In the US, the African-American population forms an important part of the culture and history, Africans basically brought in as slaves to North America, Central America and Latin America. There has been growth and development in the African-American populations, but their development is often distressing to view because their growth and development has been poor compared to other including the European Americans and the Hispanic. The growth of the African-Americans actually began in the year 1790, when their population was recorded to be about 757, 000. Within a period of 100 years, their populations rose 10-fold to 7.5 million. In the year 1993, the largest minority group in the US was African-Americans. There were about 7% or 1.5 million African-American above the age of 65 years in the year 1970.
Since then, there has been a gradual increase in the number of African-Americans above the age of 65 years. There has been a faster growth of people above the age of 65 years than for people in the under 18 year old group or the 18 to 64 years old group in the African-American communities since the year 1970. There are three patterns currently observed in the African-American communities. There has been a decline in the fertility rates, there has been an improvement in the healthcare provided to them and there has been an improvement in the life-expectancy of the African-American population above the age of 65 years and would continue to rise. In the year 2000, more than 30 million people that lived in the US were African-Americans, and about 1.7 million were cross-breeds.
About 2.8 million African-Americans who lived in the US in the year 2000 were above the age of 65 years and were estimated to be about 8 % of the senior population. Keeping in mind that the African-American senior population would continue to rise, by the year 2050, the 65 year and above African-American group would be 10 million in number or 12 % of the senior American population. However, several facts of the African-American population are still unknown and needs to be investigated further. The pattern of residing of the African-American populations has also changed within the last 100 years. In the year 1890, about 80 % of the African-American populations lived in rural areas, whereas in the year 1970, about 80 % lived in urban areas. In the year 1990, about 50 % of the African-Americans resided in the South-USA compared to the other parts (Gordon, 2008).
A significant portion of the Africa-American senior populations are belonging to the lower incomes groups, and smaller portions to the middle income and the upper income groups. Most of these individuals are retired and belong to religions such as Catholic, Protestants and Islam. Most of the senior African-Americans are moderately educated, but studies have shown that their educational levels may vary from almost no education to holding higher degrees such as Doctorates. Most of the senior Black men are being cared for by their children, and very few are cared by their grandchildren.
About 24 % of the African-American live with their spouses and 52 % may be staying without their spouses. About 10 % of the African-American men actually stay with their family relatives. The rate at which the African-Americans are put in elderly care centers is less than the White elderly populations. However, a higher number of African-American Black men above the age of 65 years are put in nursing homes. About 22 % of the senior African-American men live in poverty, facing poor socio-economic conditions. On the other hand, 29 % of the African-American women above the age of 65 years live in poverty. Both these figures are very much higher compared to the White and the Hispanic groups (Gordon, 2008).
Health Issues affecting African-American Elderly Men
The African-American populations face several health risks which can result in health problems and mortality. There may be several factors as to why the risks are higher in these populations including poor education, lack of awareness, decrease in the access to healthcare, poor knowledge of risks, etc. An average Black American man can live for 67.2 years as in 1997, compared to Black females who can live for 74.7 years. Once the individuals cross 85 years, they can live on an average of 5.7 years for men and 6.7 years for women.
From all causes of deaths in the above 65 years groups, the rates seem to be highest in the African-American population. In the age of 85 years, the African-Americans were the second highest following the Whites. Some of the most common causes for mortality in the African-American populations included cardiovascular diseases, malignancies, stroke, diabetes mellitus and its complications, pneumonia and chest diseases. Heart diseases, malignancies and stroke are common causes of death even in the senior populations of other ethnic groups. The Black populations seem to be more affected with diabetes and its complications than other ethnic groups.
The excess mortality rate (differences in mortality between the minority and other populations, when other factors are the same) is about 24 % for the African-American men and 41 % for the African-American women. In the year 1998, about 2000 African-Americans died from heart diseases, 1300 died from cancer and 489 from CVA. In the case of cancers, the mortality rate is 30 % greater in African-Americans compared to the White populations. Black women and men commonly suffer from lung cancers, bronchitis, emphysema and hypertension, and the rate at which they are affected and would die from the disease is also rising (Gordon, 2008).
The African-Americans are one of the groups that most commonly suffer from distressing chronic diseases such as cancers, hypertension, stroke, dementia, renal disease, and coronary heart disease. About 37 % of the Black males over 65 years were affected with hypertension in the year 1980. In this population, it is frequently seen that those individuals from the lower socioeconomic strata are more often implicated into hypertension than the other strata. One of the most common forms of cancers that affected elder African-American men is prostate cancer. Compared to other populations, there is a 60 % higher chance of Black elderly men to develop prostate cancer than any other community. Compared to Hispanic, there is a two-fold chance of developing prostate cancer in the Blacks.
Another problem is that once cancer affects the Black individuals, the chances of reporting, treatment and better survival is much lesser due to poor awareness and lack of access to healthcare. For example, Black women have a lower risk of developing breast cancer, but their survival following the development of the disease is much lower compared to other populations. However, in recent times there has been a slight improvement in the survival rates following provision of education, greater awareness and improvements in the healthcare system. One of the cancers which are very common in the Black populations is multiple myeloma, and the risk for the diseases increases with age.
African-American men and women are also at the risk for visual problems especially glaucoma and cataract which tend to occur at an earlier age and causes blindness to a greater extent. The chances of hip fractures in African-American men are higher. Besides, there were also other complications such as longer hospital stays, poor mobility, reduced rehabilitation, etc. The rates of dementia were also higher in the African-American population compared to other populations. In some places in the US, the Black populations were affected with greater cases of Alzheimer’s disease and vascular dementia. However, Hispanics are more often affected than African-Americans with dementia. 54 % of the African-Americans above the age of 85 years were affected with dementia (Gordon, 2008).
Overall, the general number of people with good or excellent health in individuals over the age of 65 years was less in African-Americans compared to other communities. 59.3 % of the African-American men were in good health over the age of 65 years compared to Whites of 73.5 % and 65.4 % Hispanics. In men above the age of 75 years, 56.4 % of the Black men were in good health compared to 69.4 % in Whites and 59.7 % in Hispanics. In men above the age of 85 years, about 45 % were in good health, compared to 67 % Whites and 51 % Hispanics.
These figures were almost the similar in Black women, except in the above 85 years age group, which had a slightly positive health status. Above the age of 70 years, the ability to function in Black men significantly reduced compared to other communities. Limitations in bathing activities existed in 11.5 % of the Black populations, 8.5 % had problems with dressings, 11 % had problems with moving around, 25 % had problems with walking, 11 % hand problems with moving outside the house and 3 % had problems with using the toilet, clearly higher than the populations from other communities (Gordon, 2008).
In this study, the racial and ethnic factors that increase the chances of developing hypertension, and cancers in the Black male population would be determined.
In a study conducted by Winterich et al (2009), the perceptions and the feeling elderly men developed for digital rectal examinations and colonoscopy for the screening of colorectal cancers and prostate was studied. In this study, the masculinity and the health theory was utilized to support the perceptions developed by the men. About 64 Black and White men belonging to the middle and the senior age groups were involved in the studies. Colorectal cancers was the third most common cancer in the aged men and in Black men, the condition particularly claimed a high mortality and morbidity rate. Black men also had a higher incidence and mortality from prostate cancer. The American cancer Society has strongly recommended the use of annual colonoscopy and physical examination to help determine the presence of colorectal cancers and help to treat the disease immediately if present. However, African-American men often find digital rectal examination embarrassing and colonoscopy as offensive. The masculinity and health theory is utilized to determine the reason for these embarrassments.
In the past it is found that men more often than women use the healthcare system less frequently and would engage in behavior that would be risky to health. Men often develop constructions on masculinity and would strongly develop attitudes towards colorectal screening and examination. In this study conducted by Winterich 2009, about 35 Black and 29 White men between the ages of 40 to 65 years from different backgrounds were studied the various experiences and attitudes they had towards rectal examination. In colorectal examination, the physician would enter the finger in the rectum to determine if there is any mass in the rectal and the prostate regions. The doctors would also insert a colonoscope to view for any mass inside the colon.
Many of the Senior Black and White men develop attitudes, beliefs and negative thoughts towards digital screening and colonoscopy examination of the rectum. Black men are more often anxious and fear such procedures compared to the White men. Due to this reason, beyond the age of 50 years, the screening of the disease for colorectal cancers has been low. Often the Black men consider these acts as acts of homosexuality. However, recent studies have suggested that the misbelief that is present in the Black men may actually be present in other communities. The characteristics of masculinity include are culturally constructed beliefs that develop due to interactions with others and having power over others especially women and their offspring.
Frequently men may reject health practices that they consider to be feministic or homosexual. Often men out of practices for masculinity may reject cancer screening procedures and put themselves at a higher risk for developing these cancers. The Black men especially disliked penetration during the rectal examination procedures. The men belonging to the lower education background also did not like such procedures. Men considered that the rectum was a private part of the body and hence did not want to volunteer to such procedures. Men also feared that during an examination procedure they may get stimulated. Only three Black men considered the procedure as vital for cancer screening. Although men perceived the colonoscopy examination as offensive, it was often considered to be more acceptable than the digital rectal examination.
In another study conducted by Abbott (1998), the question being asked was whether a community screening program could help to prevail over attitudes, poor knowledge, and lack of accessibility in the senior African-American men to fight prostate cancer. In this 20 month program about 944 African-American men were enrolled and were provided screening and education for prostate cancer. As part of the screening digital rectal examination and prostate specific antigen tests were provided. The subjects were given a pretest and a posttest questionnaire (before and after the screening and counseling).
The test questioned about risk factors, causative factors and clinical symptoms. However, it was found that the African-American senior men were less likely to identify the clinical symptoms of prostate cancer than that of other communities. The African-American men initially possessed very poor knowledge of the symptoms and signs of prostate cancer, but following the education sessions, the knowledge of various groups in the study were similar. It was found that the Black men considered the first symptoms of prostate cancer to be pain. In certain prostate cancer, no symptoms were produced.
Ayotte 2009 conducted a study to demonstrate that African-American men do not have the health-related knowledge to help to self-monitor and manage chronic diseases especially hypertension. In this particular study the latent variable model was utilized. A latent variable model is a statistical non-linear model that can be graphically represented and is often utilized by social scientists. The constructs (such as behavior, attitudes, and traits) can be observed directly by the social scientists and can be measured indirectly using observable indicators through questionnaire tools (Vermunt, 2000). More than 1177 subjects participated, which included 45 % African-Americans and 65 % men.
The multiple indicators and the multiple cause modeling were utilized which included data regarding socioeconomic status, education levels, race, sex, age, etc. The subjects were given a questionnaire regarding knowledge of hypertension. The latent knowledge were higher in women, Whites, educated participants rather than the African-American and male subjects, who had education levels. The Black and the male population also had poor knowledge of the linkage between the risk for hypertension and renal disease and also the chances of the Black population being at an increased risk for developing hypertension (Ayotte, 2009).
The Black elderly men are unlikely to see the physician if they fall ill as the access to healthcare is bad. The risk of certain terminal infectious such as HIV/AIDS is also high in the Black community. Compared to White men, the Black men are at a higher rate of developing this deadly infection due to risky behavior and habits, lack of awareness, poor education, bad socioeconomic conditions and poor access to healthcare facilities. Although Black communities occupy 13 % of the population of the US, about 50% of the HIV/AIDS cases in the country are in Black men (Office on Women’s Health – HHS, 2009).
The African-American populations are younger than the White populations that are present in the US. It is also a known fact that cancers occur in the later stages of life. However, it is found that cancer occurs more frequently and claim larger mortality in the African-American populations compared to the White population in the US. In all cancers, the Black men up to the age of 75 years have higher rates as compared to the White population. At all age groups, esophageal cancers occur at a higher rate in African-American men than their White male counterparts. The incidence of gastric cancers is higher in elder Black men compared to the elder White men. The incidence of several other cancers including prostate, colorectal, etc, are higher in the Black male population, mainly due to the presence of higher risk factors and exposure. However, attitudes, practices and knowledge that can help to fight the cancer are very poor in the Black senior men.
The incidence and complication of various other critical diseases such as heart disease, CVA, pneumonia, diabetes mellitus, renal diseases, etc, are more often higher in the Black senior male population compared to the White men or even the Black women. Black women have a longer lifespan compared to the Black men. This is a definite cause of concern which needs to be addressed through appropriate measures implemented in the healthcare system of the US (APA, 1993). There may be some hope for the African-American men as several community leaders and individuals felt a greater need organize resources and knowledge to help overcome several serious health conditions such as prostate cancer. The main idea behind such program would be to ensure changes in the beliefs, attitudes and knowledge of the community members (McFall, 2006).
Abbott, R. R. Et al (1998). A comparison of prostate knowledge of African-American and Caucasian men: changes from prescreening baseline to postintervention. Cancer J Sci Am. 4(3):175-7. http://www.ncbi.nlm.nih.gov/pubmed/9612599?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
APA (1993). Ethnic minority elderly: a task force report of the American Psychiatric, Washington: APA. http://books.google.co.in/books?id=lXw4xZARaXAC&pg=PA38&lpg=PA38&dq=aging+black+population+specific+issues&source=bl&ots=dHVeq954zh&sig=Eim4HP6sXgbI3z9HmLJ7oUZHB8s&hl=en&ei=lwA3StncCpSHkQWmi5yhDQ&sa=X&oi=book_result&ct=result&resnum=4#PPP1,M1
Ayotte, B. J. Et al (2009). Racial differences in hypertension knowledge: effects of differential item functioning. Ethn Dis, Winter; 19(1):23-7. http://www.ncbi.nlm.nih.gov/pubmed/19341159?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Gordon, S. Et al (2008). Health and Health Care Of African American Elders, Ethnogeriatric Curriculum Module – University of Stanford, Retrieved on June 12, 2009, from Web site: http://www.stanford.edu/group/ethnoger/african.html
McFall, S. L. Et al (2006). Exploring beliefs about prostate cancer and early detection in men and women of three ethnic groups. Patient Educ Couns, Apr;61(1):109-16. Epub 2005 Oct 26. http://www.ncbi.nlm.nih.gov/pubmed/16256292
Winterich, J. A. Et al (2008). Masculinity and the Body: How African-American and White Men Experience Cancer Screening Exams Involving the Rectum, Am J Mens Health, PMC2662681, http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19477742
Women’s Health – HHS (2009). Minority Men, Retrieved on June 12, 2009, from Web site: http://www.womenshealth.gov/mens/resources/minority.cfm