Advancing Research on Diversity and Disparities Among Aging Adults

As the world becomes more globalized and socially connected, challenges associated with diversity and disparities are taking center stage in the field of aging. Aging is no longer viewed as a biological monolith but one that is under-pinned and buttressed by constructs like equity, accountability, access, and inclusion. The need for research to examine diversity and disparities among healthy and clinical populations is reflected in the recent literature. Brewster et al. (2019) discussed the importance of adopting a systems-level approach (e.g., National Institute on Aging [NIA] Health Disparities Research Framework) to identify mechanisms and pathways that reinforce health disparities. Babulal et al. (2019) proposed recommendations for prioritizing and advancing recruitment of racial and ethnic minorities in Alzheimer’s disease and related dementia (ADRD) research. Fredriksen-Goldsen and colleagues (2018) elaborated on core competencies required to care for older LGBT (lesbian, gay, bisexual, and transgender) older adults living with cognitive impairment and ADRD. These perspectives and position papers originating from national conferences and working groups call for aging studies to better inform diversity and disparities research. This Special Issue of Journal of Applied Gerontology includes 12 articles that employ a spectrum of quantitative, qualitative, and mixed methodologies to critically examine the intersectionality of nationality, race, ethnicity, and LGBTQ orientation (lesbian, gay, bisexual, transgender, and queer) surrounding diversity and disparities among older adults.

The first set of articles examines several outcomes in the context of Asian ethnicity and nationality. The first article by Yuri Jang et al. explored Korean immigrants’ self-sufficiency in health care navigation across five geographically different states in the United States. The authors found that inclusive policy needs to target older adults, women, those with lower education, and people in the early stages of immigration. Cheryl Hiu-kwan Chui and colleagues used semi-structured interviews to examine the long-term care needs of aging Nepalese minorities residing in Hong Kong. Nepalese faced barriers that encompass structural, attitudinal, and knowledge domains that translational services could not address—an age-friendly city framework was proposed to improve cultural inclusivity. Carina Katigbak et al. employed mixed methods to identify embedded cultural perspectives toward physical activity among older Chinese Americans. Derived key themes included the following: the importance of mind–body connection and the need to find harmony and balance. These results provide a foundation for the development of a culturally informed and tailored physical activity intervention. The last study by Jinjiao Wang and colleagues used data from more than 3,000 Chinese Americans and found spousal support lowered the likelihood of hospitalization and emergency room visits among older Chinese adults with limitations in basic and instrumental activities of daily living (ADL/IADL). Social support highlights the importance of the dyad in aging, potential caregiver burden, and resource allocation for these collectivistic communities to age in place.

The next two articles used nationally representative samples to examine racial and ethnic differences in long-term care outcomes. Using data from the Medical Expenditure Panel Survey with more than 28,000 adults age ≥60, Elizabeth Vasquez et al. determined that non-Hispanic Blacks had a higher likelihood of ADL/IADL limitations compared with non-Hispanic Whites. However, Hispanic adults had the lowest prevalence of mobility impairments compared with non-Hispanic Whites and Blacks, suggesting that group differences may not follow patterns. Scott Landes and Suzie Weng analyzed data from more than 3,000 respondents from the National Home Health Aide Survey to identify whether turnover intent varied across race. Turnover among non-Hispanic Blacks was due to low pay and better career/education opportunities, while Hispanics left because of perceived lack of respect and difficulties with their employer. While tenure and job satisfaction decrease turnover rates, agencies must shift to nuanced and adaptable approaches for employee retention.

The following two articles targeted tailoring long-term care for distinct groups. Fayron Epps and Ishan Williams enumerated on religiosity’s role in African American older adults with ADRD via semi-structured interviews. Engagement, promotion of spiritual connectedness, and maintenance of religious practice contribute to overall meaning and well-being of both the patient and family caregiver. The other article by Faith Hopp and colleagues assessed perceptions of Arab Americans for a future adult day program and identified a number of themes for programming. Chief among these were individual respect, recognizing identity based on geography, managing multi-ethnic populations among political tension, and supporting social engagement. These studies advocate that care programs and support should recognize the role of religion and emphasize the ecological interrelationship between personal and environmental factors.

The final four articles elucidate on several disparities issues among aging adults in the LGBTQ community. The first article by Robin Jacobs and colleagues examined internalized homonegativity among midlife/older gay and bisexual men and found discrimination and diminished social support led to reduced coping self-efficacy and higher self-silencing behaviors. Meanwhile, Steven Mock and colleagues surveyed how technology shaped end-of-life planning among LGBT older adults through focus groups. While fear of technology, specifically online harassment, was prominent, there was optimism for online LGBT support communities, sharing resources, and financial and legal services—technology afforded access to a community for those without biological family connections. The third article by Allison Warren and Ann Steffen examined reactions from Area Agency on Aging providers toward transgender and gender non-conforming (TGNC) older adults. Overall, providers were open and curious to learning more about the provision of affirming care, sought more contact with TGNC older adults, instructions for creating an inclusive environment, and tailored training to working with the TGNC community. The final study, a brief report by Warren and Steffen, developed a TGNC Language Self-Efficacy Scale for providers and identified interactions and information as two factors encompassing TGNC-related terminology.

The cadre of articles in this Special Issue offers a critical and robust examination of diversity and disparities in a number of underrepresented groups. These studies employed a range of methodologies across different sample sizes using interdisciplinary perspectives to meet the challenge established by recent articles. Most importantly, they delved past simple biological constructs (e.g., race and binary gender) to examine the intricate relationships between how social determinants of health influence one’s well-being and ability to age in place. Each article provides a concise but thoughtful summary on policy implications and implications for diversity and disparities practice and/or research.