Gerodiversity is the multicultural approach to issues of aging. This approach provides a theoretical foundation for the medical and psychological treatment of older adults within an ecological context that includes their cultural identity and heritage, social environment, community, family system, and significant relationships. Gerodiversity encompasses a social justice framework, which considers the social and historical dynamics of privilege and inequality. In addition to issues of aging, gerodiversity includes race, ethnicity, language, gender identity, socioeconomic status, physical ability or disability, sexual orientation, level of education, country of origin, location of residence, and religion or spirituality.
Gerodiversity builds on the field of clinical geropsychology, which applies psychological and developmental methods to understanding the behavioral, emotional, cognitive, and biological aspects of aging in the context of providing clinical care to older adults. The goal is to develop culturally competent, scientific methods for the psychological and medical treatment of the aging population. According to this perspective, in order to ethically and scientifically provide optimal care to older adults, clinicians must be aware of the cultural factors in health care utilization, including use of physical and mental health care. Moreover, from this perspective, clinicians must continually work to improve their multicultural knowledge base, skill set, and attitudes towards cultural diversity.
Demographics and characteristics to consider in geriatric populations
Increased awareness and attention to gerodiversity parallels the aging demography of the United States. Older adults comprise 14.5% of the U.S. population, with those aged 65 and older numbering 46.2 million. Dubbed "the Silver Tsunami", this segment of the population is rapidly growing, and the Administration on Aging expects it to double to 98 million older persons by 2060. Aging confers a unique risk of marginalization due to the intersection of advanced age and other disadvantaged factors. The domains of diversity discussed herein may intersect with age in such a way to confer a "double jeopardy". More recently, attention has been paid to those who face a "triple threat of marginalization" (e.g., older lesbian women). As with other conceptualizations of diversity and marginalization, advanced age and other sociodemographic variables intersect and result in unique experiences for each group and individual. Below are a few highlighted areas for consideration.
Sex and gender Older adults are more likely to be female. Women live longer than men, and so populations of older adults are, with each successive age bracket, increasingly dominated by women. Over half (58%) of Americans over age 65 are women, a number which rises to 69% over age 85, and finally to 80% over age 100.
Older men and women also have different medical and psychological health needs, as well as different profiles of risk and protective factors for acquiring physical and mental disorders. Many biological and psychosocial variables are responsible for these differences. Sex-specific hormonal and physiological differences contribute to different risks for cancer, cardiovascular disease, arthritis, osteoporosis, diabetes, depression, and dementia. Environmental and lifestyle factors, such as sleeping, eating, and exercise habits, social network, socioeconomic resources and stressors, and intellectual engagement in work and leisure activities, also significantly contribute to physical and mental health, and are differentiated between older men and older women. Older women are more likely to have a robust social network—a factor associated with better physical and mental health. Older women from other countries tend to acculturate differently than elderly men. Older women are also twice as likely to live in poverty as older men.
Cultural groups assign different roles and values to individuals based on their gender. Women in some cultural groups are less likely to have been employed, and have lower economic resources as a result. Women are also more likely to bear most of the caregiving responsibilities for ailing family members and young children.
Race and ethnicity Ethnogeriatrics is defined by the American Geriatrics Society as the "influence of ethnicity and culture on the health the well-being of older adults". In 2015, non-Hispanic White Americans made up an estimated 61.72% of the US population, but that percentage is anticipated to drop to 43.65% by 2060. This demographic shift will be due in part to increases in Asian and Pacific Islander and Latino/Hispanic immigrants. However, Latino and Hispanic older adults as a group are expected to increase the most dramatically, by 155%.
Older adults of different ethnicities belong to different cultural groups, and may therefore have significantly different levels of access to care, different beliefs about health and aging, different expectations from care providers, and different ways of communicating their needs. In addition, ethnic minorities are vulnerable to multiple forms of minority stress: racial prejudice, discrimination, and stereotyping may contribute to lower socioeconomic status, diminished access to care, and systematic disempowerment for many minority groups in the United States. These factors have a major impact on vulnerability to poorer health, risk of mental disorders, and poorer overall prognosis.
Individuals may also belong to multiple racial and ethnic groups: older adults may be biracial or multiracial, belong to indigenous or nonindigenous populations, or be immigrants or the children of immigrants. Different ethnic groups have different genetic and cultural vulnerabilities to medical and psychological problems, which require culturally knowledgeable care.
Sexual and gender minorities Sexual and gender minorities (lesbian, gay, bisexual, pansexual, transgender, and nongendered individuals) make up an increasing portion of aging populations, and prevalence rates of these groups are expected to rise dramatically. It is estimated that 1.5 million Americans over age 65 identify as lesbian, gay, or bisexual. Because LGBT older adults are less likely to have children and more likely to be single than heterosexual older adults, reduced family support and long-term care is available to them. LGBT older adults also have lower rates of health insurance coverage, and fear discrimination by doctors and mental health care facilities. Among LGBT older adults, 8.3% have reported abuse by a caretaker due to sexual orientation or gender identity. Professional caregivers are also often untrained in the special needs of LGBT populations, and LGBT elders may be overlooked or ignored by many programs oriented towards older populations. The American Psychological Association offers a poignant article about the "double-whammy discrimination" from healthcare provider biases that affect the quality of care of older LGBT patients.
Research has shown that LGBT elders tend to be unwelcome in senior centers and volunteer programs for older adults, and tend to be overlooked in public outreach programs geared towards the elderly. They also may be denied independent housing, as well as entrance to residential nursing home and retirement communities based on sexual orientation or gender identity. They may be isolated from social resources they may otherwise have had from their extended families due to discrimination. In addition, LGBT elders may still be denied visitation rights and end-of-life decision making for their partners and loved ones by hospitals, despite the marriage equality ruling of 2015.
Religious and/or spiritual identity Older adults tend to be more deeply involved in religious activities than younger adults. Bengston, Putney, Silverstein, and Harris studied aging patterns and generation trends regarding religiosity (namely, Christianity and Judaism) in the United States. Ultimately, the results indicated an overall aging effect with an upward drift in religious intensity and strength of beliefs. Additionally, there was a generational effect indicating different conceptualizations of a monotheistic God based on one's generational cohort and a greater separation between religiosity and spirituality in later-born cohorts.
In a longitudinal study, Wink and Dillon found that adults increased significantly in spirituality between late middle (mid-50s to early 60s) and older adulthood (late 60s to mid-70s); this finding was irrespective of gender and generational cohort. They defined spirituality as "the self's existential search for ultimate meaning through an individualized understanding of the sacred".
Glicksman suggests that one be cautious when interpreting the results of research on spirituality, suggesting that measurement scales are often biased by the Protestant traditions that have shaped the American majority culture. Thus, while it is important to consider how age may impact religiosity and spirituality, it is also important to maintain a sensitive and multicultural approach to understanding an individual's unique relationship with his/her religion and how it may be impacted by other cultural variables, such as country of origin, race, and ethnicity.
Based on the research cited above, it is clear that religion and spirituality are relevant issues for older adults but that these terms may be conceptualized differently and also hold different levels of importance to different individuals. Professionals must be aware of this level of diversity when working with a geriatric population.
Ability and disability status Older adults who are aging with disabilities are yet another diverse group of individuals, with estimates of approximately 12 to 15 million older adults aging with early-onset disabilities. As medical and social advances increase and improve lifespan and quality of life for those with disabilities, this number will continue to grow. These individuals may experience unique stigma related to the aging process. A seminal and widely adopted definition of "successful aging" included growing older without disability as a hallmark of such success. However, Romo and colleagues conducted a focus group of ethnically diverse older adults with disabilities and found that despite disability, the majority felt they were aging successfully. Such individuals often employed diverse coping strategies to compensate for any changes in physical functioning. As with other groups of older adults, healthcare goals for those with disabilities emphasize reducing risk for chronic disease and preventing further disability and morbidity. However, such a narrow sense of "success" that precludes disability may limit inclusion and diversity. Like other aspects of gerodiversity and experience of marginalization, understanding an individual's sense of successful aging within the context of disability is subjective and likely varies between individuals. Conceptualization of gerodiversity should strive toward inclusion and thus include both disability/ability status as well as subjective experiences of "successful aging", including adaptation and coping with any physical limitations.
Socioeconomic status