Cognitive Aging Perceptions of Ethno-Racially Diverse Elders

Purpose:  To explore how elderly Latino, African American, and White participants in the Inland Empire region of Southern California view and experience cognitive decline and aging.  Background:  In an aging, diverse U.S. population, cognitive illnesses disproportionately affect minority ethno-racial groups.  Yet those seeking care for the treatment of cognitive decline are mostly White. Differences in knowledge, awareness, and beliefs about cognitive health may contribute to the observed disparities in negative outcomes among ethno-racial groups.  Understanding beliefs and perceptions of cognitive aging among diverse groups is essential to improving access to care and health outcomes.  Methods:  Semi-structured key informant interviews (KI) and focus groups (FG) were conducted among diverse elderly community members, family caregivers, and physicians (geriatricians, psychiatrists, neurologists, and internists).  All interviews were audio recorded and transcribed verbatim.  All transcripts were analyzed using Grounded Theory methods including inductive and deductive processes to guide analysis.  Results:  Men and women (N = 75) self-identified their ethno-racial group.  Fifteen KI interviews related to the care of elderly and cognitive aging issues were conducted in the local region among health care professionals and support staff from community based older adult serving agencies.  Eight validation FG included a group of family caregivers, a group of physicians, and 6 FG among Latino, African American, and White elderly community members. To assure a broad representation of community members, separate FG were conducted with individuals from lower and more affluent backgrounds of each ethno-racial group. Major emerging themes included (a) personal expectations about physical and cognitive aging versus what was observed; (b) societal value of older adults, often determined by one’s ability to contribute to family or society; (c) model of care preferred and barriers to obtaining the desired care; as well as (d) community concerns such as lack of resources, treatment choices, social support, choice of primary care givers, and ethics.  Latinos were more accepting of aging as a natural process and defined aging by assets.  Whites and African Americans expressed that social value of older adults was influenced by financial status.  African Americans and Latinos preferred to rely on family/neighbors for care, whereas Whites preferred to pay for care, in or out of the home.  Community concerns for all groups included availability of care.  Physicians’ perceptions often differed from elder community members and caregivers regarding expectations about aging, and care preferences. Physicians overwhelmingly expressed frustration regarding system-wide lack of access to care. An overarching theme across all groups was a sense of loss associated with aging. The way this loss was experienced and dealt with, however, varied between ethno-racial groups.  Implications: These findings offer nurses a crucial understanding of unmet needs related to cognitive decline experienced among diverse elderly community members, and perceived barriers to accessing care. This descriptive knowledge can inform nurses as they plan interventions for improving access to care for patients and family living with cognitive decline, especially among Latinos and African-Americans known to have previously failed to access such health care.