The Impact of Family Function on Healt of African American Elderly

INTRODUCTION The family is the most important social context within which health is maintained, illness occurs and health-related decisions are made. As for all elderly populations, the family is the principal source of social support and has a major role in the care of African American elderly (The Gerontological Society of America, 1994; Taylor et al., 1990; McGadney, 1995). Thus, the family has a fundamental role in the health of African American elderly, a large population that is rapidly growing and experiences poor health. In 1990, there were 2.5 million African Americans aged 65 years and older, a 19 percent increase since 1980. It is projected that by the year 2050, the African American elderly population will nearly quadruple to 9.6 million. In 1990, African Americans represented 8 percent of the total U.S. population aged 65 and over; by the year 2050, this proportion is expected to rise to 14 percent (U.S. Bureau of Census,1992). This population experiences higher rates of chronic health conditions such as hypertension, asthma and diabetes, and higher mortality rates from all causes (until age 85), and is more likely to report fair or poor overall health than White elderly (Van Nostrand et al., 1993). African American elderly also report higher rates of functional limitation compared to elderly Whites (U.S. Bureau of Census, 1992). To explore the relationship of family function to health of African American elderly, our article will first describe sociodemographic characteristics of African American elderly, care of African American elderly, and an overview of selected characteristics of African American families. Secondly, the article will describe a social systems perspective of the African American family and will propose a model of how families function in relationship to health. Thirdly, the article will present applications of this model to families of African American elderly. Finally, the article will discuss directions for future research. WHY IS FAMILY FUNCTION RELEVANT TO HEALTH OF AFRICAN AMERICAN ELDERLY? Sociodemographic Characteristics of African American Elderly The social status and resources available to African American elderly reflect social and economic conditions of earlier life, including the combined effects of institutional racism and discrimination. Therefore, African American elderly have less personal income and experience more poverty, inadequate education, substandard housing, and poor nutrition and health, than do White elderly (American Association of Retired Persons, 1987). In 1990, over 33 percent of African American elderly were below the poverty line compared to 10 percent of White elderly (U.S. Bureau of Census, 1992). Lifetime experiences for employment and earnings for elderly Whites are different from those of African American elderly; consequently, African American elderly have fewer resources for retirement and lower incomes than Whites (U.S. Bureau of Census, 1992). African Americans elderly have lower levels of education. While 55 percent of all elderly have a high school education, only one-quarter of African Americans have a high school education. Further, 57 percent of African American elderly have less than an eighth-grade education (U.S. Bureau of Census, 1992). Related to low socioeconomic status, many African Americans elderly live in communities with negative environmental factors, such as high levels of unemployment, crime, violence, drug and alcohol abuse, and AIDS (Hill, 1993). Throughout the life cycle, exposure to adverse socioeconomic and environmental risks as well as exposure to inadequate health care has produced negative accumulative effects on the health status of African American elderly (Wykle and Kaskel, 1994). In common with other elderly populations, African American elderly experience barriers to quality health care related to communication, inadequate physical access to care, lack of knowledge about available resources, and inability to negotiate with the bureaucracy of the health care system (Crawford, 1971). …