular, regarding this research, ethnically and racially diverse older people -- should be provided with an opportunity to live well. The challenges that confront Latino and African-Americans was the main focus of this paper, albeit many Asians and Native Americans suffer from the same lack of healthcare and find themselves in unhealthy environments with little access to quality healthcare. Among the positives presented in this paper is the movement called NORC in which unplanned but progressive neighborhoods become save haven and places for dependable services to a diversity of elderly people. Much more work needs to be done before all Americans can enjoy the fruits of healthy living, and it will take time, but Americans have always shown the ability to innovate and implement those needed changes.