People of color 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%; Jimenez, Alegria, Chen, Chan, & Laderman, 2010). In fact, it is estimated that people of color make up 40% of older adults (U.S. Census Bureau, 2019). Per the results of the American Community Survey (ACS; 2012-2016) 10.6 of the 46.2 million older adults in the U.S., almost 25%, live in rural areas (U.S. Census Bureau, 2019). 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 adults across racial and ethnic groups (Byers et al., 2010). In addition, incidence of dementia is higher for African Americans, Latinx Americans, American Indian/Alaska Native, and Pacific Islanders (Alzheimer’s Association, 2021; Mayeda et al., 2011). These rates are especially concerning for older adults of color since they might be less likely to use mental health services, which may be due to factors ranging from stigma and beliefs about mental health care (Conner et al., 2010) to institutional and structural barriers to care (Alzheimer’s Association, 2021; APA Presidential Task Force, 2008; Hirito & Yarry, 2017).
Cultural Factors
It is essential that clinicians and researchers consider unique cultural stressors. Older adults of color may experience racial and/or ethnic discrimination (Luo, Xu, Granberg, & Wentworth, 2012), including in mental health care settings. In addition to stress due to racial/ethnic minority status, intersectional stigma (Turan et al., 2019) should also be considered. As an example, older adults also risk experiencing age discrimination (Voss, Bodner, & Rothermund, 2018) and discrimination due to sexual orientation (Sage, 2018). Of note, it is estimated that there are approximately 3 million LGBTQ adults over the age of 50 with projections that this group will double by 2030 (Sage, 2018).
Immigration status has been associated with greater risk of mental health diagnoses (Breslau et al., 2007; Davison et al., 2021). Unique risk factors for older immigrant adults may include varying English proficiency, adapting to U.S. culture (i.e., acculturation), relation between the U.S. and country of origin, lack of U.S. citizenship and access to benefits, and lower income compared to U.S.-born older adults (Population Reference Bureau, 2013).
It is also imperative to note the unique sources of coping and resilient factors among older adults of color. For example, older adults of color tend to report higher religiosity and spirituality compared to younger adults (Krause, 2012; Skarupski et al., 2010), which has shown to be associated with decreased depression (Lynch et al., 2012) and increased social support (Hayward & Krause, 2013).
Mental Health Treatment and Treatment Seeking
Mental health conditions among older adults are highly treatable, especially depression and severe depression (National Institute of Aging, 2017). A number of studies show that psychotherapy, especially, cognitive behavioral therapy (CBT) and Problem Solving Therapy (PST), and antidepressants are helpful for older adults with depression; however, older adults should be carefully consult their providers about antidepressants due to side effects, interactions with other medications, importance of daily adherence, and sensitivity with medication (National Institute of Mental Health, 2021). Among culturally diverse older adults, there has been debate regarding the effectiveness of these interventions (Sue et al., 2009). Though, recent research has supported that when psychotherapies are tailored to the needs of a specific group of older adults of color, they are effective (Lau & Kinoshita, 2019) such as Culturally Responsive CBT (Iwamasa & Hays, 2018) and Un Nuevo Amanecer (A New Dawn; Chavez-Korell et al., 2012).
However, many barriers to high quality mental health services for older adults of color remain. Access to transportation, lack of insurance, misinformation, mental health stigma, historical persecution and documented abuse, as well as the inability to access specialized services in geriatric mental health frequently get in the way of older adults of color receiving help (Sorkin et al., 2015; Torres et al., 2020). Studies share that that older adults of color are more likely to face poverty, live in low-income housing, and have poorer access to benefits and pensions (O’Brien, Wu, & Baer, 2010). Future interventions for older adults should consider the role of institutional racism and financial inequity (Hardeman & Karbeah, 2020) to break down barriers to mental health care; collaborative care models, task-sharing, and digital technologies may aid in breaking down barriers to mental health care.
Culturally Sensitive Workforce
There is a pressing need for a larger geriatric mental health workforce (Kunik et al., 2017). It is estimated that few mental health professionals receive culturally sensitive training for providing care to older adults (Institute of Medicine, 2012). The psychology workforce is also estimated to be largely non-Hispanic White (88%, Lin et al., 2018). An important future direction for the field of geriatric mental health is to equip mental health professionals, especially those from diverse backgrounds, with training in geriatric health concerns and cultural sensitivity. As a few examples, training may focus on learning about aging from a developmental perspective, preventing and managing age-related chronic illnesses, understanding common neurological and cognitive concerns, and designing sustainable and equitable policies on long-term and palliative care.
Written by Felicia Mata-Greve, PhD, Nichole Sams, & Patricia A. Areán, PhD from the University of Washington
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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