Taking into Account the Mosaic That is America’s Older Population

According to the U.S. Census Bureau America is home to 57.8 million older adults and growing. By 2030, the number of people 65 and older will outnumber people 18 and under and this will be a diverse group of Americans. 

• Approximately one-quarter of older adults are from racial or ethnic communities;  84% are White but that percentage is projected to drop from 84% to 60% by 2050.  

• Older adults have a higher prevalence of disability (44%), with the disability rates highest among American Indian/Alaskan Native elders (55%).  

• The number of older disabled adults with long-term services and supports (LTSS) needs is expected to rise from 6.3 million to15 million in 2050.  

• The number of LGBTQ+ adults over 50 is expected to exceed five million by 2060.  

• Diversity exists among language, too, as 16% of older adults speak a language other than English.  

A Diverse Population Brings Diverse Needs 

• While older Black adults compose only 9% of the older population, they accounted for 37% of Covid-19 hospitalizations and died of COVID at more than twice the rate of older White adults.  

• Older adults with disabilities receive less preventive care, and Black and Latino/a older adults with intellectual/developmental disabilities are more likely to report fair or poor physical and mental health.  

• The intersection of age, cognitive status, and sexual identity leads to compounded marginalization for LGBTQ+ older adults with dementia that makes it hard to access social and medical supports without discrimination.  

• The number of older adults living at or near the poverty level is increasing, with the highest rates among older Latina women living alone. 

Our research showed us that national initiatives exist to address the root causes of health inequities for diverse older adults and center their voices, including the Age-Friendly Health Systems Initiative's Recipe for Equity tool and the Advancing Health Equity in Aging initiative. A handful of states have identified equity as an area of focus in the state’s Multisector Plans on Aging (MPA).

Based on these combined efforts, we believe that actions to improve health equity for all intersections of older adults include:  

• Close existing care gaps: Adopt strategies and interventions that strengthen care in populations experiencing health disparities. A Vermont MPA strategy is to “reduce the prevalence of chronic diseases” with “additional interventions...to address disparities (geographic, racial/ethnic, age, socioeconomic).” 

• Increase language access: Older adults with Limited English Proficiency and communication-related disabilities face additional hurdles. A Massachusetts MPA strategy is to “make information accessible and culturally competent to all consumers.” 

• Protect patients’ housing rights: Ensure that public housing and long-term care facilities have nondiscrimination policies that protect LGBTQ+ older adults (e.g. allowing unmarried partners visiting rights) 

• Safeguard sensitive data: Update mechanisms for collecting data like sexual orientation and gender identity data to better monitor and understand disparities in health delivery and outcomes. A California MPA initiative is to “assess community living and LTSS needs of LGBTQ+ older adults specific to race, ethnicity, disability, and geographic location.”  

• Adhere to legal protections: Enact laws and/or Equal Rights Amendments that include protections for diverse older adults. A Pennsylvania MPA strategy is to “author a Long-Term Care Patient Bill of Rights that will protect the rights and dignity of older adults in the long-term care system, especially historically marginalized people.”    

• Focus on inclusivity: Ensure that State and Area Plans on Aging are LGBTQ+ and disability inclusive 

• Understand dementia: Adopt strategies that support care systems for people with dementia. We have conducted extensive research into this topic, which can be found here  

By understanding the demographics of America’s diverse aging population, healthcare providers, government and other stakeholders will be in better position to effectively address the healthcare needs of older adults across the United States.