老年人接受公共资助的家庭和社区服务中未满足需求的种族和民族差异。
Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services.
机构信息
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
出版信息
J Am Geriatr Soc. 2024 Nov;72(11):3520-3529. doi: 10.1111/jgs.19153. Epub 2024 Aug 29.
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.
背景
对于来自少数族裔的老年人来说，家庭和社区为基础的服务（HCBS）的未满足需求可能存在明显差异。本研究旨在通过使用公共资助的 HCBS，检查 65 岁及以上消费者中与 HCBS 相关的未满足需求的种族和民族差异。
方法
我们分析了来自 23 个参与州的 21739 名居住在社区中的年龄在 65 岁及以上的 HCBS 消费者的国家核心指标-老龄化和残疾调查数据（2015-2019 年）。结果测量包括六种服务类型（个人护理、家庭佣工/家务、送餐、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、亚洲人、非西班牙裔白人、西班牙裔和多种族群体。使用逻辑回归模型，调整了社会人口统计学、健康和 HCBS 计划（即医疗补助、《美国老年人法案》（OAA）、《全面老年人关怀计划》（PACE））特征以及特定服务类型的使用情况后，检验了种族和民族与未满足需求之间的关联。
结果
在 21739 名受访者中，23.3%为黑人，3.4%为亚洲人，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，亚洲和黑人消费者在个人护理方面报告未满足需求的可能性更高（调整后的优势比[aOR]，1.45，p 值<0.01；aOR，1.25，p<0.001）。与白人消费者相比，亚洲和黑人消费者在成人日间服务方面的未满足需求的可能性显著更高（aOR，1.94，p<0.001；aOR，1.39，p<0.001）。与非西班牙裔白人消费者相比，黑人消费者在送餐和护理人员支持服务方面的未满足需求的可能性更高（aOR，1.29；p<0.01；aOR，1.26，p<0.05）。种族和民族与家务和交通服务方面的未满足需求无关。
结论
未来的研究应该确定未满足需求差异的驱动因素，以制定文化上适当的解决方案。
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