Background: The U.S. population continues to age, and the identification of disparities in geriatric care -so that they may be understood and solutions addressed - is ever more critical. A systematic review is presented on current disparities found in access to care for geriatric diseases as well as in the delivery of care within the United States. Methods: A comprehensive search for the available literature from 2010 to 2024 was carried out through the PubMed, CINAHL, and Scopus databases in peer-reviewed journals. Studies that focused on disparities in access and provision of geriatric care for adults aged 65 years and above within the U.S. health system were included in this study. The Joanna Briggs Institute critical appraisal tools were used in the quality appraisal of studies included. Results: Of the total number of 5,218 studies that were identified initially, 132 studies were eligible for inclusion. Our analysis uncovered continued inequity in geriatric care across racial, ethnic, socioeconomic, and geographic lines. Findings include: (1) low rates of early diagnosis and delayed treatment of dementia and Alzheimer's among minority seniors, who were found to be 2.3 times more likely for African Americans and 1.9 times more likely for Hispanics than their white counterparts; (2) inability to access high-level geriatric care in regions outside of metropolitan areas, where it was identified that older adults had to commute, on average, 3.2 times farther to the nearest provider; (3) socioeconomic factors found to present obstacles to home health and long-term care, with seniors from a lower income bracket 1.8 times more likely to be placed in a poor-quality nursing home; and (4) disparities in the quality of end-of-life care for elders of lower socioeconomic status, with African Americans and Hispanics being respectively 38% and 51% less likely to use hospice care. Conclusion: This review has demonstrated that important and persistent disparities exist in the availability and delivery of geriatric care in the United States. Of the 132 studies, 34 directed their efforts toward reducing interventions to have such disparities with salutary results coming from culturally tailored community-based approaches. Multipronged interventions that include policy revision, workforce development, and community-based initiatives hold promise for reducing these disparities. This should be an area of focus for future targeted interventions, which should, therefore, be evaluated for effectiveness in reducing disparities in health outcomes for all older adults. Keywords: health disparities, geriatric care, access to care, care delivery, systematic review

中文翻译：

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对美国老年疾病护理获取和提供方面的健康差异的系统审查


背景：美国人口持续老龄化，识别老年护理方面的差异——以便理解这些差异并找到解决方案——变得越来越重要。对美国境内目前在获得老年疾病护理以及提供护理方面发现的差异进行了系统回顾。方法：通过 PubMed、CINAHL 和 Scopus 数据库对同行评审期刊中 2010 年至 2024 年的可用文献进行全面检索。本研究纳入了针对美国卫生系统内 65 岁及以上成年人在获得和提供老年护理方面的差异的研究。乔安娜·布里格斯研究所的关键评估工具被用于对所纳入研究的质量评估。结果：在最初确定的 5,218 项研究中，有 132 项研究符合纳入条件。我们的分析发现，不同种族、民族、社会经济和地理区域的老年护理仍然存在不平等。研究结果包括：(1)少数族裔老年人患痴呆症和阿尔茨海默病的早期诊断率和延迟治疗率较低，非裔美国人患痴呆症和阿尔茨海默症的可能性是白人的 2.3 倍，西班牙裔老年人的痴呆症和阿尔茨海默症的可能性是白人的 1.9 倍； (2) 在大都市区以外的地区无法获得高水平的老年护理服务，在这些地区，老年人到最近的医疗服务机构平均要花 3.2 倍的路程； (3) 社会经济因素被发现对低收入阶层的老年人的家庭健康和长期护理构成障碍 1。被安置在质量较差的疗养院的可能性高出8倍； (4) 社会经济地位较低的老年人的临终关怀质量存在差异，非洲裔美国人和西班牙裔美国人使用临终关怀的可能性分别低 38% 和 51%。结论：本次审查表明，美国在老年护理的提供和提供方面存在重要且持续的差异。在这 132 项研究中，有 34 项研究的目标是减少干预措施，以通过基于社区的文化定制方法取得有益的结果。包括政策修订、劳动力发展和基于社区的举措等多管齐下的干预措施有望减少这些差距。这应该成为未来有针对性的干预措施的重点领域，因此应该评估这些干预措施在减少所有老年人健康结果差异方面的有效性。 关键词：健康差异、老年护理、获得护理、护理服务、系统评价