Background: It is a well-established fact that minority patients often have poorer health outcomes than non-minorities. Various demographic, biological, and psychosocial factors have been linked to these outcomes, but research about these factors’ effects is conflicting, and little research exists that examines the combined effects of multiple factors.

Purpose: To explore whether and to what extent recovery differs between minority and non-minority elders receiving home health care.

Study Design: This study had two distinct stages.

In the first stage of the study, investigators analyzed administrative and clinical data on 6,391 VNSNY patients who were admitted to care in 1999 to explore how and to what extent minority and non-minority seniors differed in their recovery. Taking advantage of the data available in the VNSNY patient database, this stage of the study explored similarities and differences across four self-identified racial and ethnic groups: whites, blacks, Hispanics, and Asians. These patients were 75 years of age or older. A variety of factors were examined including social support, home health care use, and discharge status.

The second stage of the study consisted of in-home interviews with home care recipients to explore the additional role on the outcomes of black and white elders of psychosocial factors not readily available in administrative databases. Specifically, interviews measured three factors that literature reviews had identified as relating to the recovery of seniors: social identity (the degree to which individuals relate to the culture, customs, and members of the ethnic or racial group with which they primarily identify); social capital (the benefits that people get from the trust, reciprocity, information, and cooperation associated with social networks); and self-efficacy (the extent to which individuals feel they have control over their own lives).

A survey instrument using validated measures was developed, piloted, and administered to 115 VNSNY patients aged 65 and over who self-identified as black or white.

Preliminary Findings: Preliminary results from the first stage of the study indicate that there were no significant differences between whites and blacks in physical functioning outcomes. However, blacks were more likely to leave home care with no additional formal and informal care support compared to whites. Whites were more likely than blacks to have poorer psychological health.

Analysis among four racial and ethnic groups found similar levels of skilled home health care use across all four groups. Upon leaving home care, black elders had the least amount of supportive assistance compared to all other groups. Fewer Hispanics and Asians had improved physical functioning compared to blacks and whites. More whites reported anxiety and depression than the three other groups.

Primary results from the second stage of the study found few differences in how psychosocial measures affected the outcomes of black and white elders. Higher levels of social identity were related to better outcomes for blacks, while it was unrelated to outcomes for whites. No differences were found between white and black elders in terms of social capital or self-efficacy.

Publications: Peng, T.R., Navaie-Waliser, M., & Feldman, P.H. 2002
Social support, service use, and health outcomes among elders in home health care: Similarities and disparities by race/ethnicity. The Gerontologist 43(4).

Sponsor: The Jacob and Valeria Langeloth Foundation