|Disparities in Clinical Trials|
Ideally, all Americans should have equal access to physicians, hospitals, and medical tests in their communities. The fact is that large disparities exist in access to U.S. health care services based on race, ethnicity, socioeconomic status, and education. The elderly, minorities, and low-income individuals are most likely to experience various obstacles to receiving quality health care services.
Given the changing demographics of American society and the link between high quality health care and quality of life, health care disparities are likely to soon become a pressing problem in communities across the country.
Consider these facts:
- One-fourth of older adults have no supplemental insurance coverage for their health care needs, while 16 percent of Americans under age 65 have no health insurance coverage.
- Preventive health screening rates are particularly low for minorities, low-income individuals, and older adults.
- Health care facilities are often not accessible or do not have the necessary equipment to serve people with disabilities.
Americans now live longer than ever before. Medical advances have boosted the life expectancy from less than 50 years to more than 76 years and have greatly improved the overall health of Americans in the past century. Since people are living longer, however, the number of individuals who experience higher rates of illness and disability is expected to increase dramatically.
By 2030, there will be roughly 70 million Americans age 65 years or older, which is more than double the number of age 65+ Americans in 2000, according to the Federal Interagency Forum on Age-Related Statistics. In 25 years, the number of people age 85 or older is expected to double, while the number of people age 100 or older is expected to triple.
Older adults experience the effects of health care disparities more dramatically than any other population group. They are particularly at risk because they are more likely than younger people to have chronic illnesses, make frequent visits to medical facilities, and live in poverty.
While a disparity certainly exists between older adults and those under age 65 in access to medical professionals and services, there is also an age disparity in medical research practices. Older adults are markedly underrepresented in clinical trials.
Historically, clinical trials have focused on relatively young participants. As a result, treatment decisions for older adults are based on the knowledge gleaned from the younger population. As one example, the Journal of the American Medical Association noted that older adults make up 63 percent of cancer patients, but only 25 percent of participants in clinical trials.
A lack of transportation to the research site is one reason to explain this disparity. In addition, older adults are often excluded from research studies since they are more likely to have chronic conditions and take numerous prescription drugs; therefore, they don’t meet strict research protocols. Insurance is also a contributing factor since Medicare and many insurance companies will not pay for experimental treatments.
Most diseases affecting older adults have been studied primarily in white male populations. Research on the health conditions of women, minorities, and other sectors of the older adult population is limited because these groups have traditionally been excluded from major research studies.
Despite the fact that the imbalance in study participants has been recognized for years, the disproportionate lack of older people participating in clinical trials still exists. Yet, finally this trend appears to be shifting as both the research community and policy groups have begun to emphasize the inclusion of older adults in clinical trials.
Improving access to health care services for older adults has been an important public policy objective for decades. Many policy initiatives, such as Healthy People 2010 and Medicare reform, call for eliminating disparities in health care to foster better qualify of life for current and future older Americans.
Community governments, social service agencies, health care facilities, and other entities will need to prepare for the increasing older adult population to ensure that older adults’ health needs are addressed and that quality medical services are readily available. The social work profession is dedicated to addressing the health care disparities issue and is promoting equal health care access, especially for vulnerable populations that need health care services the most.
Source: Older Adults and Health Disparities: The Impact on Access to Care by Lisa Yagoda, LICSW, ACSW, published in the NASW Specialty Practice Sections Annual Bulletin InterSections in Practice, Volume 4, Fall 2005.