As the study and treatment of elderly people have progressed, three issues have raised concern among clinicians: the problems faced by elderly members of racial and ethnic minority groups, the inadequacies of long-term care, and the need for a health-maintenance approach to medical care in an aging world.

First, discrimination based on race and ethnicity has long been a problem in the United States (see Chapter 3), and many people suffer as a result, particularly those who are old. To be both old and a member of a minority group is considered a kind of “double jeopardy” by many observers. For older women in minority groups, the difficulties are sometimes termed “triple jeopardy,” as many more older women than older men live alone, are widowed, and are poor. Clinicians must take into account their older patients’ race, ethnicity, and gender as they try to diagnose and treat their mental health problems (Kwag et al., 2011; Knight et al., 2006) (see Figure 18-4).

Some elderly people in minority groups face language barriers that interfere with their medical and mental health care. Others may hold cultural beliefs that prevent them from seeking services. Additionally, many members of minority groups do not trust the majority establishment or do not know about medical and mental health services that are sensitive to their culture and their particular needs (Ayalon & Huyck, 2001). As a result, it is common for elderly members of racial and ethnic minority groups to rely largely on family members or friends for remedies and health care.

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Today, 10 to 20 percent of elderly people live with their children or other relatives, usually because of increasing health problems (Span, 2009; Etaugh, 2008). In the United States, this living arrangement is more common for elderly people from ethnic minority groups than for elderly white Americans. Elderly Asian Americans are most likely to live with their children, African Americans and Hispanic Americans are less likely to do so, and white Americans are least likely (Etaugh, 2008; Armstrong, 2001).

Second, many older people require long-term care, a general term that may refer variously to the services offered outside the family in a partially supervised apartment, a senior housing complex for mildly impaired elderly persons, or a nursing home where skilled medical and nursing care are available around the clock (Samos et al., 2010). The quality of care in such residences varies widely.

At any given time in the United States, only about 4 percent of the entire elderly population actually live in nursing homes (1.5 million people), but around 13 percent of people 85 years and older do eventually wind up being placed in such facilities (USDHHS, 2011; Edelstein et al., 2008). Thus many older adults live in fear of being “put away.” They fear having to move, losing independence, and living in a medical environment. Many also worry about the cost of long-term care facilities. Around-the-clock nursing care is expensive, and nursing home costs continue to rise. Most health insurance plans available today do not adequately cover the costs of long-term or permanent placement (Durso et al., 2010). Worry over these issues can greatly harm the mental health of older adults, perhaps leading to depression and anxiety as well as family conflict.

Finally, clinical scientists suggest that the current generation of young adults should take a health-maintenance, or wellness promotion, approach to their own aging process (Markle-Reid, Keller, & Browne, 2010; Pacala, 2010). In other words, they should do things that promote physical and mental health—avoid smoking, eat well-balanced and healthful meals, exercise regularly, engage in positive social relationships, and take advantage of psychoeducational, stress management, and other mental health programs (Nation et al., 2011; Szabo et al, 2011). There is a growing belief that older adults will adapt more readily to changes and negative events if their physical and psychological health is good.

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