Geriatric Gynecologic Care of Minorities

Abstract

African-American and Hispanic-American women, as well as women of other minorities are susceptible to the same gynecologic diseases as white women. Elderly minority patients need gynecologic care; they reluctantly seek care because they harbor both fear and distrust. Gynecologists who care for the elderly are expected to provide the same quality of care to whites and minorities. However, ethnicity, cultural differences, and socio-economic status can impact negatively on outcomes. This racial/ethnic disparity is most clearly demonstrated in the poor prognosis, increased mortality, and decreased 5-year survival rates for several gynecologic cancers in African-Americans compared with whites. Poverty, ignorance, and a history of limited access to and limited availability of quality health care are all contributing factors to the late detection of most cancers in African-Americans. Distrust of the medical establishment and fatalism prevent many members of minority groups, particularly the elderly members, from fully using screening procedures. Gynecologists who are providing care to geriatric minority patients must be aware of, and sensitive to the ethnic and cultural differences that may contribute to either noncompliance or poor compliance with medical management. Also, an awareness of the problems that are endemic within minority communities, such as domestic violence, drug abuse, and HIV/AIDS, will assist the gynecologist or other providers of gynecologic care in identifying elderly patients who may be at high risk. Education is a critical component in the practice of caring for elderly minorities. It is only through education about the benefits of screening, early diagnosis and treatment, and the need for routine gynecologic examinations (even if hysterectomized), that any significant improvement will be made in the dismal cancer-related mortality and survival rate statistics for minorities, both young and old.