Health Care for African-American Elders

• The number of Black elderly in USA is expected to rise from the current 2.8 million to almost 10 million by 2050.

  In Kansas, about one in ten elders will be Black and most will live in the cities and larger towns. Traditionally, this group has increased levels of poverty (29% of older Black women and 22% of men – twice the rates for Whites) and lower educational achievement (44% graduated high school) but Black elders are a very heterogenous group with a wide range of socioeconomic factors, life experiences and health concerns.

  African Americans have lived in Kansas since before the Civil War and were crucial to the development of the early “Free State”. Many of the elderly now in Wichita came during or after the Second World War because of aircraft jobs.

• At birth, African-Americans have a shorter life expectancy than Whites (by 5 years for women and 7 years for men) but this difference disappears in the very elderly.

  The reasons why are unclear but are commonly attributed to the “healthy survivor” effect or to increased social supports and more prestigious role of elders in non-white communities. Life expectancy is marginally longer for African-Americans than whites after age 85.

  By old age, many of the genetic conditions/diseases that cause excess morbidity and mortality in persons of African descent (such as sickle-cell disease) are no longer influential as the elderly are the “healthy survivors” of their generation – the ones who were sufficiently lucky, healthy, or resourceful to avoid dying from anything previously!

• Life Expectancy at Birth, 65 and 85 Years

    White WomenBlack WomenWhite MenBlack Men 
   At Birth79.974.774.367.2 
   At 65yrs19.317.616.014.2 
   At 85yrs6.66.75.45.7 
  

  Mortality differences by race do not apply to very elderly patients

• Overall, only 58% of African-Americans older than 65 report their health to be excellent or good compared to 74% of Whites of the same ages.

  Elderly African-Americans carry a heavier health burden than other groups for several conditions, especially certain cancers and the accumulated effects of hypertension, cardiovascular disease and diabetes. Compared to Whites, coronary heart disease and stroke account for 24% of excess mortality in Black men and 41% in Black women and cancer death rates are 30% higher in elderly Black Americans.

  Hypertension: One in three Black men and two in three Black women over 65 has hypertension. The high prevalence has been linked to multiple factors including genetic salt-conserving abilities, accumulated lifelong stress, and diet/physical inactivity but has not been completely explained.

  Cardiovascular Disease: The high prevalence of hypertension, diabetes, and other risk factors is believed to contribute to the very high rates of cardiovascular and cerebrovascular disease (especially stroke) in elderly African Americans. Other factors include lifestyle factors and problems in screening and treatment programs – such programs have not always been available or acceptable to African-Americans.

  Diabetes: Rates of type II diabetes in elderly African-Americans are approximately double those of Whites, with the highest rates in women. Obesity, lifestyle factors and metabolic syndrome are believed to contribute to this high prevalence. The combination of late/delayed diagnosis, adherence difficulties, socioeconomic problems, and comorbidities results in particularly high rates of diabetic complications such as heart failure, retinopathy, end-stage renal disease, and amputations in elderly African-Americans.

  Cancer: Cancers that take an exceptionally heavy toll on elderly African Americans are prostate and breast. The incidence of prostatic cancer is 2-3 times higher in Blacks than Whites. The incidence of breast cancer in Black women is roughly the same as for Whites but the survival rates are much lower. Less dramatic, but still significantly increased mortality is seen in other cancers such as cervical cancer and multiple myeloma. Traditionally, rates of tobacco-related cancers have been lower in elderly African-Americans.

  In cancer and other diseases, elderly African-Americans may suffer higher impact from diseases not just because of increased incidence of the disease but also because of a constellation of adverse factors including

  • limited access to health care
  • difficulties in using health services (including discrimination, distrust of medical services, poverty)
  • poverty, low education, limited literacy, isolation
  • lack of advocacy
  • limited information on ethnically-specific aspects of disease and treatment
  • accumulated comorbidities and life stressors.

Minority: Elderly Minorities | Minority Groups | Significance | ETHNICS | Factors | Beyond the Words...
Hispanic: Health Care for Elders | Health Problems | Managing Health Problems | Aspects of Dementia
African-American: Health Care for Elders | Managing Health Problems | Aspects of Dementia