Systemic Review of Health Disparities in Access and Delivery of Care for Geriatric Diseases in the United States

Abstract

AbstractBackgroundThe U.S. population continues to age, and the identification of disparities in geriatric care -so that they may be understood and solutions addressed - is ever more critical. A systematic review is presented on current disparities found in access to care for geriatric diseases as well as in the delivery of care within the United States.MethodsA comprehensive search for the available literature from 2010 to 2024 was carried out through the PubMed, CINAHL, and Scopus databases in peer-reviewed journals. Studies that focused on disparities in access and provision of geriatric care for adults aged 65 years and above within the U.S. health system were included in this study. The Joanna Briggs Institute critical appraisal tools were used in the quality appraisal of studies included.ResultsOf the total number of 5,218 studies that were identified initially, 132 studies were eligible for inclusion. Our analysis uncovered continued inequity in geriatric care across racial, ethnic, socioeconomic, and geographic lines. Findings include: (1) low rates of early diagnosis and delayed treatment of dementia and Alzheimer’s among minority seniors, who were found to be 2.3 times more likely for African Americans and 1.9 times more likely for Hispanics than their white counterparts; (2) inability to access high-level geriatric care in regions outside of metropolitan areas, where it was identified that older adults had to commute, on average, 3.2 times farther to the nearest provider; (3) socioeconomic factors found to present obstacles to home health and long-term care, with seniors from a lower income bracket 1.8 times more likely to be placed in a poor-quality nursing home; and (4) disparities in the quality of end-of-life care for elders of lower socioeconomic status, with African Americans and Hispanics being respectively 38% and 51% less likely to use hospice care.ConclusionThis review has demonstrated that important and persistent disparities exist in the availability and delivery of geriatric care in the United States. Of the 132 studies, 34 directed their efforts toward reducing interventions to have such disparities with salutary results coming from culturally tailored community-based approaches. Multipronged interventions that include policy revision, workforce development, and community-based initiatives hold promise for reducing these disparities. This should be an area of focus for future targeted interventions, which should, therefore, be evaluated for effectiveness in reducing disparities in health outcomes for all older adults.