“African-American older adults are a diverse group. They can vary from an elder living in the rural South to an urban area in the Northeast. They may have been born in the northern or southern United States or (in) Jamaica or Haiti.
“Their socioeconomic and marital statuses vary as well as their work history, educational and religious backgrounds…The (current) cohort of African American older adults … represent a group that has experienced the worst American educational and health care systems. Most have experienced segregated education and housing.
“They were more likely to receive substandard health care when they were younger, which now impacts their current health status. Many have worked for years in high-risk jobs under dangerous conditions, which contributed to the development of multiple chronic illnesses and poor overall health at relatively young ages” (Brangman, 1995).
When exploring outcomes and quality of care, it is important to note that African Americans tend to emphasize the “process” of care (Fongwa, 2001). Consistent with what is reported anecdotally, African Americans are at risk of under-utilization of preventive services.
In a large epidemiological study of cancer prevention services among men and women age 70 and over in the Piedmont area of North Carolina, the Black respondents reported significantly lower use of Pap testing, clinical breast examination, mammography, rectal examinations, and fecal occult blood testing.
When levels of education, income, and insurance coverage were controlled for, however, the racial differences in cancer prevention services were no longer significant (Hegarty et al., 2000
