1. Patient-Based Factors

Medical anthropologists suggest that African American older adults have culturally-derived perceptions of illness and socially reinforced health behaviors which significantly influence their help-seeking behaviors. These perceptions and behaviors contribute to their delayed entry into primary care clinics and hospitals. Some African American older adults believe that illness is an expression of divine punishment for sinful behavior. Others consider illness a result of exposure to cold air and various environmental impurities.

Spiritual and Home Remedies

Some African American older adults believe that good health is an indication that one’s body and spiritual life are in harmony and that illness can best be cured through prayer and faith. Many African American older adults use home remedies (salves, teas, herbs and over the counter medicines) for self-treatment before seeking professional medical advice.

Since they often do not disclose their use of these products to their health providers, physicians and nurses working with African American older adults need to promote open discussion in their working relationship to minimize the potential for dangerous drug interactions (Brangman, 1995).

Emergency Room Utilization

Some investigators report that African American older adults use a crisis oriented approach to health care services, more often coming to hospital emergency room and less often having a primary care provider. African American older adults higher levels of dissatisfaction with physician services and perception of poor treatment may contribute to their tendency to avoid primary care (Sherkat, 2007). However, delaying treatment until emergency services are required may increase mortality rates (Brangman, 1995).

Additional Factors

Additional patient-based factors include:

  • low socioeconomic status
  • inadequate health insurance coverage
  • underestimation of their health risks
  • lack of trust in the health care system

Use of Long-Term Care

Studies of African American older adults utilization of community-based long term care services have produced contradictory results. Though many studies report that African American compared to white older adults are less likely to use adult day care or in-home assistance services, other studies have reported that they have equivalent or higher utilization rates of these services.

Nursing Home Use

Most studies report lower use of nursing homes by elderly African Americans and attribute this phenomenon to:

  • patient preference
  • geographic distance of facilities from minority communities
  • socio-economic differences
  • discriminatory referral patterns by health care providers