Gerontology

Gerontology is the comprehensive study of the aging of the population and the aged. One only has to work in a health care facility that has a majority of older African-Americans to realize that there is inadequate care, ignorance, diverse opinions, attitudes and values that are quite different from the same type of setting that serves White elderly persons. I was a pharmacy manager for three years in an HMO sponsored by Medicare and served a 95% African-American elderly population where the administration was White. I was appalled and often dismayed at many of the policies that were in place with respect to the care that was offered to this special segment of the population. Often I was not aware of the meetings among the chairpersons of the various departments within the HMO because of my vocal oppositions to the policies that were being formed. I was in fact a non-entity. However, many of the patients were very open voiced their concerns with me and gave me real perspectives of their attitudes, care and desires. Certainly, there were not health care providers in this particular institution who also realized that these poor elderly were not receiving optimum care and were just as frustrated as I was.

“Sources of Individual Differences in Indices of Health Disparities among Older African-Americans” by Keith E. Whitfield, Ph.D. of the Department of Bio-behavioral Health of The Pennsylvania State University has recognized this problem. He notes that there are complexities surrounding health disparities among this socio-economic population. Historically, African Americans have suffered with essential hypertension, a chronic disease with no known etiology. The pharmaceutical has been able to find particular sources of anti-hypertensive drugs that are more effective in the Black population. However, this paper deals with the health disparities that relate to increasing age and the burden of poor health experienced by this population. “Some research suggests that African-Americans may experience events and circumstances which have socio-cultural origins that significantly influence development and aging”

The purpose of this article is to provide a summary of some results from a study of the individual differences in health among African-American twins with particular focus on adulthood and later life. The Carolina African-American Twin Study of Aging (CAATSA) is one of the few in-person studies of adult African- American Twins and provides a unique opportunity to examine how genetic and environmental influences work in concert to create individual variability in a relatively unstudied population. It also provides an opportunity to examine potential areas of discovery of environmental influences on health. Demographic variables included age (in years), gender, and education (in years). Health variables included doctors diagnosis of diabetes, high blood pressure, cardiovascular disease, cancer, and kidney trouble.

African-Americans are not a monolithic group of persons. There are differences among individuals within the group, and one must account for these differences. Whitfield acknowledges that these individual differences have implications for the quality as well as the quantity of late life. He speaks of the multiple jeopardy hypothesis where poor social and economic conditions of early life often continue in senior years and explains the health differentials between African-Americans and Caucasians. The differentials can be social, psychological, biological and even genetic All of these affect health indices. This is a vantage point from which the health care system understand the health conditions of elderly African-Americans and perhaps a perspective that gives a different set of variables that must be understood in order to provide adequate care to this particular group.

Whitfield understands the benefits and the deficiencies of the work of The National Human Genome Research Institute (NHGRI) of the National Institutes of Health. As they

developed a working draft of the human genome, they realized the limitless possibilities, including new insights about diseases and how to treat and prevent them. These recent advances in molecular genetics have increased our ability to understand the contribution of genes to health disparities. In the past, genetics have been used to rationalize racist perspectives. Currently, these molecular genetic findings accurately and appropriately help to define disparities but, equally important will be our knowledge of how the environment influences health, disease, and complex behaviors associated with health differentials. “The manner in which genes potentially play a role in creating health differentials requires further explanation….Previous research on the significant impact of combinations of socio- demographic and psychosocial factors upon disease processes and complex behaviors is perhaps our best indicator that science must avoid a reductionist view." Manipulating genomes will not cure all of our ills Whitfield believes that genetic information will help us to understand the effects health differentials on the effects genes have on the aging population. He believes that health “disparities among older African-Americans related to disease and health that are created, modified, or triggered by cultural and contextual factors”. This is a perspective that is shared not only by health care practitioners, but also by many in the Black community. One of the theories that has been proposed for the etiology of essential hypertension is the stress that was endured by Blacks during slavery. He evaluates the complementary, interdisciplinary approaches that examine the influence of genes and environment that are important for understanding individual differences that arise in indices used in the exploration of the underlying causes of health disparities.

His particular study was to provide a summary of some results from a study of the by unique environmental factors, although common environmental factors did not contribute

 to variance in scores. One of the major conclusions of the study is that behaviors are responsible for much of the differences in health and disease among ethnic minorities. These behaviors are interwoven in the fabric of being called culture. African-Americans may share in this perspective.

Research indicates that for many chronic illnesses, the prevalence of chronic health conditions such as hypertension tends to increase with advancing age. This is particular for true for older African-Americans as these conditions significantly increase the burden of poor health experienced by this population. This study recognizes other research suggests that African-Americans may experience events and circumstances, which have socio-cultural origins that significantly influence development and aging. We acknowledge that socio-cultural differences and influences contribute to differences between racial groups as well as differences between individuals within groups in late life. Previous research on the significant impact of combinations of socio- demographic and psychosocial factors upon disease processes and complex behaviors is perhaps our best indicator that science must avoid a reductionistic view. The reductionistic approach has just begun to be applied to the study of minority populations and conceptual and statistical advances in these methods are still required.

“Health Disparities Among Older African-Americans Blood Pressure One of the most critical health disparities experienced by African-Americans as a group is the incidence of hypertension. African-Americans have one of the highest rates of hypertension in the world and are estimated to have a prevalence two times that of Caucasians. This disease affects approximately 65 percent of African-American elders between the ages of 65 and 74 and is predictive of functional decline”. The authors have also suggested that environmental forces, such as stress associated with racism or the struggle for economic security, may be especially influential on blood pressure at younger ages for African-American adults. They also believe that environmental forces play less of a role in older African-Americans. It is also proposed that there is an increased interest in understanding psychosocial variables that may be causally and otherwise related to variability in health status, particularly among minorities. In past research, active coping was found to have a relationship with cardiovascular disease among African-Americans. The vast majority of previous research on psychosocial indices has focused on active coping and its relationship to cardiovascular health among African-Americans.