Geriatric Care for Populations That Have Been Disadvantaged in Service Delivery: Q&A With Margarita Alegría, PhD

Older patients in minoritized populations often experience health disparities. Socioeconomic, cultural, and linguistic factors can affect how individuals receive or seek healthcare as they age. The Disparities Research Unit at Massachusetts General Hospital seeks to reduce disparities for disadvantaged and minority populations.

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In this Q&A, Unit Chief Margarita Alegría, PhD, discusses how her team's research efforts and interdisciplinary programs are working to improve geriatric and palliative care services for minority populations.

Q: What is the goal of the Disparities Research Unit at Mass General?

Alegría: Our goal is to generate innovative mental health and healthcare services research to inform practice, policy, and service delivery to reduce disparities for disadvantaged and minoritized populations. Our interdisciplinary team incorporates community perspectives into the design and implementation of our programs, and we emphasize the importance of services in languages other than English. We currently offer clinical trials in Mandarin, Cantonese, Spanish, and English, and are working to expand to Arabic languages, Vietnamese, and Haitian Creole. We have both national and international collaborations and lead projects spanning the entire life course, focusing on youth, adults, and older adults.

Q: How can older, minority patients be particularly disadvantaged in healthcare?

Alegría: There is a large population of racial/ethnic minority older adults that show high rates of mood disorders, emotional distress, and a high risk for premature disability. This has been particularly prominent in Black and Latinx groups where there are marked disparities in healthy aging; for example, minoritized older adults in need of services often receive no mental health treatment. We know that this population has suffered significant disparities in access to and poor quality of care, partly due to workforce shortages but also due to a lack of culturally and linguistically tailored care.

Q: How is the Disparities Research Unit working to improve geriatric and disability care services for minority populations?

Alegría: We are working on three main fronts, the first of which is developing and implementing interventions to reduce disability among older adult populations, particularly older adults of color and immigrant populations. Our team is also training faculty on how to conduct clinical research for older minoritized populations that addresses their needs. We are collaborating with four junior faculty members who are developing interventions for older racial/ethnic minority populations:

• Altaf Saadi, MD, a neurologist at Mass General
• Rawan AlHeresh, MScOT, PhD, OTR/L, an occupational therapist at the Mass General Institute of Health Professions
• Elizabeth Vasquez, DrPH, MPH, an associate professor at the University at Albany
• Mayra Sanchez Gonzalez, PhD, a psychologist at the Johns Hopkins University School of Medicine

In addition, we are publishing information on how to include the voices of these populations in research and policy discussions. Some of these works include a recent piece in The American Journal of Geriatric Psychiatry and contributions to the National Academies of Sciences, Engineering and Medicine's report, Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences.

Q: What kind of research regarding older populations are you interested in?

Alegría: I am interested in preventive and early identification interventions related to disability, mental health, and functioning for older populations. The first phase of our National Institute of Aging/National Institute of Mental Health-funded clinical trial, "Building Community Capacity for Disability Prevention for Minority Elders," examined how to successfully build collaborative research for the provision of evidence-based mental health and disability prevention treatments delivered by community health workers and exercise trainers in community-based organizations (CBOs).

We also have a Positive Minds—Strong Bodies Enhanced (PMSBe) Implementation Trial, where we work with diverse older adults to determine whether the effectiveness of this enhanced version of our previously tested intervention is strengthened through added group maintenance components. Additionally, we secured funding for a supplement to examine the impact of the PMSBe program in reducing mortality and mental health symptomology for racial/ethnic and linguistic minority older adults, assessing the feasibility and adoption of public health interventions related to COVID-19.

Q: How do these studies and your work in the Disparities Research Unit ultimately lead to improved patient care?

Alegría: Our main driver is that there is always an opportunity to intervene earlier. This includes identifying people with the first signs of disability and symptoms of depression, anxiety, and trauma that are affecting their wellbeing, so we can work with them to prevent or delay the onset of disability. We partner with CBOs to conduct outreach and perform psychosocial interventions to understand symptoms, increase physical exercise, decrease stigma, and augment access to care. These are evidence-based interventions where we have demonstrated effectiveness in delaying disability (published in The American Journal of Geriatric Psychiatry). We aim to offer services based in community clinics and CBOs so people can receive care, even if they don't recognize the need or seek services themselves.

Learn about the Disparities Research Unit

Explore research in the Division of Palliative Care & Geriatric Medicine