Inclusive Aging Research Within the Context of Social Determinants of Health

Abstract

Over the last few years, we have seen an increasing interest in acknowledging that social determinants of health (SDoH) exist. According to the Healthy People 2020 (healthypeople. gov), SDoH are the conditions in which people are born, grow, live, work, and age. In this Special Issue, the authors reinforce the visibility of these SDoH not only as contextual factors but also as factors that influence the growing inequities among and between diverse populations. As such, aging research needs to be inclusive to reach a place of equity for groups who have traditionally been marginalized or underrepresented in research, specifically when based on one’s income, geographical location, and or their race/ethnicity. Facing these challenging “gaps” in aging research allows researchers, practitioners, and scientists to facilitate discussions that move us into actionable social justice research. Given the broad scope and impact of SDoH on one’s mental and physical health, it is essential for researchers to capture a variety of social and structural factors known to be associated with inequities across groups (Deferio et al., 2019). The authors in this Special Issue aimed to provide evidence for engaging in new strategies to showcase inclusive ways of addressing inequities through acknowledging the interrelated factors of SDoH and mental health, discrimination, food insecurity, and research participation. The 11 articles in this issue will provide more evidence for practitioners and researchers to use the information to interrupt beliefs, practices, and policies perpetuating inequities in our aging communities across the globe. Some key topics include raising awareness about the concerns of lesbian and gay older adults, the impact of SDoH on racially and ethnically diverse older adults, and about the unique barriers these groups encounter in gaining access to housing, health care, food, and clinical research trials. The authors in this issue recognize a key point in that individuals have social situations that contribute to their health, their lack of knowledge of disease progression, community resources, and how to access them (Axelson et al., 2018). By incorporating interventions aimed at identifying and intervening on issues of SDoH, we may be able to better serve those older adults who need us the most. The first set of five articles in this Special Issue focuses on inequities based on one’s experience with discrimination (i.e., age, race/ethnicity, sexual orientation) and social and economic inequalities. Gonzales, Lee, and Marchiondo present research on the impact of major lifetime discrimination and negative neighborhood conditions on mental health and retirement age. The authors used Health and Retirement Survey (HRS) data, exploring cumulative (dis)advantage as it relates to mental health and the age at which individuals retire. Authors provide insight into the structural and complex factors that are associated with social disadvantages. Reducing incivility, bias, discrimination, and prejudice can be used as prevention strategies to mental health issues and will likely increase the capacity to work longer. Lyons et al., explored sexual orientation and disclosure to health care providers, within a large nationwide sample of Australian adults who identified as lesbian and gay adults aged 60 and above. The authors found that more frequent experiences of discrimination could contribute to feeling uncomfortable disclosing their sexual orientation. Addressing the psychological and social impact of discrimination are potential areas of focus in this research. Overall, the authors highlight how older lesbians and gay adults are further marginalized in health care settings. Park and Seo’s article examined economic inequalities, housing tenure, and mental health among older adults in Korea and found that income was associated with depression. Their findings further suggest that structural factors need to incorporate an understanding of wealth and health to address economic determinants of aging. Massa and Filho further examined economic inequalities and selfrated health among Brazilian adults. They found that adults were more likely to have poorer health if they lived in areas with medium and high levels of income inequality. This evidence supports the need to improve social programs and health care strategies for older adults residing in developing countries. The last study in this section, Walker and colleagues, also using data from the HRS, examined the relationship between multiple measures of financial hardship and glycemic control among older adults with diabetes. Similar to other studies in this group, the cumulative financial hardship per person was associated with increasing HbA1c (poorer health). Authors suggest that including multiple methods of assessing financial hardship (instead of the traditional methods of education and income) may capture the true impact of income on one’s health. The next three articles provide readers with “action plans” on how to address food insecurity or inform policies attempting to mitigate the effect of marginalization on diverse older adults via food insecurity. In the first article, authors focus on the impact of social programs in a middle-income country, Mexico, among older adults and its relationship with food 974653 JAGXXX10.1177/0733464820974653Journal of Applied GerontologyWilliams editorial2020