Reassessing the Needs of Black Elders ANN W. NGUYEN, PH.D., M.S.W. - PowerPoint PPT Presentation

Reassessing the Needs of Black Elders ANN W. NGUYEN, PH.D., M.S.W. MANDEL SCHOOL OF APPLIED SOCIAL SCIENCES CASE WESTERN RESERVE UNIVERSITY ANNA V. BROWN COMMUNITY FORUM & CONFERENCE

Overview of Black Elderly 2 Health Service Use Social Isolation Social Support Caregiving Concluding Remarks

3 Today there are 46 million Americans ages 65 and older. U.S. Census Bureau U.S. Census Bureau

4 By 2030, 1 in 5 Americans will be 65 years or older. U.S. Census Bureau

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U.S. Population Projections for Persons 65+ 6 90 77 80 70 59 % of Population 60 50 40 30 20 20 12 9 9 8 10 4 3 2 0 2016 2050 White Black Asian Hispanic Other U.S. Census Bureau

7 Race of Adults 60+ in Cuyahoga County Other 0.8 Native Hawaiian/PI/AIAN 0.5 Asian 1.9 Black 23.9 White 72.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 % ACS 2011-2015

Educational Attainment among African Americans 8 Age 65+ in the U.S. 80 75 70 60 50 44 40 % 30 18 20 7 10 0 High school/GED Bachelor's or higher 2017 1998 U.S. Census Bureau

Adults Ages 65+ in the U.S. 9 Median Household Income Poverty Rate 15696 Women African 18380 18.7 Americans 22177 Men 31618 All Americans 9.3 43554 Total population 58559 0 20000 40000 60000 80000 0 5 10 15 20 % African Americans All Americans U.S. Census Bureau

Marital Status of African Americans Age 65+ in 10 the U.S. Never married 13% Separated 5% Married 36% Divorced 19% Widowed 27% U.S. Census Bureau

Living Arrangements among African Americans 11 Age 65+ in the U.S. 60 50 50 43 40 30 30 30 % 24 20 14 6 10 2 0 Live w/spouse Live w/other Live w/non- Live alone relatives relatives Men Women U.S. Census Bureau

12 HEALTH

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Life Expectancy 16  Improvement in the life expectancy gap has been gradual  Highest gains in life expectancy among African American men — from 74.7 years in 1999 to 78.4 years in 2013

Why is the life expectancy gap decreasing? 17

18 HELP-SEEKING & SERVICE USE

Help-Seeking 19 None 14% Professional & Informal 51% Informal Only 31% Professional Only 4% Woodward, Chatters, Taylor, Neighbors, & Jackson, 2010

Professional Service Use 20  Older African Americans less likely to seek professional help than younger African Americans and older Whites  More likely to seek care for mental health problems from primary care physician than mental health specialist  More likely to seek care at emergency rooms than outpatient services

Barriers to Service Use 21  Cost  Insurance  Transportation  Knowledge of services and access  Perception of problem  Perception of service/service provider  Communication style  Discrimination

Race of Service Providers 22 100 90 80 70 60 50 40 30 20 10 0 African Whites African Whites African Whites African Whites Americans Americans Americans Americans Psychiatrist Other Mental Health Family Doctor Clergy Professional White Provider Black Provider Nguyen, Taylor, Chatters, Taylor, & Woodward, 2019

Implications of Provider-Client Race 23 Discordance  Implicit bias  Barrier to effective communication  Affects client’s reactions to and trust in provider recommendations

24 SOCIAL ISOLATION

25 Social isolation is equivalent to smoking 15 cigarettes a day. Holt-Lundstad, Smith, Baker, Harris, & Stephenson, 2015

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Two Components of Social Isolation 27 1. Objective Social Isolation Tangible & quantifiable lack of connections • with other people 2. Subjective Social Isolation Perceived lack of closeness between person • and members of their social network

Objective Isolation Subjective Isolation 28 Isolated from Isolated from Isolated from Isolated from Both Friends Both Friends 4% 7% 2% 11% Isolated from Family Isolated from 2% Family 6% Not Isolated Not Isolated from Both from Both 79% 89% Hamler, Taylor, & Nguyen, 2019

Effects of Subjective Isolation on 29 High Blood Pressure 0.9 0.8 0.7 High Blood Pressure 0.6 0.5 0.4 0.3 0.2 0.1 0 Not Subjectively Isolated from Either Group Subjectively Isolated from Family and Friends Men Women Hamler, Taylor, & Nguyen, 2019

30 SOCIAL SUPPORT

Frequency of Contact with Extended Family 31 Hardly ever 2 A few times a year 3 At least once a month 5 A few times a month 10 At least once a week 28 Nearly every day 53 0 10 20 30 40 50 60 National Survey of American Life: Coping with Stress in the 21 st Century

Emotional Closeness to Extended Family 32 Not close at all 1 Not too close 3 Fairly close 12 Very close 84 0 10 20 30 40 50 60 70 80 90 National Survey of American Life: Coping with Stress in the 21 st Century

Social Support from Extended Family 33 40 34 35 30 25 23 25 20 18 % 15 10 5 0 Never Not too often Fairly often Very often National Survey of American Life: Coping with Stress in the 21 st Century

Family Support 34  Older African Americans are well integrated into family support networks  Family members are viable sources of support  Providers should consider how family members can be incorporated into the care of older African Americans

The Black Church 35  Historically played a major role in African American communities  Social, civic, political, educational, and economic institution  Offer wide range of community programs and services

How important is religion/spirituality in your life? 36 2 Not important at all 1 2 Not too important 2 Religion 6 Fairly important Spirituality 7 90 Very important 89 0 20 40 60 80 100 % National Survey of American Life: Coping with Stress in the 21 st Century

37 Religious Service Attendance among Older African Americans 50 45 45 40 35 30 23 25 % 20 15 12 9 8 10 3.4 5 0 Never Less than A few times A few times At least Nearly once a year a year a month once a everyday week National Survey of American Life: Coping with Stress in the 21 st Century

Relationships with Church Members 38 Emotional Closeness Contact Hardly ever 2 Not close at all 1 A few times a year 3 Not too close 3 At least once a month 5 A few times a month 10 Fairly close 12 At least once a week 28 Very close 84 Nearly every day 53 0 50 100 0 20 40 60 National Survey of American Life: Coping with Stress in the 21 st Century

Social Support from Church Members 39 40 34 35 30 24 25 23 19 20 % 15 10 5 0 Never Not too often Fairly often Very often National Survey of American Life: Coping with Stress in the 21 st Century

Instrumental Support 40 1. Financial assistance 2. Help with chores 3. Transportation 4. Help during illness National Survey of American Life: Coping with Stress in the 21 st Century

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Discrimination, Contact & Generalized Anxiety 42 Disorder 0.25 Generalized Anxiety Disorder 0.2 0.15 0.1 0.05 0 0 5 10 15 20 25 30 35 40 45 50 Discrimination Low frequency of contact with church members High frequency of contact with church members

Discrimination, Emotional Closeness & Generalized 43 Anxiety Disorder 0.12 Generalized Anxiety Disorder 0.1 0.08 0.06 0.04 0.02 0 0 5 10 15 20 25 30 35 40 45 50 Discrimination Low emotional closeness to church members High emotional closeness to church members

44 CAREGIVING

Caregiving among African 45 Americans  Older African Americans less likely to be institutionalized  Caregiver-recipient relationship diverse  Caregivers have higher need for formal support services but lower utilization rates

46 Depression Psychological Distress Burden Role Strain

Take Home Message 47  Older adult population is becoming increasingly diverse  Social support is critical for well-being  Providers should take into account resources clients have available/lack  Assessments of social isolation should consider both objective and subjective isolation  Services must be culturally relevant

48 Thank You