Aging and Culture, Race & Ethnicity

Abstract

As with the rest of society, the population of older adults is heterogeneous across numerous factors. Although some of these factors are irrelevant to the concerns of aging, others are not. In particular, culture, race, ethnicity, and gender have been found to have a compounding effect on the experience of old age. Two major hypotheses have been posited to describe the phenomenon of minority aging. The double jeopardy hypothesis states that the simultaneous effects of aging and one additional factor that negatively impacts the health and welfare of the individual can increase an individual's risk for problems. Others theorists, however, believe that age is a leveler and that differences based on minority status from earlier in life tend to disappear or level out with advancing years. Although the relationship between minority status and old age is complex and still not well understood, it is not necessary to understand this relationship in detail in order to do something about the problems experienced by many elders. It is important that action be taken to not only understand the impact that being a member of these classes has on the experience of old age, but also to set in place programs that will help neutralize any ill effects.

Aging & Elderly Issues

Overview

It is easy to consider all elders within a society as a homogenous group with the same risks, needs, and preferences. However, as any statistician will explain, "average" is just a point on a curve. Within the general classification of elders (however that may be defined) exist many subgroups distinguishable from each other not only by various social constructs or physiological characteristics, but by how these characteristics affect health and welfare. In particular, the factors of race, culture, gender, and ethnicity that are so important during other times of one's life do not suddenly become moot when one turns sixty-five. Instead, these factors continue to be an important influence even during old age, often compounding its deleterious effects.

Hypotheses Regarding Aging & Community Status

There are two major hypotheses that have been posited to describe the phenomenon of minority aging. The first of these is called the double jeopardy hypothesis. It has been noted in the literature that certain groups are more likely to be at risk for poverty, disease, or other negative consequences in old age. This phenomenon is sometimes referred to as double jeopardy: the simultaneous effects of aging and another factor that also can negatively impact health and welfare (e.g., aging and race). When there is more than one compounding factor, similar terms may be used (e.g., quadruple jeopardy refers to the simultaneous effects of being old, the member of a minority group, female, and poor).

One of the most at risk groups is an example of quadruple jeopardy: older women who are both poor and minorities. Older women in general are significantly more at risk for living below the poverty threshold than are males of the same age. Further, minorities are more at risk than whites for living below the poverty threshold. As a result, elders who are both female and a member of a minority group are at higher risk than those who are not. Individuals falling into this category are at higher risk for health dangers. Andersen and Taylor (2002), for example, cite the fact that older black and Hispanic women tend to be more at risk for hypertension, diabetes, heart disease, cancer, and other serious health problems often associated with old age than are either older white males or females.

Not all observers agree with the double jeopardy hypothesis, however. The second major hypothesis regarding minority aging posits that age is a leveler. According to this hypothesis, differences in status between minority and majority groups tend to decrease over time, particularly as members of the majority experience reductions in status and age stratification that bring them, on average, closer to the average socioeconomic status of members of minority groups.

Variables of Increasing Concern

The interaction of age with confounding variables such as culture, race, ethnicity, and gender is of concern not only today but will become increasingly so in the foreseeable future. It has frequently been observed that the number of people in the United States who can be classified as older adults will continue to increase for quite some time in the future. This is due in part to advances in medical science and health care that result in increased longevity. In addition, this phenomenon is also dependent on the fact that the baby boom generation has reached the age where its members are beginning to collect Social Security. According to the United States Census Bureau, by the year 2030, the number of persons in the United States aged 65 years or older is expected to double from the 1990 number to 66 million, a figure equal to 20 percent of the country's population. However, the rate of increase for various subgroups within the population of older adults is not expected to remain the same. It is expected that older adults from minority group backgrounds will increase by 500 percent by the year 2050 (Scharlach, Fuller-Thomson, & Kramer, 2002). Such projections are also reflected in reports by the US Census Bureau and the US Administration on Aging. In 2012, the US Census Bureau released projections of the US population in 2060 based on the 2010 census. In these projections, the older adult population is expected to grow from 43.1 million in 2012 to 92.0 million in 2060. According to a 2011 report by the Administration on Aging, based on data from 2008, 20 percent of people age 65 and older were minorities in 2010 and the percentage is expected to increase to 41.5 percent by 2050. Furthermore, the United States is expected to become a majority-minority nation in 2043 (US Census Bureau, 2012). Although whites will continue to remain the majority within the sixty-five-plus age group, it will become increasingly important to recognize and address the needs of minority group elders.

In general, the literature considers four subgroups within the classification of minority elderly: black or African American, Hispanic, American Indian or Native Alaskan, and Asian or Pacific Islander. However, as within the population of older adults in general, it should not be assumed that these subgroups are homogeneous themselves. The US Census Bureau allows people of all ethnic backgrounds to self-identify as more than one race, national origin, or sociocultural group. For example, although individuals within the Hispanic category may share a common language and some cultural traditions, they may identify themselves as any race or a combination of races. There are also significant differences between various subgroups within this category (e.g., Cuban, Central American, Latin American, Mexican, Puerto Rican) Similarly, the category of Asian/Pacific Islander includes a number of distinct cultural groups (e.g., Chinese, Filipino, Japanese, Korean, Samoan). The American Indian classification includes approximately 566 federally recognized tribal entities according to the US Bureau of Indian Affairs in 2015. There are even differences within the African American population that reflect such factors as rural versus urban lifestyle, geographic region, and socioeconomic conditions (Scharlach, Fuller-Thomson, & Kramer, 2002). Sorting out interaction between aging and minority status is a very complex process.

Applications

Gender as a Consideration

Although the literature suggests that culture, ethnicity, and race are compounding factors that influence the effects of aging, one other "minority" factor needs to be considered in order to comprehensively look at differences between major subpopulations: gender. Although in the first few decades of life, girls outnumber boys in virtually every country in the world, by the age of thirty or thirty-five, this balance shifts until women greatly outnumber men within the population of older adults (Kinsella & Gist, 1998). The Administration on Aging reported in 2011 that there were 23.0 million older women and 17.5 million older men; older women outnumbered older men by a ratio of 132 to 100. Yet even in the early twenty-first century, women continue to have lower socioeconomic status than men. As discussed above, within the classification of older adults, women are at greater risk than men for poverty. In addition, women are more likely than men to need long-term care services, become disabled, and use home health and nursing home services (Davis, 2005). It is predicted that this phenomenon of increased longevity and morbidity will continue into the future. To leave gender out of consideration for the influence of minority status on the experience of old age, would clearly be to do a disservice to the majority of older adults.

A Health Care Study

Just as in the case of the cultural/ethnic/racial minority definitions discussed above, the classification of older women is far from heterogeneous. Within this classification are finer cultural distinctions, underscoring the complexity of this sociological issue. To better understand the relationship between cultural, ethnic, and racial subcategories within the larger classification of older women, Davis (2005) investigated the differences in the health care needs and service utilization of women in nursing homes. Understanding these differences is important not only because of the higher probability of older women needing longterm care, but also because literature suggests that members of ethnic and racial minority groups encounter additional barriers when they try to access or utilize healthcare services when compared with other groups.

Subjects in the study included 8,215 residents over the age of sixty across 1,423 nursing homes. The study used a survey research design. Subjects in the study were not interviewed directly. Instead, nursing personnel familiar with the patient and her situation were interviewed. Data collected included the number of comorbidities experienced by the subject both at the time of admission to the nursing home and at the time of the survey, the subject's abilities to meet the needs of daily living, diagnosis of Alzheimer's disease, other dementia, or mental disorders both at the time of admission and at the time of the survey, the number of therapy services received by the subject (i.e., physical, occupation, or speech therapy), and whether or not the subject received either dental or mental health services.

The Results

The results of the study showed noticeable differences between the various categories of minority women in the study. African American and Hispanic women were somewhat younger than the other women in the study both at admission to the nursing home and at the time of the study. The results also show that Hispanic women as a group have the shortest stay in the nursing home whereas American Indian women had the longest. As far as covering the costs of the nursing home were concerned, American Indian women were more likely than the other groups to pay either using private insurance or personal funds. However, they were the least likely to have Medicaid. On the other hand, African American women were the least likely to self-pay or have private insurance but the most likely to have Medicare. With the exception of American Indian women, all other subjects in the study converted from other means of payment to Medicaid the longer they were in the facility.

Of the groups included in the study, American Indian women tended to have the most health problems whereas Asian/Pacific Islanders tended to be the most healthy. Further, African American, Asian/Pacific Islanders, and Hispanic women who had only short stays in the facilities tended to be healthier overall than were residents who stayed for longer periods of time. However, this finding did not hold true for American Indian women. African Americans, Asians/Pacific Islanders, and Hispanic residents tended to receive a high level of therapy during their first year of admission to the nursing facility, with therapy levels tapering off thereafter. Once again, however, these findings were reversed for the American Indians in the study.

In general, the study found that the older women in the cultural, ethnic, and racial groups studied were similar along certain dimensions. However, the study also found sufficient significant differences between these groups to suggest that these groups cannot be meaningfully collapsed and analyzed together for most purposes. The findings of poorer health for American Indian women suggest that the lack of access to adequate longitudinal services may mean that these women enter long-term care with more impairment than the other groups. Possible explanations for other differences noted in the study include language and cultural differences between elderly female patients and their health care providers which may result in misunderstanding and misdiagnoses. Although the reasons for the observed differences between groups are still not understood, the fact remains that these groups tend to be heterogeneous. To be meaningful, future research into the compounding effects of culture, ethnicity, race, and even gender need to take into account the differences within these groups.

Conclusion

Just as in the rest of society, the population of older adults varies by numerous characteristics. Although some of these characteristics are irrelevant to the aging process, others have been found to compound other effects of aging, often to the detriment of members of that group. In particular, minority status is frequently found to be a compounding variable that results in differential effects for members of the minority versus members of the majority. One of the most at risk groups comprises older women who are both poor and minorities. Since race and ethnicity are considered to be social constructs, it could be hypothesized that these differential effects are social in nature (e.g., cultural norms for behavior that lead members of a minority group to be less likely to seek the help they need or that lead members of other groups to be less likely to offer the help needed; members of minority groups still experience institutionalized racism and prejudice). However, biology may also play a part. For example, the increased risk run by women for various deleterious effects may be social in some circumstances (e.g., being a greater risk for poverty because they did not earn or save as much earlier in their lives as did their male counterparts) but may be also be biological (e.g., different risks for various ailments associated with old age). Similarly, medical science has found some ethnic and racial groups to be at greater risk for various diseases than other groups. Since these groups tend to have a common biological heritage, these effects cannot necessarily be attributed to social factors alone (if at all).

Understanding the causes of the compounding effects of minority status in old age is one question; doing something about them is another. The relationship between minority status and old age is a complex one and may not ever be completely understood. However, it is not necessary to understand this relationship in detail in order to do something about it. Minorities are a rapidly growing subset of the rapidly growing population of older adults within the United States. In addition, although it might be argued that in some ways women still receive the same lower status and other ill effects of being the member of a minority group, they do, in fact, comprise over half of the population of older adults. Therefore, it is important that action be taken to not only understand the impact that being a member of these classes has on their experience of old age, but also to set in place programs which will help neutralize any ill effects.

Terms & Concepts

Activities of Daily Living (ADLs): Activities that are routinely performed in the course of a day in order for the purposes of self-care (e.g., bathe, dress, groom, eat, use the toilet, transfer to or from the bed or chair, get around the house).

Age Stratification: The hierarchical ranking of groups by age within society. In age stratification, different social roles are ascribed to individuals during different periods in their lives. These roles are not necessarily based on physical capabilities and constraints at different times in life.

Baby Boomer: An individual who was born during an unusual period of greatly increased birth rate following World War II. Although the span of years that comprise the baby boom is usually considered to encompass the years between 1946 and the early 1960s, the definition of both the start and end dates for the time period does vary slightly from researcher to researcher.

Culture: Defining and common characteristics of a group or society; includes behavior patterns, arts, beliefs, and institutions.

Dementia: In the generic sense of the term, dementia is a generalized, pervasive deterioration of a person's cognitive abilities (e.g., memory, language, executive function). The deterioration caused by dementia can be very severe and can significantly impact the ability of the individual to perform on the job, function well within society, or even accomplish the daily activities of living. There are many specific types of dementia including Alzheimer's disease, vascular, Pick's disease, Parkinson's disease, Huntington's disease, and AIDS dementia complex. Brain tumors and other treatable conditions may also cause dementia. Although the onset of dementia may vary, in most cases it occurs later in life, typically after 65 years of age.

Double Jeopardy: In the sociology of aging, double jeopardy refers to the simultaneous effects of aging and another factor that also can negatively impact health and welfare (e.g., aging and race). When there is more than one compounding factor, similar terms may be used (e.g., quadruple jeopardy refers to the simultaneous effects of being old, the member of a minority group, female, and poor).

Ethnicity: A social construct used to describe a relatively large group of people who share a common and distinctive culture such as common history, language, religion, norms, practices, and customs. Although members of an ethnic group may be biologically related, ethnicity is not the same as race.

Instrumental Activities of Daily Living: Non-self-care activities necessary for daily life (e.g., going outside the home, light housework, preparing meals, taking medications in the manner prescribed, using the telephone, paying bills, and keeping track of money).

Interview: In survey research, an interview is a data collection technique in which the researcher directs a conversation with the subject for the purpose of gathering specific information. Interviews can range from highly structured instruments (with questions that are specifically worded and administered in a prescribed order from which the interviewer may not deviate) to unstructured (in which interviewers only follow a general form and are allowed great latitude in what specific data are collected or what follow-up questions they are allowed to ask). Interviews can be carried out in person or over the telephone.

Race: A social construct that is used to define a subgroup of the human population that has common physical characteristics, ancestry, or language. Racial groups are often neither objectively defined nor homogenous, and racial categories may differ from culture to culture.

Social Construct: Any phenomenon that is invented (i.e., constructed) by a culture or society. Social constructs exist because the members of a society behave as if it exists rather than because of the availability of criteria that are necessarily obvious to an objective outside observer. Race and ethnicity are both examples of social constructs. (Also referred to as a social construction.)

Society: A distinct group of people who live within the same territory, share a common culture and way of life, and are relatively independent from people outside the group. Society includes systems of social interactions that govern both culture and social organization.

Socioeconomic Status (SES): The position of an individual or group on the two vectors of social and economic status and their combination. Factors contributing to socioeconomic status include (but are not limited to) income, type and prestige of occupation, place of residence, and educational attainment.

Status: A socially established position within a society or other social structure that carries with it a recognized level of prestige.

Survey Research: A type of research in which data about the opinions, attitudes, or reactions of the members of a sample are gathered using a survey instrument. The phases of survey research are goal setting, planning, implementation, evaluation, and feedback. As opposed to experimental research, survey research does not allow for the manipulation of an independent variable.

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Suggested Reading

Choi, M., & Mezuk, B. (2013). Aging without driving: Evidence from the health and retirement study, 1993 to 2008. Journal of Applied Gerontology, 32, 902–912. Retrieved November 12, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebsco-host.com/ login.aspx?direct=true&db=sih&AN=90146688

Daker-White, G., Beattie, A. M., Gilliard, J., & Means, R. (2002). Minority ethnic groups in dementia care: A review of service needs, service provision and models of good practice. Aging and Mental Health, 6, 101–108. Retrieved July 5, 2008, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/ login.aspx?direct=true&db=sih&AN=6687625&site=ehost-live

Ford, M. E. & Hatchett, B., (2001). Gerontological social work with older African American adults. Journal of Gerontological Social Work, 36(3/4), 141–155. Retrieved July 5, 2008, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/ login.aspx?direct=true&db=sih&AN=7475731&site=ehost-live

Fung, H. H. (2013). Aging in culture. Gerontologist. 53, 369–377. Retrieved October 7, 2014 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=87375911

Hsu, T., & Liew, H. (2010). An individual growth curve analysis of SES-health relationship: Evidence from the 1992-2006 Health and Retirement Study. Conference Papers—American Sociological Association, 158. Retrieved November 12, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=86646247

Krisberg, K. (2005). Cultural competencies needed to serve all older Americans. Nation's Health, 35, 30–32. Retrieved July 5, 2008, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=17380069&site=ehost-live

Lariscy, J., Hummer, R., & Hayward, M. (2015). Hispanic older adult mortality in the United States: New estimates and an assessment of factors shaping the Hispanic paradox. Demography, 52(1), 1–14. Retrieved January 13, 2016 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=100781884&site=ehost-live&scope=site

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Yan, T., Silverstein, M., & Wilbur, K. H. (2011). Does race/ethnicity affect aging anxiety in American baby boomers? Research on Aging. 33, 361–378. Retrieved October 7, 2014 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=60981066

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