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9 September 2022

Differences in care-related outcomes in skilled nursing facilities for minority communities: a systematic review

Mary Scott , Bruyere Research Institute , Canada

Alixe Menard, Bruyere Research Institute
Amy Ramzy, Bruyere Research Institute
Annie Sun, Bruyere Research Institute
Prabasha Rasaputro, uOttawa
Maya Murmann, Bruyere Research Institute
Anna Cooper-Reed, University of Toronto
Amy Hsu, Bruyere Research Institute

Abstract

Introduction: Disparities in access to care and health outcomes exist for minority populations. With a globally aging population, there will be an increasing proportion of minority seniors who may need the level of care and support that are provided in residential care settings. However, the literature surrounding the care experience and outcomes of minority seniors living within residential care facilities has yet to be synthesized.

The primary objective was to determine if there is evidence of care-related differences for minority seniors in residential long-term care facilities compared to majority populations.

Methods: We developed a protocol a priori following the Peer Review of Electronic Search Strategies (PRESS) and registered our study on PROSPERO (CRD42021269489). We searched 10 databases for studies published between January 1, 2000, and September 26, 2021. All study designs were considered, however only analyses that compared outcomes of minority against majority populations were included. Dual screening was conducted for title-abstract and full-text screening by independent reviewers. Studies were extracted and assessed for the risk of bias by independent reviewers and subsequently reviewed by a second independent reviewer. Studies were delineated by the minority population of focus, study design, and care-related outcome(s) examined.

Results: The literature search captured 11,254 articles and 2,127 duplicates were removed. A total of 9,127 title and abstracts and 170 full texts were dual-screened, with 48 studies included. All studies used retrospective secondary data sources. Nearly all (>90%) of the studies were conducted in the United States and defined minority populations using race and ethnicity. Three studies were conducted in Canada on French-speaking residents in a linguistic minority context. Care-related outcomes examined included pressure ulcers, hospitalizations, incontinence, psychoactive medication use, quality of life, hip fracture, falls, restraint use, COVID-19 infections, social engagement, length of hospice stay, and secondary stroke prevention. Due to heterogeneity in their study design, cohort definition and analytical approach, most of the evidence was narratively synthesized. Consistently, studies (n=12) have found greater incidence, risk, and less healing of pressure ulcers in racial minority populations compared to majority populations, particularly for more advanced ulcers. Evidence from Canada on French linguistic minorities in residential care facilities found mixed results, with only one study finding higher odds of hospitalizations in minority residents living with dementia compared to English-speaking non-dementia residents. This may be partly attributed to French being the second official language in Canada and the high prevalence of bilingualism among Francophone Canadians.

Conclusion: Our review found evidence of disparities in care-related outcomes within residential care settings, particularly for racial minorities. However, the lack of observed differences among other minority identities may be primarily attributed to the lack of research in this area. Most notably, this synthesis highlights significant gaps in evidence and an absence of literature on the experience of all minority identities, such as ethnicity, religion and spirituality, gender identity, disability and sexual orientation.


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