Disparities and Racism Experienced Among Older African Americans Nearing End of Life

Abstract

Purpose of Review The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan. Recent Findings In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults. Summary Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.

Demystifying African American Spirituality: Exploring the Measurement of Spirituality in the Context of Medical Decision-Making

“…Many African American adults have not benefitted equitably from recent advances in medicine and in the field of palliative care. They are more likely to be diagnosed with chronic disease at earlier ages than whites, less likely to have their chronic illnesses managed as well as whites and are more likely to suffer from poorer health outcomes throughout their lifespan until they die (Aaron et al, 2021). These inequitable outcomes are indicative of a healthcare system that still struggles with the long legacy of systemic racism (Macias-Konstantopoulos et al, 2023).…”

“…These inequitable outcomes are indicative of a healthcare system that still struggles with the long legacy of systemic racism (Macias-Konstantopoulos et al, 2023). As a result, many African Americans, 97% of whom believe in God or a higher power that is intimately involved in their lives (Mohamed et al, 2021), rely on their faith or spirituality to navigate the toxic stress produced by the inadequate access to timely and responsive care, racist interactions, and unconscious bias they often encounter while pursuing treatment (Aaron et al, 2021). African American patients' reliance on their spirituality and the resilience they achieve through their spiritual orienting systems and spiritual coping strategies remain understudied and underappreciated by palliative care clinicians and researchers despite the guidelines that govern their practice (Siler et al, 2021).…”

“…While researchers and clinicians often lament the relative underutilization of palliative care treatment modalities in favor of inpatient intensive care by African American patients experiencing serious illnesses during the last six months of life as compared to whites (Aaron et al, 2021), little research has been conducted into how a clinician's understanding of African American spirituality or religious belief may contribute to better patient-provider communication and goal concordant care at end of life (EOL) (Siler et al, 2021). Since the voices of African Americans are often silenced in healthcare settings, research on how spiritualty and/or religion affect African American patients’ end-of-life decision making is critical (Siler et al, 2021).…”