Gerodiversity
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Gerodiversity is the
multicultural The term multiculturalism has a range of meanings within the contexts of sociology, political philosophy, and colloquial use. In sociology and in everyday usage, it is a synonym for "Pluralism (political theory), ethnic pluralism", with the tw ...
approach to issues of aging. This approach provides a theoretical foundation for the medical and psychological treatment of older adults within an ecological context that includes their cultural identity and heritage, social environment, community, family system, and significant relationships. Gerodiversity encompasses a
social justice Social justice is justice in terms of the distribution of wealth, opportunities, and privileges within a society. In Western and Asian cultures, the concept of social justice has often referred to the process of ensuring that individuals fu ...
framework, which considers the social and historical dynamics of privilege and inequality. In addition to issues of aging, gerodiversity includes race, ethnicity, language,
gender identity Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the i ...
,
socioeconomic status Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...
, physical ability or disability,
sexual orientation Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. These attractions are generall ...
, level of education, country of origin, location of residence, and religion or spirituality. Gerodiversity builds on the field of
clinical geropsychology #REDIRECT Clinical geropsychology {{Rcatshell, {{R from move {{R from alternative capitalization ...
, which applies psychological and developmental methods to understanding the behavioral, emotional, cognitive, and biological aspects of aging in the context of providing clinical care to older adults. The goal is to develop culturally competent, scientific methods for the psychological and medical treatment of the aging population. According to this perspective, in order to ethically and scientifically provide optimal care to older adults, clinicians must be aware of the cultural factors in health care utilization, including use of physical and mental health care. Moreover, from this perspective, clinicians must continually work to improve their multicultural knowledge base, skill set, and attitudes towards cultural diversity.


Demographics and characteristics to consider in geriatric populations

Increased awareness and attention to gerodiversity parallels the aging demography of the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
. Older adults comprise 14.5% of the U.S. population, with those aged 65 and older numbering 46.2 million. Dubbed "the Silver Tsunami", this segment of the population is rapidly growing, and the
Administration on Aging The Administration on Aging (AoA) is an agency within the Administration for Community Living of the United States Department of Health and Human Services. AoA works to ensure that older Americans can stay independent in their communities, mostly ...
expects it to double to 98 million older persons by 2060. Aging confers a unique risk of marginalization due to the intersection of advanced age and other disadvantaged factors. The domains of diversity discussed herein may intersect with age in such a way to confer a "double jeopardy". More recently, attention has been paid to those who face a "triple threat of marginalization" (e.g., older lesbian women). As with other conceptualizations of diversity and marginalization, advanced age and other sociodemographic variables intersect and result in unique experiences for each group and individual. Below are a few highlighted areas for consideration.


Sex and gender

Older adults are more likely to be female. Women live longer than men, and so populations of older adults are, with each successive age bracket, increasingly dominated by women. Over half (58%) of Americans over age 65 are women, a number which rises to 69% over age 85, and finally to 80% over age 100. Older men and women also have different medical and psychological health needs, as well as different profiles of risk and protective factors for acquiring physical and mental disorders. Many biological and psychosocial variables are responsible for these differences. Sex-specific hormonal and physiological differences contribute to different risks for cancer, cardiovascular disease, arthritis, osteoporosis, diabetes, depression, and dementia. Environmental and lifestyle factors, such as sleeping, eating, and exercise habits, social network, socioeconomic resources and stressors, and intellectual engagement in work and leisure activities, also significantly contribute to physical and mental health, and are differentiated between older men and older women. Older women are more likely to have a robust social network—a factor associated with better physical and mental health. Older women from other countries tend to acculturate differently than elderly men. Older women are also twice as likely to live in poverty as older men. Cultural groups assign different roles and values to individuals based on their gender. Women in some cultural groups are less likely to have been employed, and have lower economic resources as a result. Women are also more likely to bear most of the caregiving responsibilities for ailing family members and young children.


Race and ethnicity

Ethnogeriatrics is defined by the
American Geriatrics Society The American Geriatrics Society (AGS) is a non-profit professional society founded on June 11, 1942, for health care professionals practicing geriatric medicine. Among the founding physicians were Dr. Ignatz Leo Nascher, who coined the term "geri ...
as the "influence of ethnicity and culture on the health the well-being of older adults". In 2015, non-Hispanic White Americans made up an estimated 61.72% of the US population, but that percentage is anticipated to drop to 43.65% by 2060. This demographic shift will be due in part to increases in Asian and Pacific Islander and Latino/Hispanic immigrants. However, Latino and Hispanic older adults as a group are expected to increase the most dramatically, by 155%. Older adults of different ethnicities belong to different cultural groups, and may therefore have significantly different levels of access to care, different beliefs about health and aging, different expectations from care providers, and different ways of communicating their needs. In addition, ethnic minorities are vulnerable to multiple forms of minority stress: racial prejudice, discrimination, and stereotyping may contribute to lower socioeconomic status, diminished access to care, and systematic disempowerment for many minority groups in the United States. These factors have a major impact on vulnerability to poorer health, risk of mental disorders, and poorer overall prognosis. Individuals may also belong to multiple racial and ethnic groups: older adults may be biracial or multiracial, belong to indigenous or nonindigenous populations, or be immigrants or the children of immigrants. Different ethnic groups have different genetic and cultural vulnerabilities to medical and psychological problems, which require culturally knowledgeable care.


Sexual and gender minorities

Sexual and gender minorities (
lesbian A lesbian is a Homosexuality, homosexual woman.Zimmerman, p. 453. The word is also used for women in relation to their sexual identity or sexual behavior, regardless of sexual orientation, or as an adjective to characterize or associate n ...
,
gay ''Gay'' is a term that primarily refers to a homosexual person or the trait of being homosexual. The term originally meant 'carefree', 'cheerful', or 'bright and showy'. While scant usage referring to male homosexuality dates to the late 1 ...
,
bisexual Bisexuality is a romantic or sexual attraction or behavior toward both males and females, or to more than one gender. It may also be defined to include romantic or sexual attraction to people regardless of their sex or gender identity, whi ...
,
pansexual , meaning "all" , definition = Sexual or romantic attraction to people regardless of gender , classification = Sexual identity , parent = Bisexuality , synonyms = , associated_terms = Polysexual, queer, heterofl ...
,
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through tr ...
, and nongendered individuals) make up an increasing portion of aging populations, and prevalence rates of these groups are expected to rise dramatically. It is estimated that 1.5 million Americans over age 65 identify as lesbian, gay, or bisexual. Because LGBT older adults are less likely to have children and more likely to be single than heterosexual older adults, reduced family support and long-term care is available to them. LGBT older adults also have lower rates of health insurance coverage, and fear discrimination by doctors and mental health care facilities. Among LGBT older adults, 8.3% have reported abuse by a caretaker due to sexual orientation or gender identity. Professional caregivers are also often untrained in the special needs of LGBT populations, and LGBT elders may be overlooked or ignored by many programs oriented towards older populations. The American Psychological Association offers a poignant article about the "double-whammy discrimination" from healthcare provider biases that affect the quality of care of older LGBT patients. Research has shown that LGBT elders tend to be unwelcome in senior centers and volunteer programs for older adults, and tend to be overlooked in public outreach programs geared towards the elderly. They also may be denied independent housing, as well as entrance to residential nursing home and retirement communities based on sexual orientation or gender identity. They may be isolated from social resources they may otherwise have had from their extended families due to discrimination. In addition, LGBT elders may still be denied visitation rights and end-of-life decision making for their partners and loved ones by hospitals, despite the marriage equality ruling of 2015.


Religious and/or spiritual identity

Older adults tend to be more deeply involved in religious activities than younger adults. Bengston, Putney, Silverstein, and Harris studied aging patterns and generation trends regarding religiosity (namely,
Christianity Christianity is an Abrahamic monotheistic religion based on the life and teachings of Jesus of Nazareth. It is the world's largest and most widespread religion with roughly 2.38 billion followers representing one-third of the global pop ...
and
Judaism Judaism ( he, ''Yahăḏūṯ'') is an Abrahamic, monotheistic, and ethnic religion comprising the collective religious, cultural, and legal tradition and civilization of the Jewish people. It has its roots as an organized religion in the ...
) in the United States. Ultimately, the results indicated an overall aging effect with an upward drift in religious intensity and strength of beliefs. Additionally, there was a generational effect indicating different conceptualizations of a monotheistic God based on one's generational cohort and a greater separation between religiosity and spirituality in later-born cohorts. In a longitudinal study, Wink and Dillon found that adults increased significantly in spirituality between late middle (mid-50s to early 60s) and older adulthood (late 60s to mid-70s); this finding was irrespective of gender and generational cohort. They defined spirituality as "the self's existential search for ultimate meaning through an individualized understanding of the sacred". Glicksman suggests that one be cautious when interpreting the results of research on spirituality, suggesting that measurement scales are often biased by the Protestant traditions that have shaped the American majority culture. Thus, while it is important to consider how age may impact religiosity and spirituality, it is also important to maintain a sensitive and multicultural approach to understanding an individual's unique relationship with his/her religion and how it may be impacted by other cultural variables, such as country of origin, race, and ethnicity. Based on the research cited above, it is clear that religion and spirituality are relevant issues for older adults but that these terms may be conceptualized differently and also hold different levels of importance to different individuals. Professionals must be aware of this level of diversity when working with a geriatric population.


Ability and disability status

Older adults who are aging with disabilities are yet another diverse group of individuals, with estimates of approximately 12 to 15 million older adults aging with early-onset disabilities. As medical and social advances increase and improve lifespan and quality of life for those with disabilities, this number will continue to grow. These individuals may experience unique stigma related to the aging process. A seminal and widely adopted definition of "successful aging" included growing older without disability as a hallmark of such success. However, Romo and colleagues conducted a focus group of ethnically diverse older adults with disabilities and found that despite disability, the majority felt they were aging successfully. Such individuals often employed diverse coping strategies to compensate for any changes in physical functioning. As with other groups of older adults, healthcare goals for those with disabilities emphasize reducing risk for chronic disease and preventing further disability and morbidity. However, such a narrow sense of "success" that precludes disability may limit inclusion and diversity. Like other aspects of gerodiversity and experience of marginalization, understanding an individual's sense of successful aging within the context of disability is subjective and likely varies between individuals. Conceptualization of gerodiversity should strive toward inclusion and thus include both disability/ability status as well as subjective experiences of "successful aging", including adaptation and coping with any physical limitations.


Socioeconomic status

Socioeconomic status Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...
(SES) is frequently a combined measure of income, education, and occupation. One's SES impacts one's daily life and opportunities, especially those related to quality of life and health care. The elderly in the United States are one of the most economically vulnerable groups. As of 2006, nearly 10% of the elderly in the United States lived below the poverty line. An inability to work, declines in health, and the loss of a spouse are a few of the causes contributing to a lowering of one's SES as one ages. Female and racial/ethnic minority statuses are additional risk-factors for low SES in older adults. Fleck reported that approximately 23% of older African Americans and 19% of older Hispanics live in poverty; Lee and Shaw found that women are nearly twice as likely to be impoverished as males. The
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
reports that older adults with low SES can only afford substandard levels of care, if at all, and that mortality rates are significantly higher in low SES older adults. This applies to both physical and mental health care. Additionally, older adults with lower education and/or who come from low-income environments are more likely to develop depression; these risk factors are also associated with higher incidences of Alzheimer's disease and dementia. It is important to be aware of an older patient or client's resources and coping styles. Healthcare providers and other professionals working with older adults must also be aware of what their community may offer for aging individuals of low SES.


Rural versus urban living environment

According to the
National Rural Health Association The National Rural Health Association (NRHA) is a national nonprofit professional association in the United States with more than 18,000 members. The association’s mission is to provide leadership on rural health In medicine, rural health or ...
(NRHA), the elderly make up a large percentage of the rural American population with approximately 20% of older adults living in non-metropolitan areas. The living environment and occupational opportunities available to rural elders impacts their health throughout their lifetime. Furthermore, their health is impacted by limited access to care for prevention, management, and treatment of physical and mental health conditions. It can be particularly difficult for elders and their families when they have difficulty completing activities of daily living and are unable to provide their own transportation. It is important to acknowledge and maintain awareness of the obstacles to healthcare that older individuals in rural communities face. Some older research did not find rural older adults to be disadvantaged in their use of health-related services in comparison to urban dwelling older adults. However, distance to providers and healthcare facilities have been cited as a common barrier among rural-dwelling veterans. While not an issue exclusive to rural locations, older adults cite difficulty traveling and lack of transportation, as well as affordability of care, as the most common barriers to utilizing psychological services. Transportation barriers to healthcare access may be most notable for those with lower incomes.
Telehealth Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, mon ...
(also known as telemedicine; with related specialties of
telepsychiatry Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing. Telepsychiatry se ...
, telemental health, and
telenursing Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points ...
, to name a few ) is one such way that health care providers, researchers, and policy makers are striving to offset the physical distance and related barriers in rural health care delivery. Such provision of services using telecommunications can also be used to deliver care when patients are immobilized, have chronic conditions requiring monitoring, or are homebound.


National identity/origins

An increasing number of Americans, both adults and older adults, can claim a foreign national identity. The
Pew Research Center The Pew Research Center is a nonpartisan American think tank (referring to itself as a "fact tank") based in Washington, D.C. It provides information on social issues, public opinion, and demographic trends shaping the United States and the w ...
projects that by 2050, nearly one in five Americans will be foreign born. Issues of national origin may dovetail with issues of citizenship for some older adults; the latter confers social and legal rights that interact with the experience of aging to include access to healthcare (including Medicare in the U.S.) and other social and financial welfare programs (e.g.,
Social Security Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refer specificall ...
). In addition, cultural perspectives of aging can profoundly shape one's experience of growing old. Regardless of citizenship, older adults with diverse national identities may experience the aging process differently in the U.S. compared to their country of origin. There is much variability with which cultures approach aging, frailty, and death. For some, a veneration of youth marks aging as a shameful process and likely contributes to ageism in the U.S. and other Westernized countries. However, an increasingly globalized world requires a review of theoretical frameworks and research agendas to better understand cross-cultural differences in aging attitudes.


Courses of action

A report of the APA Committee on Aging offered overarching recommendations for fostering multicultural competencies in working with older adults. Clinicians, researchers, and others in organizations that interface with older adults are called upon to recognize and dispel ageism, both professionally and personally. Key to this is recognizing age as an element of cultural diversity. There are multiple levels at which to conceptualize gerodiversity, beginning with individual factors, and expanding to organizational, institutional, political, and societal frameworks. The article herein emphasizes individual experiences of social inequality to consider with the acknowledgement that aging occurs in a diverse sociocultural and political milieu. Gerodiversity and multicultural competence also posits that age will intersect with other elements of diversity, with incredible variation among individuals. Above all, a gerodiversity approach emphasizes the strengths that come from cultural diversity. Fostering such a multicultural approach to the issues of aging is a developmental process that begins with education and training and evolves over the course of one's professional and personal experiences. Molinari recommended that opportunities for education and training with older adults be available as early as high school and college. There is a dearth of healthcare workers, including psychologists and physicians, adequately trained to address the needs of the aging population. Therefore, some advocate for geriatric training as a core competency in graduate and internship programs in clinical psychology. Notably, the US
Health Resources and Services Administration The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for peop ...
(HRSA) has devoted funding to preparing health care providers, including nurses, social workers, and psychologists, to better meet the needs of older adults through the Geriatric Workforce Enhancement Program. Notably, one's development and competency in gerodiversity extends past one's formal education. Molinari urges clinicians and researchers to seek independent learning opportunities with a multicultural focus and inclusion of the geriatric population. Providers and policy makers are encouraged to provide outreach for physical and mental health care for older adults, perhaps in the context of equally diverse settings, such as faith communities. The APA Guidelines for Psychological Practice with Older Adults advises clinicians to promote evidence-based treatments shown to be effective with older populations, and seek supervision or consultation on such practice issues. Finally, from a systems perspective, a gerodiverse approach to clinical practice, research, and policy will be fostered with research on evidence-based treatment approaches for diverse older adults, as well as dissemination of such work so that the public is educated about common mental disorders in the elderly, which may eliminate stigma. Supporting federal initiatives to train health workers in gerontology, particularly with multicultural considerations, and advocating for increased funding for research in these areas, is a crucial ongoing step.


References


Sources

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See also

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Gender variance Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-bina ...


External links


Bibliography of Research and Clinical Perspectives on LGBT Aging (2008) (PDF, 99KB)

Curriculum in Ethnogeriatrics (2002) 2nd edition, Stanford University Collaborative of Ethnogeriatric Education

Diversity Advancement Toolkit: Strengthening Cultural Competence within National Aging Network, Area Agencies on Aging, Title VI Programs and Service Providers



Fact Sheet on Aging and Socioeconomic Status (2010)

Family Caregiver Briefcase — Variations for Practice for Culturally Diverse Groups (2011), American Psychological Association Presidential Task Force on Caregivers

Multicultural Competency in Geropsychology

Older Americans Behavioral Health Issue Brief 11: Reaching Diverse Older Adult Populations and Engaging Them in Prevention Services and Early Interventions (2011) (PDF, 1MB)

Reference and Resource Guide for Working with Hispanic/Latino Older Adults, Based on Treatment Improvement Protocol 26: Substance Abuse Among Older Adults (2008)



Teaching and Learning about Aging (2008)

The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults (2012) (PDF, 14KB)

The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (2012), Institute of Medicine

The Resource Centers for Minority Aging Research

Toward an Inclusive Psychology: Infusing the Introductory Psychology Textbook with Diversity Content (2003) (PDF, 3MB)

Transforming Mental Health Services for Older People: Lesbian, Gay, Bisexual and Transgender Challenges and Opportunities (2007), FORGE: Transgender Aging Network
Caregiving Gerontology Social justice