ETHNIC, RACIAL, AND CULTURAL ASPECTS OF HEALTH CARE FOR OLDER ADULTS

Introduction and Demographics

Because effective geriatric care is heavily influenced by cultural beliefs and practices of elders and their family members and the differential health risks of specific populations, any comprehensive discussion of geriatrics needs to include the recognition of the growing ethnic and racial diversity of America's older population. One measure of the growing diversity is the projection that elders from populations described as ethnic and racial minorities will grow from 18% to 39% of all older Americans by mid-century.

Table 53.1 summarizes the projected increases in ethnic and racial minorities of older adults aged 65 years and older by race and Hispanic origin. These projections, however, drastically understate the cultural diversity that geriatric providers will increasingly face because within each of these categories there is great heterogeneity, for example, the rapidly increasing population of Asian American elders include immigrants from more than 30 countries with very different cultures, and the non-Hispanic white category includes elders from the diverse Middle Eastern and eastern European countries as well as those from western European ancestry. Then within each of the ethnic and racial populations, there are vast differences in acculturation levels to the mainstream society, English language proficiency, educational and occupational backgrounds, income, religion, and family structure; all of which effect their interactions and expectations with health care providers.

So, how can geriatric team members attempt to work effectively in the face of such growing diversity? Part of the solution is knowing as much as possible about the background of the elders and their families the providers are likely to see, which may be challenging in very diverse regions.