Seniors Health

Black adults aged 65 and older carry a disproportionate chronic disease burden accumulated over a lifetime of navigating inequitable healthcare, environmental exposures, and socioeconomic stress. Alzheimer's disease and related dementias are twice as prevalent in older Black adults as in white adults. Diabetes affects nearly half of Black seniors. Cardiovascular disease remains the leading cause of death, and hypertension — undertreated for decades in many Black adults — drives significant organ damage by the time people reach their 60s and 70s.

At the same time, Black elders bring particular strengths to aging: robust social support networks, deep community ties, spiritual resources, and multigenerational family structures that support independent living longer. This hub aims to honor those strengths while providing the clinical and systems information that helps Black seniors and their families navigate healthcare, insurance, and the options for remaining healthy and independent.

Black Americans are approximately two times more likely to develop Alzheimer's disease than white Americans, according to the Alzheimer's Association. Yet Black seniors are less likely to receive a formal diagnosis, partly because dementia symptoms are sometimes attributed to normal aging or to depression by providers who underscreen Black patients. Early diagnosis matters: it enables planning, access to support services, enrollment in clinical trials (where Black patients are significantly underrepresented), and access to FDA-approved disease-modifying therapies for early Alzheimer's. The SAGE (Self-Administered Gerocognitive Exam) and the Montreal Cognitive Assessment (MoCA) are validated screening tools that can be administered at primary care visits. Any family concern about memory or cognitive change warrants a formal evaluation.

Diabetes management in older Black adults requires careful calibration: aggressive glucose control targets appropriate for younger patients may increase hypoglycemia risk in older adults, which can trigger falls, cardiac events, and cognitive episodes. The American Diabetes Association recommends individualized HbA1c targets for older adults — often 7.5-8.0% rather than the more aggressive less-than-7.0% target used in younger patients. Diabetes complications including diabetic kidney disease, peripheral neuropathy, and retinopathy require regular monitoring: annual ophthalmology visits, regular foot exams, and urine albumin testing. SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated cardiovascular and kidney-protective benefits beyond glucose control and should be discussed with your provider.

Hypertension in older Black adults often reflects decades of elevated blood pressure inadequately treated in earlier life, resulting in left ventricular hypertrophy, chronic kidney disease, and significantly elevated stroke risk. Black adults have the highest rate of stroke in the country, and post-stroke disability disproportionately affects Black patients. Blood pressure targets in older adults are currently debated: the SPRINT trial, which included a significant proportion of Black participants, found that targeting systolic blood pressure below 120 mmHg reduced cardiovascular events but increased adverse effects. A personalized target developed with your provider — accounting for fall risk, kidney function, and other medications — is more appropriate than a universal guideline.

Medicare enrollment is available at age 65 for most Americans. The enrollment window opens 3 months before your 65th birthday and closes 3 months after — missing it results in late enrollment penalties that apply permanently. Medicare Advantage plans (Part C) bundle coverage and often include extra benefits (dental, vision, hearing) but restrict provider networks and require prior authorization for many services. Traditional Medicare (Parts A and B) with a Medigap supplement offers more flexibility but higher premium costs. Black seniors disproportionately enrolled in Medicare Advantage plans have reported higher rates of denied prior authorization claims, according to KFF research — a disparity worth understanding when choosing coverage. State Health Insurance Assistance Programs (SHIPs) offer free, unbiased Medicare counseling.

Although Black adults have higher bone mineral density on average than white adults, they still experience fractures — and post-fracture mortality for Black seniors is comparable to or higher than for white seniors. Osteoporosis is underdiagnosed in Black patients partly because provider assumptions about racial differences in bone density can lead to under-screening. Bone density scans (DEXA) are recommended for women 65 and older and for men 70 and older (or earlier with risk factors). Fall prevention is critical: falls are the leading cause of injury death among adults 65 and older. The STEADI initiative provides evidence-based fall prevention protocols including balance assessment, medication review, and home hazard assessment.

Black families provide an estimated 30 percent more hours of informal caregiving per week than white families, partly reflecting cultural values around caring for elders within the family and partly reflecting lower access to paid home health services. Family caregivers — often Black women — are at elevated risk of caregiver burnout, depression, and their own health decline. Respite care (temporary relief caregiving) is available through Area Agencies on Aging (AAA) in every county — a resource many families are unaware of. Medicare covers limited home health services following hospitalization. Medicaid-funded home and community-based services (HCBS) waivers can provide longer-term in-home support for eligible older adults with functional limitations. Find your local AAA at eldercare.acl.gov.

Older adults benefit from a primary care provider experienced in geriatric medicine — including medication review (polypharmacy is a major safety issue in older adults, with many common medications interacting poorly), functional assessment, and advance care planning. Our provider directory includes Black geriatricians and internists experienced with older Black patients. The American Geriatrics Society's Choosing Wisely recommendations list tests and treatments that are commonly overused in older adults — worth reviewing with your provider.

Every older adult should have a documented advance care plan — a healthcare proxy designation, a living will or POLST form, and a conversation with family and providers about treatment preferences. Black seniors are less likely to have these documents, partly due to historical reasons to distrust medical systems around end-of-life care. Culturally affirming conversations about advance care planning, conducted in the context of your values and your community's traditions, are worth having early — not in a crisis.

If you or an older adult in your care is experiencing a mental health crisis, call or text 988. For falls or medical emergencies, call 911. For ongoing senior support services including meal delivery, transportation, and caregiver respite, contact your local Area Agency on Aging at eldercare.acl.gov. See our full crisis resources page.