How will the U.S. healthcare system meet the challenge of the ethnogeriatric imperative?

Abstract

Much of the geriatric imperative that is facing providers in the United States is an ethnogeriatric imperative, because one-third of older Americans are projected to be from one of the minority populations by mid-century, and that vastly underrepresents the actual diversity providers will see. Because of the vast heterogeneity of culture, language, health beliefs, risk for disease, and other factors, it is important for policy makers and health providers to be familiar with the diverse characteristics and needs of the various groups that will need geriatric care if they are to receive effective services. Challenges to high-quality ethnogeriatric care include disparities in health status and health care, differences of acculturation level and other characteristics within the populations, language and limited English proficiency, health literacy, culturally defined health beliefs and syndromes, and specific beliefs and preferences about long-term and end-of-life care. Some models of successful ethnogeriatric care have been identified and have in common the involvement of members of the target population in the development and design of the services and the use of cultural liaisons from the ethnic community being served, such as community health workers, or promatores. Thirteen recommendations are suggested for policy and practice changes in multiethnic and ethnic-specific health programs to provide competent ethnogeriatric care in the U.S. healthcare system.