In the next half century, the proportion of racial minorities and Hispanics among the elderly population is expected to increase rapidly and become more diverse. Life expectancy at older ages has increased significantly in the last quarter century for all major racial groups, although there are disparities. More marked differences among these racial and ethnic groups exist in "active life expectancy," the average number of years lived without a limiting disease or disability. Improved diagnosis and treatment of major medical conditions have led to growth in the number of persons living with one or more chronic conditions, which impact not necessarily on the length of life, but on the quality of life. Genetic, lifestyle, and socioeconomic factors also play an important role in the severity or time of onset of disease and disability. It is important to understand the special needs of minority elderly persons to design appropriate interventions to improve health status and quality of life for all older persons.
Analyze Disease Prevalence and Course in Minority Populations and Subpopulations
The prevalence of many diseases, including heart disease, hypertension, diabetes, Alzheimer's disease, and certain types of cancer vary significantly among minority populations. For example, blacks suffer from hypertension and prostate cancer at higher rates than their white counterparts, while Hispanics have more diabetes and less heart disease. Scientists still do not understand all of the factors involved in these health disparities. Differences in the prevalence of Alzheimer's disease in blacks and Hispanics compared to non-Hispanic whites may be related to socioeconomic factors, including education, language, and access to health care, biological factors such as the higher incidence of cardiovascular disease in African-Americans, and genetic factors such as different prevalence of risk factor genes in these populations.
Different prevalences or frequency of declines in cognitive function have been observed among populations. This may be partly due to stress-related diseases, such as hypertension, cardiovascular disease, and diabetes. Despite the substantial evidence these diseases affect cognitive functioning, there are scant relevant data examining minority and ethnic populations. Future research will focus on studies of cognitive functioning, health behaviors, and disease processes in minority populations using culturally equivalent and standardized measures to better understand these differences and to suggest culturally appropriate interventions.
Research also will focus on determining the factors contributing to the differences in the prevalence of Alzheimer's disease among different racial and ethnic populations. For example, Japanese-Americans living in Hawaii have lower prevalence of stroke-related dementia and higher rates of Alzheimer's disease than do Japanese nationals. Data are needed on the specific incidence and prevalence rates in different ethnic subpopulations and the distribution of subtypes of dementia, genetic and environmental risk factors, and differences in caregiving.
Increase Inclusion of Minorities/Subpopulations in Research
Historically, members of minority populations have been underrepresented in clinical trials. There are many difficulties associated with enrollment of minority individuals in research studies and clinical trials. Cultural and language barriers must be overcome, and ways to inform individuals of the studies and trials available and their potential benefits for improvements in health must be found. Outreach efforts, such as involving church and community organizations in emphasizing the importance of medical research and in recruiting study participants, are important for minority elderly. Research on improving strategies to include minorities in research and direct efforts to recruit minorities to clinical studies are underway.
Develop Preventive and Interventional Strategies for Healthy Aging Appropriate for Diverse Populations
To prevent or lessen the effects of disease, interventions must be designed that are culturally appropriate. For example, minority elderly individuals are more likely to use their medication appropriately if the labels and instructions are printed in their native language. Interactions with health care professionals can be difficult if there are language and cultural barriers. To diagnose Alzheimer's disease in minority elderly, assessments of cognitive impairment must be designed for individuals with low levels of education or lack of fluency in English.
Future research will focus on strategies for self-management of chronic diseases such as arthritis, heart disease, lung disease, and diabetes. Research also will investigate the factors affecting medication misuse and strategies for enhancing proper use and compliance with medication regimens.
Improve Culturally Appropriate Health Care Delivery
Communication with health care professionals can be a problem for many Asian, Hispanic, and other elderly who come to the United States. with a wide variety of educational and language skills. Often, family members or friends must act as interpreters for the elderly individual to communicate symptoms and health care instructions between the patient and the health care provider. If the elderly individual is hospitalized or placed in a nursing home, communication becomes a critical issue in assuring appropriate health care.
Recent studies reveal that how older people are diagnosed and treated is as much a function of who they are, who is treating them, and where care is provided, as a function of the symptoms they present. Future research will focus on enhancing the quality of health care encounters to reduce health disparities associated with poor provider-patient interactions.
Develop Strategies for Information Dissemination
Because of language, educational, and cultural differences, many minority elderly individuals are not receiving the information they need about healthy lifestyle behaviors. Community and religious organizations may be helpful in disseminating information. Public service advertisements can also be useful if specifically designed for foreign language newspapers, cable television, and radio. Research is needed to better understand effective strategies for communicating health messages.
Improve Health Behaviors and Health Promotion Strategies
Studies targeted to enhance healthy behavior in older racial and ethnic populations are a high priority. Efforts to reduce disparities through this research will include development of culturally appropriate screening tools and health care services and means to enhance the likelihood of elders initiating and maintaining health promotion interventions.
