Health, double jeopardy, and culture: the use of institutionalization by African-Americans.

Elderly African-Americans are admitted to nursing homes at between half and three-quarters of the rate of elderly whites. This review examines the theoretical approaches and the nature of the evidence typically brought to bear in addressing this issue. The double jeopardy hypothesis effectively describes but does not explain apparent racial inequities in the use of institutional care. Explanations based on the hypothesized African-American subculture will remain inadequate until they are grounded in data and take into account inequality.

Discrimination against older women in health care.

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.

Gender and race differences in effects of health and pension on retirement before 65.

Prior work on early retirement has given inadequate attention to differences by gender and race in the influences of health and pension on the decision to leave the labor force before 65. A study of previously or currently employed black and white men and women aged 60 to 64 reveals that white males were most likely to be retired and black women the least. Bivariate analysis showed that activity limitations and the presence of chronic health conditions were related to early retirement for men, but not for women. Analysis of women by race showed that while white women who assessed their health as poor were likely to be retired, black women in poor health were apt to be still working. Pension coverage was unrelated to early retirement for both genders. Logistic regression was used to analyze the simultaneous effects of health, pension and race on men's and women's decisions to leave the labor force early, with other variables controlled. The results led to the conclusion that different motivations toward early retirement apply to women and men, and blacks as compared to whites.