Heterogeneity
IMPORTANT TERM
Fictive Kin– People that are considered ‘family’, as the result of longstanding relationships, but may not be linked directly by blood ties. These individuals may be serving as the primary care giver or even as the surrogate decision makers
and may be sometimes more involved than the directly related family members.
Fictive Kin: References and Abstracts
Older Americans who identify themselves as Black or African American are extremely varied. Although many are low income, very large and growing segments are in the middle and upper income categories. Some are retired professionals, and many others have children with professional careers.
Religious affiliations include:
- Protestant
- Catholic
- Muslim
- none
Many are still living in the rural South, but more are in urban areas in the North and West. Educational levels vary from almost no years of schooling to those with doctorates. While many in their 70s and 80s are dependent on care from children, grandchildren, or “fictive kin,” many others are raising their grandchildren or great grandchildren.
It is important for clinicians to recognize the vast array of characteristics that may be represented in older Black patients so that each patient can be treated as an individual.
Living Arrangements
Among community dwelling older adults, African American men were more likely to live alone. In 2004, 56 percent of African American older men lived with their spouses, 13 percent lived with other relatives, 5 percent lived with nonrelatives, and 27 percent lived alone. For African American older women, 24 percent lived with their spouses, 33 percent lived with other relatives, 2 percent lived with nonrelatives, and 41 percent lived alone. (Administration on Aging (AoA), 2006).
Historically, African Americans have resided in nursing homes at about half the rate of White older adults (Yeo, 1993). More recent evidence shows an increase in the use of nursing homes among Black men and women over 65 than Whites (Kramerow, Lentzer, Rooks, Weeks, & Saydah, 1999). See Figure 3 in Access and Utilization: Long Term Care.
Education
The AoA (2004) reported that 81% Blacks age 25 and older, the proportion that had at least a high school diploma in 2004.
This proportion rose by 8 percentage points from 1994 to 2004 and the number of black college students in fall 2004 roughly double the number 15 years earlier.
Poverty
The poverty rate in 2004 according to AoA was 24.7% for those reporting black as their only race. This rate was unchanged from 2003. This is slightly more than older Hispanics and more than twice the rate of older White Americans (Kramerow et al., 1999). The percentage increases with age and for those who are widowed or live alone.
Morbidity and mortality rates are higher among African American older adults than in the general population. Because of decreased educational levels and decreases in personal resources, the awareness of health problems, knowledge of causes and risk factors, and capacity to access medical care may be greatly decreased.
