3. End-of-Life Care Issues

Several studies describe significant ethnic differences in palliative and hospice care settings. African American compared to white older adults nearing end of life tend to receive higher rates of high intensity, hospital based care, are more likely to die in hospitals and prefer more aggressive life-sustaining treatment (Garrett 1993, O’Brien et al. 1995). Family members of African Americans were more likely to report lower overall satisfaction with end of life care as compared to family of white decedents.

Family members of African Americans of deceased older adults more often reported concerns about physician communication, being informed about treatments, what to expect and receiving support for their own needs while a loved one was dying.

Lack of Studies on Hospice Care and Ethnic Older Adults

Though hospice care is an important long-term care resource, few studies have examined the use of hospice care by ethnic older adults in the United States. African Americans and other ethnic older adults are less likely to use hospice care. Some authors suggest that cultural stigma associated with accepting hospice care outside of the home and/or lack of knowledge about palliative care services contribute to under-utilization of the services.

Barriers to Use of Hospice Care

African Americans older adults may be ambivalent and mistrustful of hospice programs which require them to forego curative treatments. Inadequate hospice related services in poor urban communities may also interfere with African American older adults receiving hospice care. Haas et al. (2007) suggest that minority communities may have an inadequate medical infrastructure to provide hospice care.

For example, the pharmacies in those neighborhoods may not stock sufficient quantities of opioids needed for the severe pain of terminal illness. Hospice workers may be less willing to go into minority neighbourhoods and hospice services are less likely to be located in these communities.