背景:对家庭和社区服务(HCBS)的未满足需求可能会对种族和族裔少数群体的老年人产生不同的影响。我们研究了使用公共资助的HCBS在≥65岁的消费者中未满足的HCBS需求中的种族和种族差异。
方法:我们分析了来自23个参与州的21,739名年龄≥65岁的社区HCBS消费者的国家核心指标-老龄化和残疾调查数据(2015-2019年)。成果衡量标准包括六种服务类型中自我报告的未满足需求(即,个人护理,家庭主妇/家务活,送餐,成人日服务,交通运输,和护理人员支持)。种族和族裔群体包括非西班牙裔黑人,亚洲人,非西班牙裔白人,西班牙裔,和多种族群体。Logistic回归模型检查了种族和民族与未满足的需求之间的关联,适应社会人口统计学,健康,和HCBS程序(即,医疗补助,美国老年人法案[OAA],老年人普惠性护理计划[PACE])特征,和使用特定的服务类型。
结果:在21,739名受访者中,23.3%是黑人,3.4%是亚洲人,10.8%是西班牙裔,58.8%是非西班牙裔白人,3.7%为多种族或与其他种族/族裔认同。亚洲和黑人消费者报告个人护理需求未满足的几率高于白人消费者(调整后的优势比[aOR],1.45,p值<0.01;和aOR,1.25,p<0.001)。与白人消费者相比,亚洲和黑人消费者在成人日间服务中未满足需求的几率明显更高(AOR,1.94,p<0.001和aOR,1.39,p<0.001)。与非西班牙裔白人消费者相比,黑人消费者在送餐和照顾者支持服务方面的未满足需求的几率更高(AOR,1.29;p<0.01;和aOR分别为1.26,p<0.05)。种族和种族与未满足的家庭主妇/家务或运输服务需求没有显着相关。
结论:未来的研究应确定未满足需求差异的驱动力,以开发适合文化的解决方案。
BACKGROUND: Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS.
METHODS: We analyzed the National Core Indicators-Aging and Disability survey data (2015-2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types.
RESULTS: Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services.
CONCLUSIONS: Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.