III Clinical Care in Ethnogeriatrics
Health Disparities: Access and Utilization
The views expressed in this chapter are those of the author and do not necessarily represent the views of the National Institutes of Health-National Institute on Aging, The U.S. Department of Health and Human Services, or the U.S. Federal Government.
Life expectancy and overall health have considerably improved over the years for most Americans, but not all older adults are benefiting equally. Older adults carry 60 % of the national disease burden, having disproportionately high rates of cancer, cardiovascular disease, hypertension, diabetes, dementia, arthritis, Parkinson’s disease, and other conditions. They spend 36 % of the total U.S. personal health care dollars and consume 42 % of all prescription drugs. One-quarter of older adults reaching Medicare eligibility already have >5 chronic conditions, making this population responsible for over two-thirds of the Medicare spending. Older adults’ health status varies by race and ethnicity, gender, socioeconomic power, and other characteristics. Older adults of racial and ethnic groups bear the heavy burden of multiple chronic conditions. African-Americans and Latinos, in particular, are disproportionately affected by chronic illnesses, disability, depression, poverty, and substandard quality of life .
Although Medicare has played a critical role in ensuring access to care for older adults, particularly among low income and racial and ethnic minorities, evidence shows that access to and utilization of health care services is unequal among older racial and ethnic minorities . The issue is similar for Medicaid, the primary payer for long-term services and supports, with provider shortages and low provider participation in Medicaid (particularly specialists) being a major concern to accessing services .
R. Correa-de-Araujo, M.D., M.Sc., Ph.D. (*)
Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services,
Blacks and Hispanics receive fewer medical services and spend less than Whites. This is clearly the case for cardiac procedures, prescriptions for life-saving medications, narcotic medications for pain relief, and other important services . Table 7.1 summarizes additional information on disparities in health services utilization by older racial and ethnic groups [5, 6].
To add to the problem, older adults in general and, in particular, older minorities and/or those with multiple chronic conditions are less likely to be included in clinical studies, which make evidence-based information on the effectiveness and safety of a variety of interventions irrelevant, incomplete, or unavailable to support clinical decision making. This frequent exclusion impedes the bridging of the research- practice gap intended to accelerate implementation of effective interventions in clinical practice. Failure in translating research into practice and policy is also a consistent finding from health services research. As a result, patients fail to have access to and to benefit optimally from advances in medicine and health care and are exposed to unnecessary risks of iatrogenic harms. In addition, health care systems are also exposed to unnecessary expenditure potentially resulting in significant costs [7, 8]. Provider and system changes are needed to accommodate for the complex care of older minorities with multiple chronic conditions (for more information see Chap. 14).
In 2050, the population of older adults >65 years is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. Although this population is not anticipated to turn into majority-minority in the next four decades, it is projected to be 39.1 % minority in 2050 (up from 20.7 % in 2012), with the largest increases among Hispanics, Asians, Native Hawaiians, and other Pacific Islander groups . Therefore, documenting, and addressing disparities will be critical to help monitor progress, tackle barriers and other gap areas across health care settings, allocate resources, implement existent effective interventions, or design and implement new ones to eliminate these disparities. These efforts should ultimately improve access to and utilization of health and support services and help enhance clinical practice to incorporate the provision of culturally sensitive care. Older minorities will likely benefit from improved outcomes and quality of life.