“All I Want to Ask Is: Do They Really Care About Us?”: Research and Reflections on Behavioral Health in Black Older Adults

Dear Clinical Gerontologists

In 2020, the United States had a glaringly bright light cast on two systemic issues that have disproportionately impacted the Black population: COVID-19 and racism (Milam et al., 2020; Taylor, 2021; Yancy, 2020). News reports, newspaper articles, and statements from the larger field (see the American Psychological Association’s statement addressing their history of racism: https://www.apa.org/about/policy/racism-apology; American Psychological Association, 2021) all focus on “calling out” the longstanding systemic injustices that have been prevalent in American society targeted at Black people. In the genesis of this special issue, editors of the Clinical Gerontologist discovered that the larger issues being called out in America surrounding the exclusion and mistreatment of Black people were also occurring in our field. Specifically, in a brief metanalysis of papers published in the Clinical Gerontologist over time, it was found that only 2% of the papers highlighted factors affecting older Black populations. It has become apparent that even our field is not excluded from the racial reckoning surrounding the treatment of the Black population. For this special issue, authors were invited to submit manuscripts targeting behavioral health outcomes and protective factors in older Black populations. In addressing these factors, this special issue investigates both older Black adults and the spaces where they are cared for.

To start this issue, authors explore differential influences on older Black behavioral health, highlighting the notion that “Black” is not monolithic. In a descriptive study of a grossly understudied group, Nkimbeng et al. (2021) found that among 148 older African immigrants living in the Baltimore-Washington metro area, 8.1% displayed symptoms clinically significant for depression. The most predominant display of depression in this sample was sleep difficulties, which is an association that has been previously supported within older Black populations (Bazargan, 1996). A secondary data analysis investigating the amalgamation of stress, depressive symptoms, physical problems, and psychological resilience among Black and Latinx older adults found that while Black and Latinx older adults experience more depressive symptoms than their non-Hispanic White (NHW) counterparts, experiencing a higher incidence of stressful life events did not show as great of an increase of their depressive symptoms as it did within older NHW populations (Arpawong et al., 2022). Moreover, older Black adults were found to have poorer physical health than NHWs, but in terms of psychological resilience (i.e., a person’s ability to retain or regain well-being following a stressful life event; Aldwin & Igarashi, 2012; Rutter, 2006), higher rates of stressful life events affected older Black adults’ psychological resilience less than NHWs. The final article speaking to older Black adult behavioral health tackles a topic of critical importance within older adult populations: falls. One of the most common causes of both fatal and nonfatal hospitalizations among older adults is falls (Burns et al., 2016). With fear of falling being a risk factor for future falls, Washington et al. (2020) found that Black older adults and older adults with lower mobility and a higher risk of falls based on prior fall history were more likely to develop a fear of falling, creating a particularly detrimental feedback cycle.

In expanding from the investigation of behavioral health as a whole, one of the most influential factors affecting the behavioral health of older adults is cognition. There is evidence to suggest that older Black adults are more likely to be diagnosed with dementia than other racial/ethnic groups (Carlson et al., 1998; Inouye et al., 1993; Manly et al., 1998; Marcopulos et al., 1997; Ripich et al., 1997; Unverzagt et al., 1996). In a sample of Black adults pre-morbid for cognitive impairment via Alzheimer’s Disease (AD), having past personal experiences with AD lead to a higher likelihood of attributing research memory impairment prompts to AD than other potential etiologies, such as “normal aging” (Mills et al., 2020). Additionally, pre-morbid Black adults in the sample were found to be less concerned about the development of AD and less likely to engage in help-seeking behaviors for AD. In investigating cognitive impairment among a more specific older adult population (i.e., older adults with schizophrenia), Black older adults living with schizophrenia were found to be more cognitively impaired than their non-Black counterparts, but that impairment was mediated by level of educational attainment (Dobbins et al., 2021). This is consistent with prior literature noting the effects of educational attainment on cognitive impairment widely (Schaie, 1996). Finally, in acknowledging that dementia affects not only the individual with cognitive impairment but also the family, it is important that we explore experiences that connect older Black adults with cognitive impairment to places and activities that hold meaning. Using a multiple-case study design, Gore et al. (2021) found religious worship services to be a place where older Black adults living with dementia were engaged and even displayed moments of clarity, which supports literature noting the importance of religion in the Black population and its use as a coping mechanism (Harrison et al., 2005; Kalish & Reynolds, 1981; Taylor & Chatters, 2010).

Finally, as a culture that is bolstered by community, kinship, and social support (Billingsley, 1992; Stack, 1974; Sudarkasa, 1997), necessary in addressing older Black behavioral health is investigating the care being provided to and received by older Black adults. Within Black culture, there is a strong cultural preference for familial caregivers (Nkimbeng & Parker, 2021). Within the experiences of Black caregivers of older adults, caregivers who hired paid help (an act that might be perceived as culturally incongruent) were more likely to report physical and emotional difficulties within their caregiving experiences (Fabius & Parker, 2022). For familial caregivers of older Black adults with dementia, a novel psychoeducational intervention (“Caregivers Passage Through Dementia” through the Universal Dementia Caregivers’ Bootcamp) improved caregivers’ knowledge, confidence, and quality of life relative to adaptive attitudes toward themselves and their care recipients (Duren et al., 2022). A final study exploring the care provided to older Black adults in nursing home settings highlights the importance of promoting self-dominion and autonomous decision-making among Black adults, particularly in the context of Black adults within this population being younger and more functionally impaired (Hicks et al., 2021).

We close this editorial with two concurrent truths. Foremost, we are excited to promote the novel and groundbreaking work of the beforementioned scholars. At the same time, we would be remiss in not acknowledging that compared to prior special issues, there were fewer manuscripts submitted for consideration for this issue. As a field and a society seeking to bring about more racial equity, the question becomes whether there is adequate research being done in older Black populations and if not, why that is. A longer and more in-depth editorial in this issue speaks about some of the considerations and issues in research centered on Black older adults. It is worth a read. And while you read, we implore you to think about your overarching values as clinical gerontologists. If we are only researching, treating, helping, finding, working with “some” of the population of older adults, are we really invested in the health and wellbeing of “all”?