Helping Elderly African-Americans Manage Health Problems

• Stereotypes are dangerous and unfair but it is reported that elderly African-Americans tend to be fatalistic and accepting of illness, thus limiting their motivation for preventive measures or comfort in long-term adherence such as glycemic or blood pressure control.

  They are also reported to regard conditions such as hypertension and diabetes as “temporary” –leading to the common practice of discontinuing medications once control is achieved.

• Although a distinct African-American traditional healing process based on herbs and magic manipulated by a “root doctor” is described, most elderly African-Americans are believed to be less likely to use Complementary and Alternative Medicine/Practices (CAM) than other groups.

  Most have a qualified respect for and high expectations of conventional medicine (see below), particularly the use of pills. Remember, not all Black patients are African-American. Recent immigrants from Africa or the Caribbean may use CAM extensively.

• Concepts and Terms

  “Falling out” refers to fainting or any loss of consciousness, especially if associated with an emotional state such as fainting during church services.
  “High blood” means having too much blood or blood that is too high in the body - a temporary condition, not to be confused with elevated blood pressure.
  “Hypertension” to an elderly Black patient might mean “high blood” or excessive stress, or a combination of the two.
  Losing weight or being slim is regarded as unhealthy by many elderly Black patients, especially women.

• In helping elderly African-Americans managing health problems, experts stress the importance of several key issues

  Family and Community: Intergenerational family support and the involvement of extended family and “fictive kin” are reported to be key determinants of health and quality of life in elderly African-Americans. These support systems stress strong emotional bonds as well as practical support services. Health problems of elders are likely to be widely discussed and solutions sought within the “family”. Paradoxically, families and patients may be uncomfortable with full disclosure to elderly African-American patients about the severity of their illness or the prognosis and may negotiate with the physician about what to tell the patient. Informal caregiving of elders by family and others is expected, partly due to the sense of family/community obligation and partly due to distrust of “official” health and social services (see below). Traditionally, elderly African-Americans were rarely admitted to nursing homes but this trend may have changed in recent years.

  Spirituality: Both personal spirituality and organized religion are very important to many elderly Black patients. Individuals may believe that illness is related to punishment for sin or offers a means of atonement or spiritual purification and that the ability to treat illness has profound spiritual meaning. Taking purposeful action to improve health can therefore be perceived as either a religious duty (“using divinely-revealed knowledge to take care of the body”) – or as refusing to accept an ordained suffering (the “Job syndrome”). The faith or church community can provide a strong support system and exert a powerful influence on how individuals interpret and deal with health conditions. Health problems are very likely to be discussed with a clergyman and may be widely known to other church members. Prayer by individuals and groups, even special services, may be powerful forces in managing health problems.

  Distrust of Medical Services: The long history of segregation and discrimination in most aspects of life, including health services, has left a legacy of distrust of health services that compounds the general impression that physicians from other races “don’t understand Black people”. Elderly African-Americans may be particularly distrustful of experimental treatment due to the Tuskegee experiment. One result is the very low participation of African-Americans in research and clinical trials, thus limiting specific information about how treatments might differentially affect Black individuals. Elderly African-Americans and their families may be particularly sensitive to any suggestion that they are receiving substandard care. This can make discussions about end-of–life care and do not resuscitate (DNR) orders particularly troubling.

  Personal Respect: Personal respect is extremely important for elderly African-American patients. Elderly Black patients have personal experience of segregation, the turmoil of the Civil Rights era, and the daily realities of life as a member of a disadvantaged minority. They may be may be particularly sensitive to respect issues from young physicians as deference to elders is expected. (See communication)

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