Research on Aging

This article examines factors that affect the utilization of health care services and home- and community-based care (HCBC) programs by older Taiwanese, a rapidly growing and newly arrived immigrant group. Currently, knowledge about the health status and utilization of health-related services among newly arrived Asians is limited. This article analyzed data from the 1994 Southern California Taiwanese American Elderly Survey (n = 240) based on a modified Andersen behavioral model that included both cultural and structural variables. Significant variables included health needs, cultural beliefs, and socioeconomic and structural variables; however, variables predicting utilization of health services and HCBC programs were different. Implications for both gerontological research and practice include the following: (1) Future programs addressing service utilizations by older Taiwanese should be culturally sensitive and consider family as a unit of intervention, and (2) more multidisciplinary research should explore how cultural and structural variables contribute to service utilization among newly arrived elderly Asian immigrants.

This cross-sectional study examines utilization of health care resources, including nursing homes, among 1,433 rural Hispanic and non-Hispanic White participants in the San Luis Valley Health and Aging Study. Results show substantially greater non-Hispanic White residence in nursing homes, greater Hispanic use of professional home nursing services, but little ethnic difference in outpatient care or hospitalization. Analyses based on the behavior model of utilization find health care use strongly associated with need factors. In particular, outpatient care correlated with disease and instrumental daily living activity dependence, home nursing care with basic daily living activity dependence, and nursing home use with daily living activity dependence and cognitive impairment. Predisposing characteristics (age, marital status, education) and enabling supports and barriers (insurance, availability of no-or low-cost care, transportation difficulties) also influenced utilization. The differential ethnic pattern of nursing home use persisted after controlling for these important characteristics.

Satisfaction with long-term care has received the attention of academics, policymakers, and the general public. However, little attention has been paid to ethnic differences in satisfaction, despite the increasing proliferation of long-term care options and minority representation in such facilities. The authors find that ethnic differences exist in satisfaction with adult care homes. Dependency, satisfaction with health, resident involvement in placement decisions, home type, and percentage of private rooms vary in their impact on satisfaction by ethnicity. Predictors of satisfaction within groups are primarily intra/interpersonal versus organizational characteristics. African Americans are more affected than Whites by organizational factors. Different predictors of satisfaction by ethnicity may indicate that elders bring different life experiences, cultural beliefs, and expectations with regard to long-term care that may influence their degree of satisfaction. Service delivery in long-term care institutions should be aware of the unique experiences of their residents and implement services to ensure optimal satisfaction and care.

The authors examined how racial matching between older patients and physicians relates to effectiveness of care, use of services, and satisfaction with care. In this cross-sectional, community-based cohort study, 2,867 elderly African American and White North Carolina residents with regular physicians were interviewed and screened for hypertension (HBP). African Americans were more likely than Whites to be told they had HBP, to receive HBP medication, and to take it regardless of their physician’s race. White elders with African American physicians were more likely to report that they delayed care quite often. African American elders were less likely to delay care quite often, regardless of their physicians’ race. These results did not support the position that African Americans require treatment by African American physicians to achieve better care. Although elders of both races who had African American physicians were less satisfied with care received, interpretation of this finding is difficult without better measurement of patient satisfaction.

This study explored the effects of racial differences between nursing home residents and nurse’s aides. One-third of residents exhibited race-related attitudes. This took two forms: “anachronistic racism,” language not acceptable today, used in a context not intended to be offensive, and its opposite form, “malignant racism.” Three-quarters of the aides had experienced racism on the job. They distinguished the two forms of racism and discounted racist comments by residents they judged to be mentally incompetent but held others—competent residents, family members, and fellow staff—to a higher standard. In this way, they were able to maintain a caring attitude in their work. Foreign-born aides were more likely to experience racism on the job than African American aides were. They also experienced prejudice against immigrants; they interpreted it as such because it sometimes came from people of their own race.