Improving Equity in Geriatric and Disability Care: Q&A With Margarita Alegría, PhD
Margarita Alegría, PhD, is a catalyst for change. As a Mass General Brigham researcher and chief of the Disparities Research Unit at Massachusetts General Hospital, Dr. Alegría leads programs aimed toward reducing the health disparities hurting older adults in disadvantaged and minority populations.
In this Q&A, Dr. Alegría discusses the challenges faced by older people of color, the important relationship between mental health and disability, and the work her team is doing every day to improve geriatric care and build a more equitable health care system.
Q: What is the Disparities Research Unit?
Alegría: The Disparities Research Unit is a research practice where investigators, clinicians, and community groups work to improve health care for multicultural populations. Our group members include psychologists, social policy analysts, health economists, psychiatrists, data analysts, sociologists, and others.
We collaborate with groups across the country and around the world to develop and lead projects that affect people at every stage of life, from youth, to adulthood, to older age.
Our team weaves our community perspectives into the design and implementation of all our programs. We emphasize the importance of services in languages other than English. Currently, we’re offering clinical trials in Mandarin, Cantonese, Spanish, and English. We are working to expand to Arabic languages, Vietnamese, and Haitian Creole.
Q: What are the unique needs of older people of color?
Alegría: Caring for our older generations is a racial justice issue. People of color face continued racism in health care as they age—on top of the challenges they’ve faced over the course of their lifetimes, like securing access to healthy foods, clean, fresh air, safe drinking water, and outdoor recreation spaces like parks. And elderly people of color in need of mental health services often lack access to quality treatment. These challenges can all contribute to a decline in physical and mental health.
Q: Can you tell us more about the connection between mental health and disability? How does a lack of mental health care contribute to premature disability in underserved communities?
Alegría: Both U.S.-born minority elders and immigrant elders have higher levels of functional limitations and disability than U.S.-born whites in both mid and late life. Functional limitations refer to how difficult it is for a person to see, hear, move, communicate, think, and practice self-care. Physical disability is a risk factor for depression and vice-versa.
Mobility issues, such as trouble with balance and limited walking speed, also can signify later disability and health care use. We can address this by treating mood symptoms and restoring function. However, 1 in 3 older adults in the U.S. is expected to belong to a racial or ethnic minority group by 2040. We anticipate they will have an increased risk of mental and physical disability and face significant barriers to accessing mental health care.
Because health care providers often do not recognize these symptoms, they are treated as a normal part of aging. These symptoms may not be addressed, contributing to premature disability. As a result, many minority elders who need services receive no mental health treatment and suffer significant gaps in access to and quality of care. These things impact their opportunities for healthy aging.
Q: How does your work at the Disparities Research Unit improve patient care?
Alegría: Our principle is that there is always an opportunity to intervene earlier. That includes identifying people who are showing their first signs of disability and/or their first symptoms of depression, anxiety, or trauma, so we can work with them to prevent or delay the onset of disability.
At the Disparities Research Unit, we partner with other community-based organizations to conduct outreach and perform interventions to help delay geriatric disability and improve geriatric care. For example, in a successful trial, we offered a form of talk therapy together with strength exercise training to people with mood symptoms and some physical dysfunction.
Overall, we aim to offer services based in community clinics and community-based organizations so people can receive care, even if they don’t realize they need it or seek it themselves.
Q: What research are you most excited about in the year ahead?
Alegría: I am excited about preventive interventions related to disability, mental health, and functioning. There is a large population of racial/ethnic minority elders with high risk for premature disability and high rates of mood disorders and emotional distress. This has been particularly prominent in Black and Latino groups, with marked disparities in healthy aging.
We now know a lot about healthy aging and how building relationships, improved sleep, nutrition, and exercise make a difference. We are excited to spread this intervention in community-based organizations to see if we can improve healthy aging in our underserved communities.
