Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown
Published: March 19, 2025
Health disparities have been defined by the Institute of Medicine (IOM) as "differences in quality healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness intervention" [1]. The World Organization (WHO) describe health inequities status, distribution resources between different population groups, arising from social conditions which people born, grow, live, work, age" [2]. WHO emphasizes a global issue is "unfair could be reduced right mix government policies" often lead negative outcomes such increased morbidity disability, higher mortality rates life for groups experience treatment. In 2000, Department Human Services launched comprehensive nationwide, promotion disease prevention agenda United States [3]. report called elimination all disparities, including differences occur ethnicity, sex, education, income, geographic location, sexual orientation. published 2003 entitled Unequal treatment: confronting racial ethnic Hall-Lipsy Chisholm-Burns carried out systematic review "pharmacotherapeutic disparities" medication treatment [4]. A total 311 research articles were identified investigated whether race, sex was associated with Seventy-seven percent included revealed significant drug across sex. most frequent disparity found almost three-quarters studied receipt prescription drugs. Documented also occurred related drugs prescribed, dosing administration, wait time drug. these hospitalization, decreased therapeutic goal attainment, survival. Clinical content areas asthma, cardiovascular disease, diabetes mellitus, HIV infection, mental health, oncology, osteoporosis, pain control/palliative care, Parkinson's disease. top three terms number publications care. this edition Journal American Geriatrics Society (JAGS), Cassara et al. on study use discontinuation long-acting injectable (LAI) antipsychotic medications among older adults, focus based race/ethnicity [5]. authors utilized Medicaid databases identify adults diagnosed schizophrenia, schizotypal, schizoaffective disorders. More than 500 individuals an average age 70.4 years met inclusion analysis. prescribing LAI antipsychotics Black White populations. Although second-generation generally recommended being optimal versus first-generation antipsychotics, especially suggests patients receive significantly more patients. This particular concern because at risk adverse effects development movement compared antipsychotics. note prominent include neuromotor problems parkinsonism tardive dyskinesia, anticholinergic autonomic effects, dysfunction. Older likely polypharmacy can contribute drug–drug interactions severe may earlier discontinuation. evidence prescriber bias present perceived effectiveness first- does some limitations, noted authors. They patient diagnoses collected using ICD-10 billing codes neither validity nor severity schizophrenia properly defined. Another limitation self-reported identification common large data claims. retrospective preclude understanding reasons mention exclusion criteria diagnosis Alzheimer's other dementias. suggest further studies needed assess presence accessibility people. recent example psychotropic U.S. veterans. Among depression, whom antidepressants clinically indicated, 1.87 times antidepressant [6]. IOM Report provided summary key findings, remain highly relevant today exist, worse outcomes, concludes they "unacceptable." notes context broader historic contemporary economic inequality persistent discrimination many sectors life. systems, providers, patients, utilization managers healthcare. Bias, stereotyping, prejudice, uncertainty part providers disparities. while indirect several lines supports latter statement, greater prevalence influence processes should sought through research. includes series recommendations, promoting awareness Recommended interventions subsequently grouped into following categories: legal, regulatory, policy; systems; education empowerment; cross-cultural professions; collection monitoring; needs later promising interventions, ethical issues, barriers eliminating Lundebjerg Medina-Walpole described commitment (AGS) take purposeful steps address racism given its impact their families, communities [7]. highlight commendable AGS 2020 added vision future. statement follows: "We supported able where ageism, ableism, classism, homophobia, racism, sexism, xenophobia, forms no longer access, quality, caregivers." paper concrete critical issue. Farrell JAGS intersection structural ageism compounds disadvantage experienced historically marginalized [8]. explain constructs magnified when race intersect. emphasize working dismantle structures create perpetuate combined injustices and, so doing, just system. fundamental changes required First, workforce must both reflect better prepared care populations it serves. Second, how we train support next generation professionals change truly supporting trainees diverse backgrounds achieve success chosen careers. Third, aspects examined perspective only but biases (e.g., xenophobia). Rhodes 2022 editorial ambitious efforts journal enhance diversity, equity, [9]. Hopefully, excellent goals paragraph will positive long-lasting throughout system emulated countries facing similar challenges. David Conn reviewer original wrote editorial. author declares conflicts interest. publication linked article To view article, visit https://doi.org/10.1111/jgs.19386. l.
Language: Английский