Stanford Aging and Ethnogeriatrics Center, Stanford University School of Medicine, VA Palo Alto Health Care System, Palo Alto, California.
J Am Geriatr Soc. 2019 May;67(S2):S423-S432. doi: 10.1111/jgs.15939.
The population of minority older adults is going to explode over the next four decades. Older adults from racial and ethnic minorities face persistent and pervasive health disparities. Health disparities exert a huge fiscal burden on the nation. The national financial cost of health disparities for the years 2002 to 2006 was an estimated 1.23 trillion dollars. As the aging population becomes more diverse, these disparity-related costs are expected to increase. Older adults from racial and ethnic minorities face multiple barriers to accessing health and support services that will help them to age and die in place in the community. Patient-related barriers include limited English proficiency, low health literacy, varying levels of acculturation, biases about Western healthcare and medications, mistrust of clinicians, inability to navigate the complex healthcare system, and cultural beliefs and taboos. Clinician-related barriers include ageism (ie, discrimination against older people due to negative and inaccurate stereotypes), conscious and unconscious bias, being deeply entrenched in the culture of biomedicine, and the lack of training in the principles and practice of providing culturally respectful care. Health system-related barriers include lack of culturally tailored services, including access to medical interpreters. We conclude by identifying three specific strategies to facilitate culturally humble and respectful care for diverse patients. J Am Geriatr Soc 67:S423-S432, 2019.
未来四十年，少数民族老年人口将大幅增长。少数族裔老年人面临持续存在且普遍存在的健康差距。健康差距给国家带来了巨大的财政负担。 2002 年至 2006 年，健康差距造成的国家财政成本估计为 1.23 万亿美元。随着老年人口更加多样化，这些与差异相关的成本预计将会增加。少数族裔老年人在获得帮助他们在社区中安享晚年和死亡的健康和支持服务方面面临多种障碍。与患者相关的障碍包括英语水平有限、健康素养低、不同程度的文化适应、对西方医疗保健和药物的偏见、对临床医生的不信任、无法驾驭复杂的医疗保健系统以及文化信仰和禁忌。与临床医生相关的障碍包括年龄歧视（即，由于对老年人的负面和不准确的刻板印象而对老年人的歧视）、有意识和无意识的偏见、深深植根于生物医学文化以及缺乏提供尊重文化的护理原则和实践的培训。卫生系统相关的障碍包括缺乏文化适应服务，包括获得医疗口译员。我们最后确定了三种具体策略，以促进为不同患者提供文化谦逊和尊重的护理。 J Am Geriatr Soc 67：S423-S432，2019 年。
