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A Lifetime Of Inequity: How The Elderly Carry The Burden Of Social Biases

A woman in a red blazer and long dark hair smiles into the camera
Dr. Lena Makaroun

A University of Pittsburgh geriatric medical expert is giving a virtual talk for Berkshire Community College today. She says the elderly face outsized inequities in the American healthcare system.

Dr. Lena Makaroun says the universal social determinants that impact health like housing, food access, transportation, and economic status accumulate over time – leaving the elderly to carry often disproportionate burdens.

“Black older adults, Hispanic older adults, Native American older adults have experienced those types of biases, exposure to structural racism throughout their entire lifetime," she told WAMC. "And that kind of culminates in a lot of the accumulation of chronic medical conditions that we see for older adults, such as high blood pressure, diabetes, dementia, which is, you know, becoming a bigger and bigger problem as more and more adults in the United States are aging, and, you know, leads to also, in many ways, a decreased ability to cope with or have resiliency to the effects of those health problems.”

Rather than just supporting the current healthcare system, Makaroun says the elderly would be better served with a holistic approach to structuring care.

“Infusing resources into ensuring sustainable intergenerational housing for older adults, for example, across the socio-economic spectrum," she said. "Ensuring adequate food access, so reducing food insecurity. Infusing resources into caregiving and better supporting our caregiving workforce. Thinking about how we can better support long term care options for those who need that. I think these are all incredibly underfunded programs and services that actually drastically impacts the health and wellbeing of older adults, and in many ways, much more so than traditional Medicare, medical care within the health care system.”

She says the horrific toll of the COVID-19 pandemic on the elderly, especially in nursing homes, isn’t just a biological susceptibility to infection, but a reflection of social biases and discrimination.

“When we think about also who are long term residents in nursing facilities, that's where we see the intersection of a lot of these other things we were discussing," said Makaroun. "So people who are not able to have the support to live in their own home or live in their own community with, you know, maybe they don't have resources to pay for a caregiver to take care of them at home, maybe they don't have a robust family network of someone who can have the luxury to stay home from work and care for their parents.”

Even efforts to combat the pandemic manage to further entrench these divides. Makaroun says the vaccination rollout perpetuates societal inequity, particularly with efforts around the elderly.

“Not only do you need access to a smartphone or a computer, but you need access to internet, and you need the savvy and know how to know how to do that," she said. "And if you don't have it yourself, you need a family member who has the luxury of time and access to be able to do that for you. And I think that contributes a lot to what we're seeing, which is that a far lower percentage of Black Americans, for example, have been vaccinated compared to white, you know, older Americans, as we've been rolling out the vaccine to adults 65 and above in many states.”

While she’s heartened by the Biden administration’s early efforts to shore up resources for elder care, Makaroun says there’s a long way to go.

“There's a lot of ageism in this country, unfortunately, and a lot of ableism," said the doctor. "And generally speaking, residents of long term care facilities don't get a lot of attention, they don't get a lot of clout, they don't, aren't seen as highly valuable. And I think that that's a tragedy. And this pandemic, if anything, to me has highlighted that disparity, that we don't react with the same degree of urgency when it is this population being impacted by something as we would, for example, if it had been, you know, children or young adults that were getting sick and dying, when the pandemic first started.”

Dr. Lena Makaroun’s talk, titled “Healthcare Does Not Equal Health: Drivers of Health Inequities for Older Adults,” is part of the "Changing Aging: Healthcare" series presented by the Osher Lifelong Learning Institute at Berkshire Community College. It begins at 3:30 this afternoon.

Josh Landes has been WAMC's Berkshire Bureau Chief since February 2018, following stints at WBGO Newark and WFMU East Orange. A passionate advocate for Western Massachusetts, Landes was raised in Pittsfield and attended Hampshire College in Amherst, receiving his bachelor's in Ethnomusicology and Radio Production. His free time is spent with his cat Harry, experimental electronic music, and exploring the woods.
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