Geriatrics: Gaining Trust with Cultural Disparities


An absence of trust in healthcare providers is usually associated with insufficient adherence to treatment guidelines and, therefore, to poorer health outcomes. The issue is especially relevant for Americans over 65, who are most vulnerable to chronic diseases. The factors that contribute to the distrust is limitations in access to health care, elevated prices for treatment, and broad cultural changes. Although the USA has a long and rich history of caring for the older adults, the current funding of programs for the senior population is insufficient to provide the needed level of service. Therefore, more thought should be put to healthcare policies for older Americans to regain their trust and improve health outcomes.

Describing Senior Citizens

Older Americans suffer from an increased number of chronic diseases and are in need of special preventative screening and treatment.The elderly population is in most need of health care due to health and functional status. Older people often experience economic hardships, feel depressed, lonely, anxious, and isolated (Osborn, Doty, Moulds, Sarnak, & Shah, 2017). The older population is more likely to suffer from “dementia, stroke, chronic obstructive pulmonary disease, and vision impairment” (Prince et al., 2015, p. 549). The factors mentioned above put the vulnerable population at risk of condition deterioration if the needs for special care are not met. In short, older Americans suffer from the health care system being designed to treat acute episodic illnesses rather than chronic conditions.

US Healthcare for Senior Population

The US government has always treated citizens over 65 with special attention, as older males are heads of their households and can significantly influence the political views of their family members. Therefore, the US healthcare system always tried to meet the special needs of the elderly population. Due to improvements in the sphere, life expectancy of the population has grown considerably, and reports show better health outcomes in comparison with 1998 (Olson, Schommer, Mott, & Brown, 2016). The improvements are mostly due to the introduction of Medicare and Affordable Care Act (ACA).

The first step by the government towards older population was the introduction of Medicare in 1965 that made access to medical services a universal right for Americans once they reach age 65. This policy improved the health and longevity of older Americans; however, due to the rapid evolution of the healthcare system in the US, Medicare failed to keep the pace and was subjected to revisions and additions.

ACA was another try to serve the needs of the elderly, as it allowed improved access to prescribed drugs. According to Olson et al. (2016), after Medicare Part D and ACA were put to practice, “the proportion of seniors without prescription drug coverage decreased” (p. 1150). The same study, however, shows that financial hardships from purchasing medications of the target population increased (Olson et al., 2016). Therefore, while the improvements in health care services provided to older citizens are considerable, there are still steps to be made to achieve better affordability.

The ongoing health care reform in the US has shown limited success in addressing the problems of senior citizens. Its results are far from being the best among developed countries, as older Americans are sicker and face more financial barriers to get medical care (Osborn et al., 2017).

Thirty-nine percent of senior Americans suffer from three or more chronic diseases, which is the highest level among high-income countries (Osborn et al., 2017). At the same time, 55% of the US elderly citizens are taking 4 or more prescribed drugs and 15% report cases of avoidable ED visits (Osborn et al., 2017). Therefore, one can conclude, that the US government spends more money to achieve poorer results, which causes dissatisfaction among the older population.

The underperformance of the US health care system in addressing the older population may be due to several reasons. First, Medicare still feature cost sharing practice that has proven to be a severe burden for many beneficiaries, while other developed countries have no such practice (Osborn et al., 2017). Second, funding is poorly shared between health care and social care, which causes unneeded doctors’ appointment and ED visits occur (Osborn et al., 2017). Third, the US lacks a universal health care system, which makes funding distribution complicated and inefficient (Blendon, Benson, & Hero, 2014). The flaws of the system mentioned above serve as a basis for distrust among all layer of the population, especially the elderly.

Trust Issues Among Older Americans

The level of public trust in physicians is among the lowest in the developed countries. Only 58% of adults believe that doctors in the US can be trusted (Blendon et al., 2014). Low-income population, including the elderly, generates the majority of distrust, as the quality of services differs considerably between those who have public health insurance and those who pay for their insurance. Therefore, the leading issue contributing to the distrust in the US health care system is the elevated cost of the provided services and prescribed drugs.

Another source of mistrust in American doctors is the limitation in access to healthcare among the older US population. According to Osborn et al. (2017), 22% of the interviewed population did not hear from a regular doctor when contacted about a medical concern. At the same time, 18% of people had to wait for six or more days to get a doctor’s appointment when sick (Osborn et al., 2017). Moreover, broad cultural changes are underway, as modern means of communication and social media make the information about the underperformance of the US healthcare system. As a considerable number of older Americans find it difficult to get healthcare services, and more people are getting to know about the matter, trust levels in American doctors are falling.

Why Trust Matters

Confidence in physicians and treatment they are prescribing is crucial for the effectiveness of care and patients’ satisfaction. According to Graham, Shahani, Grimes, Hartman, & Giordano (2015), trust in physicians is closely correlated with improved patients’ contentment and, consequently, with improved retention in care. Treating patients without having their confidence can become quite complicated, as people poorly adhere to the treatment guidelines and fail to make their clinic appointments. Moreover, the atmosphere of trust can make the patients feel less stress and perceived stigma associated with some illnesses (Graham et al., 2015). In short, confidence in the health care system is crucial for providing effective treatment and for long-term health outcomes.


Performance of the health care system is measured by how well it addresses its patients with the most significant needs. The high level of dissatisfaction and mistrust among elderly population manifests that the US health care system is unable to address their needs. The matter provokes poorer health outcomes and discontent about the services. The main reasons for distrust in the system are affordability and access problems. In conclusion, trust issues should be stated as the primary concern for the healthcare provider, as regaining confidence can improve adherence to treatment that can result in better well0being for all layers of the US population.


Blendon, R., Benson, J., & Hero, J. (2014). Public trust in physicians — U.S. medicine in international perspective. New England Journal of Medicine, 371(17), 1570-1572. Web.

Graham, J., Shahani, L., Grimes, R., Hartman, C., & Giordano, T. (2015). The influence of trust in physicians and trust in the healthcare system on linkage, retention, and adherence to HIV care. AIDS Patient Care and STDs, 29(12), 661-667. Web.

Olson, A., Schommer, J., Mott, D., & Brown, L. (2016). Financial hardship from purchasing medications for senior citizens before and after the Medicare Modernization Act of 2003 and the patient protection and Affordable Care Act of 2010: Findings from 1998, 2001, and 2015. Journal of Managed Care & Specialty Pharmacy, 22(10), 1150-1158. Web.

Osborn, R., Doty, M., Moulds, D., Sarnak, D., & Shah, A. (2017). Older Americans were sicker and faced more financial barriers to health care than counterparts in other countries. Health Affairs, 36(12), 2123-2132. Web.

Prince, M., Wu, F., Guo, Y., Gutierrez Robledo, L., O’Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet, 385(9967), 549-562. Web.