Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-08-29 DOI:10.1111/jgs.19153

Chanee D. Fabius PhD, MA, Romil Parikh MBBS, MPH, Jack M. Wolf BA, Stephanie Giordano DLP, MEEP, Shekinah Fashaw-Walters PhD, Eric Jutkowitz PhD, Tetyana Shippee PhD, FGSA

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Abstract

Background

Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS.

Methods

We analyzed the National Core Indicators-Aging and Disability survey data (2015–2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types.

Results

Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services.

Conclusions

Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.

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接受政府资助的家庭和社区服务的老年人在未满足需求方面的种族和民族差异。

背景：对家庭和社区服务（HCBS）的需求未得到满足可能会对来自少数种族和族裔群体的老年人造成不同程度的影响。我们研究了使用政府资助的家庭和社区服务（HCBS）的年龄≥65 岁的消费者在家庭和社区服务未满足需求方面的种族和民族差异：我们分析了全国核心指标--老龄和残疾调查数据（2015-2019 年），这些数据来自 23 个参与州的 21739 名年龄≥65 岁、居住在社区的 HCBS 消费者。结果测量包括六种服务类型（即个人护理、家政服务/家务、送餐服务、成人日间服务、交通和护理人员支持）中自我报告的未满足需求。种族和民族群体包括非西班牙裔黑人、亚裔、非西班牙裔白人、西班牙裔和多种族群体。逻辑回归模型检验了种族和民族与未满足需求之间的关联，并对社会人口、健康和 HCBS 计划（即 Medicaid、《美国老年人法案》[OAA]、《老年人全包护理计划》[PACE]）特征以及特定服务类型的使用情况进行了调整：在 21739 名受访者中，23.3% 为黑人，3.4% 为亚裔，10.8% 为西班牙裔，58.8% 为非西班牙裔白人，3.7% 为多种族或其他种族/民族。与白人消费者相比，亚裔和黑人消费者报告个人护理需求未得到满足的几率更高（调整后的几率比[aOR]，1.45，P值结论）：未来的研究应找出未满足需求差异的驱动因素，以制定文化上合适的解决方案。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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