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Diversity Issues

Ethnic minority persons constitute the fastest growing segment of the geriatric population with an increase from 5.7 million in 2000 (16.3%) to 8.1 million in 2010 (20%), and a projected increase to 13.1 million in 2020 (24%) (U.S. Census Bureau, 2011). In 2011, 81% of the geriatric population lived in metropolitan areas and 19% lived in rural areas (rural area defined as a nonurban setting with less than 950 persons per square mile) (Administration on Aging, 2012). While the number of older adults residing in metropolitan areas greatly exceeds that of rural areas, the proportion of those living in rural areas is greater than that of urban areas.

Mood disorders including depression, dysthymia, and anxiety greatly affect older minorities (Kohn, Saxena, Levav, & Saraceno, 2004). Additionally, immigration status is associate with the risk of having a mood disorder in later life (Breslau et al., 2007). Minorities are also at greater risk for dementia. According to the Alzheimer’s Association (2010), African-Americans are about two times more likely and Hispanics are about 1.5 times more likely to develop Alzheimer’s and other forms of dementia.

The mental health concerns of older adults are highly treatable. Over 80 percent are likely to respond to treatment (Alexopoulos, 2005). A number of studies show that psychotherapy is effective in treating geriatric depression with strong evidence in favor of cognitive behavioral therapy (CBT), Problem Solving Therapy (PST), and Interpersonal Therapy (IPT) (Cuijpers, 1998). However, there has been debate regarding the effectiveness of these interventions for minority populations (i.e.: Sue et al., 2009). Culturally adapted versions of CBT, PST and IPT have been tailored to the specific needs of a cultural minority population (Hall, 2001; Gil et al., 2004; Hinton et al., 2006; Gone, 2009). Recent data have found that these culturally adapted treatments are effective (Griner and Smith, 2006, Castro et al., 2010).

Despite the high success rate of mental health treatments for older adults, only 16 percent seek help from appropriate professionals (Alexopoulos, 2005). Furthermore, minorities from this group—particularly African Americans—are significantly less likely to use services than non-minorities (Chow, Jaffee, & Snowden, 2003). Barriers including misinformation, stigma, and inability to access specialized services in geriatric mental health frequently get in the way of minority older adults receiving help. A recent report from the AARP indicated that older minorities are more likely to face poverty, live in low-income housing, and have poorer access to benefits and pensions (O’Brien, Wu, & Baer, 2010).

The growth of the minority geriatric population also highlights a need for workforce development. The current shortage of geriatric prepared mental health providers is problematic. Many mental health providers are not clinically and culturally trained to serve the ethnic, geriatric population. The National Comorbitiy (NCS-R) prevalence study conducted in 2003 revealed that for all populations mental health professional provide minimally adequate services only 50% of the time and this is likely to be less for older adults because so few mental health professionals have special geriatric training (Reeves et al., 2011). Therefore, it is important to prepare health providers to meet the specific needs of the growing diverse geriatric population by increasing the number of minority, culturally competent healthcare professionals into the mental health. This includes training health professionals in geriatric care; preventing and managing age-related chronic illnesses including mental, neurological and substance use disorders; designing sustainable policies on long-term and palliative care; and developing appropriate services and settings.

Written by Grace Niu, PhD and Patricia Arean, PhD, from the University of California, San Francisco

Look at the extensive assessment database of geriatric measures from the University of Alabama’s Alabama Research Institute on Aging! Register for access to the database HERE.

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