QUALITY IMPROVEMENT


Closing the Gaps in Minority Health


and Aging By Sara Wildberger


The National Institute on Minority Health and Health Disparities at the National In- stitutes of Health researches and provides education on these diff erences and how to improve health for all. Signifi cantly to the field of senior living, NIMHD also pro- motes diversity in the biomedical workforce. As director of NIMHD, Dr. Eliseo


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Pérez-Stable oversees the Institute’s $305 million budget and serves as a speaker and educator. He previously was a professor and led several programs at the University of California in San Francisco, including serving as director of the Center for Aging in Diverse Communities, funded by NIH’s National Institute on Aging. As a physician in South Florida, he directly helped many families and older adults. Putting together years of diverse expe-


rience with recent trends, Dr. Pérez-Stable off ers some thoughts about how senior living leaders can continue to improve quality of life for increasingly diverse populations.


Closing the Gaps In the past 20 years, signifi cant strides have been made in closing gaps in minority health disparities among older people, Dr. Pérez-Stable said, just as life expectancies have improved overall. Improved and ear- lier treatment in areas that have typically shown disparities—such as heart disease, stroke, and diabetes—as well as generally earlier diagnosis and treatment of cancers have made the difference. In fact, while African-American men were highly at risk of dying in their 60s, the trend is now to- ward that population having a longer life than white men. However, that statistic only


ealth disparities among racial and ethnic minorities affect all our lives—and can continue as we age.


holds true if African-American men live to age 55—they’re still at more risk overall. One aspect that hasn’t changed over


that two-decade span: Latino and Hispanic elderly populations continue to have better life expectancies. However, health dispar- ities among Asian elderly people are more diffi cult to track; “Asian” can’t be regarded as a heterogeneous identity. Understanding ethnic and cultural diff erences increasingly take more granular information-gathering into account, he said.


New Focus on Quality of Life As gaps in life expectancy close, focus shifts to quality of life as the priority measure. “There’s an inclination to think from ages 65 to 80, many people are doing well, they’re enjoying their family, and they’re continuing to work or enjoying retirement,” Dr. Pérez-Stable said. “That is not necessar- ily the case for minorities.” Hispanics accounted for 16 percent of


total U.S. employment in 2015, but were overrepresented in several occupational groups, including 51 percent in agricultural work and 49 percent as painters, construc- tion workers, and in maintenance, accord- ing to the U.S. Bureau of Labor Statistics. For people who have done a considerable amount of manual labor, arthritis or injuries may can make them less robust or unable to enjoy a good quality of life. Long-term stresses that may be disproportionately ex- perienced by minority people also can aff ect health. And family caretakers as they age can be vulnerable to both injury and stress.


Physical Activity Is the Prescription What are some ways to keep the gaps clos- ing and improve quality of life for diverse populations?


44 SENIOR LIVING EXECUTIVE JANUARY/FEBRUARY 2019


Thought Leader Profi le


Eliseo J. Pérez-Stable, M.D. Director of the


National Institute on Minority Health and Health Disparities at the National Institutes of Health.


Number one is physical activity. While


the mechanisms may be unknown, the data show that “people who are more active do better,” Dr. Pérez-Stable said. “If there’s one message to insist on, this is it.” In San Francisco, for instance, it’s com-


mon to see older people doing tai chi in the parks. Clinical trials and data have proved that simply walking on level ground can be enough to maintain or improve health. For neighborhoods or locations where walking can be hazardous, encouraging walking groups can be a solution. Looking at the long term, designing communities with more safe places to walk and a culture of walking could have a benefi cial eff ect.


Preventing Isolation A group walk also addresses the health hazard of isolation. Yet for people in racial or ethnic minorities, language barriers or feeling diff erent can make group activities stressful instead of helpful. Added to that is the isolation to which aging itself can leave people vulnerable. The solutions here are on three levels.


Senior living communities can make the time and places for people of the same backgrounds and cultures to gather, speak


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