Tip Sheets

Diversity in aging: Putting gray in the rainbow

By Paul Kleyman

Most health journalists know that the U.S. population is rapidly aging, thanks to 78 million Baby Boomers who started turning 65 years old in 2011.

What’s not as well appreciated is the increasing diversity of our aging population.

By mid-century, the proportion of elders from ethnic and racial communities will double from about two out of every 10 seniors currently to just over four in 10 older people (42 percent). 

The ranks of Hispanic seniors will explode more than six fold, rising from 2.9 million in 2010 to 17.5 million in 2050. Also by 2050, the numbers of Asian and Pacific Islander (API) seniors will more than quintuple, and Africa American and American Indian/Native Alaskan elders will each expand more than 300 percent.

For health care journalists, the graying of the American rainbow presents a kaleidoscope of story possibilities. Those who scan articles I’ve developed or aggregated from ethnic media partners on the Ethnic Elders Newsbeat site at New America Media will see stories on everything from Chinese seniors struggling to navigate the U.S. health care system to Native America programs to curtail the rise of diabetes.

One over-arching theme deserves special attention: older adults from “minority” racial and ethnic groups often encounter different health problems and require different responses than the majority white population. 

To help health reporters cover our increasingly diverse older population, this tip sheet includes four key concepts and helpful links intended to point the way toward more ethnically representative – and interesting – stories.

Key concepts include:

Cultural Competence

Aging is a cultural and social phenomenon, as well as a physical reality, yet culturally competent health services for older adults of various racial and ethnic backgrounds are scarce.

One example of the need for culturally competent patient communication involves the stigma many traditional cultures attached to mental health concerns. Family shame can keep a senior from getting timely help for treatable depression after the loss of a spouse, for instance. Some Hispanic, Asian or other ethnic families believe dementia is a form of mental illness and may avoid seeking care out of fear that the family might be considered susceptible to becoming “crazy.” This fear runs deep and also can cuts across class and educational levels.

The American Geriatrics Society (AGS) is addressing this issue through a journal, Doorway Thoughts: Cross-Cultural Health Care for Older Adults, as well as guides on cultural competence for providers. Last year, the AGS also launched the Geriatrics Cultural Navigator, an iPhone application designed to help healthcare professionals effectively care for older adults of different ethnicities. (For more information, contact Jill Lubarsky, AGS Communications Coordinator, (800) 247-4779, ext. 329; e-mail: jlubarsky@americangeriatrics.org.)

Questions to Ask:

What does census data show about older adults of diverse backgrounds in your community?   Is the complexion of the senior population in your community expected to change significantly over the next several decades? 

Which health care organizations, private and public, are serving older adults of diverse backgrounds in your community?   Have these organizations launched special programs for these populations or are they planning on doing so? 

What do advocates for various ethnic and racial groups say about the adequacy and cultural sensitivity of health services for seniors?  

Language Access

Today more than 50 million U.S. residents of all ages speak more than 176 different languages and dialects, and all of them will eventually need health care.

The ability to communicate effectively with healthcare providers is especially important for seniors with low English proficiency (LEP), including older immigrants who have come to the United States to be cared for in their old age – or to help care for their grandchildren.

Recognizing this, federal and state governments have instituted laws and regulations requiring providers to make interpretation services available.

Federal laws and regulations are codified in Title VI of the 1964 Civil Rights Act and guidances issued by the Department of Justice and the Department of Health and Human Services. See this excellent summary from attorneys at the National Senior Citizens Law Center.

To review 14 standards laid out in federal National Standards on Culturally and Linguistically Appropriate Services (CLAS), see this write-up from Office of Minority Health of the U.S. Department of Health and Human Services  For a consumer perspective on CLAS, look at this publication from the Center for Medicare Advocacy, Inc.

On the news front, starting in July 2012, the Joint Commission, an independent agency that accredits health care facilities, will incorporate new rules for “patient-centered communication” into the accreditation process.  See a summary here. In a 2011 white paper, Language Line Services, one of the major translation companies, noted that language breakdowns are involved in large numbers of adverse events in hospitals.

Questions to Ask:

Are hospitals and health care systems meeting their legal requirement to serve patients in a language they can understand? How comprehensive, effective and appropriate are these efforts?

Cultures Within Cultures

The terms we use to describe ethnic and racial populations – “Hispanic” or “Asian” or “Native American” – mask notable cultural, linguistic and socioeconomic differences between sub-groups within these broad categories.

For instance, research findings show that older “Asians” generally have better health status than other population groups. But the gross numbers skew to more established groups, such as Japanese Americans, while masking poorer health status among older Filipino, Vietnamese, and Pacific Islanders. The Asian and Pacific Islander American Health Forum worked with the American Journal of Public Health to devote its entire May 2010 issue to this subject.

Similar work is being done to understand variations among Latino groups – Puerto Ricans, Mexican Americans, Cubans and people from Central and South America.

Questions to Ask:

Do providers know enough, for instance, not to send a Japanese-heritage doctor to treat an elderly immigrant from Korea, likely to cringe at the reminder of Japan’s brutal occupation of Korea in the early 20^th century?

Do patient-education materials written in Spanish take into account how sub-groups interpret the meaning of key words?

Health Care Disparities

Health care disparities occur when various racial, ethnic or socioeconomic groups have unequal access to medical care, receive care of unequal quality, or have unequal rates of disease or disabilities.  See this helpful list of resources from the U.S. National Library of Medicine.

Examples abound of health care disparities disproportionately affecting older people. These range from environmental pollution, which is more likely to contaminate low-income geographic neighborhoods and harm the very young and very old, to lower rates of immunization for influenza and pneumococcal pneumonia for non-white older adults.

Six resource centers for Minority Aging Research (RCMARs) funded by the National Institutes in Aging, are key sources on this topic. The National Coordinating Center, based at the University of California, Los Angeles, is directed by Janet Frank (jcfrank@ucla.edu).  She can help reporters get a handle on factors that drive health care disparities, such as poor pain management among ethnic elders, which can compound the effects of illness, or cultural resistance to Western medicine, and what can be done to help older patients get the care they need.

Other important sources include the Kaiser Family Foundation’s Minority Health website, with Kaiser’s Monthly Update on Health Disparities, and the Commonwealth Fund, especially its website on vulnerable populations.  

Questions to Ask:

How are federal health care reforms addressing access and quality issues for vulnerable minority pre-retirees and retirees?   

What issues are health and social service researchers identifying and studying in your area to improve outcomes for ethnic seniors?

General sources

Key sources for reporters covering diversity and aging include the Centers for Medicare and Medicaid Office of Minority Health and the U.S. Administration in Aging’s (AoA) state-by-state statistical breakdown of minorities.

Another valuable source for any reporter looking for recent research and experts on minority aging is the Gerontological Society of America.

At its recent 64^th annual meeting in Boston, GSA distributed a “Schedule of Sessions on Minority Topics in Aging” listing hundreds of sessions on everything from “Latinos Aging in Skid Row” to “the Asian Pacific Islander Dementia Care Network.”  Many contain the kernel of potentially strong story ideas.

GSA communication director Todd Kluss (tkluss@geron.org) can provide a PDF of this 38-page booklet and contacts for listed speakers. He’ll also search GSA’s journals on any subject and provide relevant journalists pieces at no charge.

Specialized resources

National Hispanic Council on Aging

Asociacion Nacional Pro Personas Mayores (National Association for Hispanic Elderly)

Hispanic Health and Aging in a New Century

National Caucus and Center on the Black Aged

National Asian Pacific Center on Aging

Profile of Asian American Seniors in the United States

Indian Health Service

More on the numbers:

Statistical profile:  Black  Older Americans  Age 65  

Statistical profile:  Hispanic Older Americans Age 65  

Statistical profile:  Asian Older Americans Age 65

Statistical profile:  American Indian and Native Alaskan Elderly

Paul Kleyman directs the Ethnic Elders Newsbeat at New America Media (NAM), reaching 3,000 ethnic media in the U.S. Previously, he edited Aging Today, newspaper of the American Society on Aging. Co-founder of the Journalists Network on Generations he edits its e-newsletter, Generations Beat Online.