The disparities dilemma: Critical considerations for aging research and practice

In the coming decades, the racial and ethnic make-up of the United States’ (U.S.) population aged 65 and over will become increasingly diverse (Vincent & Velkoff, 2010). Occupational science, with its attention to mitigating occupational injustices, is well-positioned to make a contribution to knowledge on participation and healthcare disparities for racially and ethnically diverse older adults. Although the medical literature is replete with information on healthcare disparities for various racial and ethnic groups, relatively little is known about disparities for people who use occupational therapy services in the U.S. The limited amount of information available on occupational therapy relates mainly to care access and this literature suggests little disparity (Chan, 2009). Other rehabilitation literatures contain studies that have examined the association between race and ethnicity on functional outcomes for rehabilitation patients; however, scholarship on this topic is relatively nascent. Similar to the broader rehabilitation literature, the occupational science literature offers little research addressing healthcare disparities for older adults; however, there are notable theoretical contributions that pertain to this topic. In both occupational science and occupational therapy, scholars have called for a critical reflexivity in research and practice that we wish to engage in the present paper. In this paper, we aim to raise the collective consciousness of our occupational science community about the healthcare disparities facing the older adult population in the U.S. We interpret and critically evaluate evidence from our experiences and a secondary data analysis on a randomized controlled trial with racially and ethnically diverse older adults (Authors, 2012). This study used a semi-crossover design to provide occupational therapy intervention to participants (n=460) over a 6-month period. Participants were pre-tested, post-tested, and follow-up tested at 18 months. In the present paper, we explore three common places for disparities in occupational science and occupational therapy to arise: recruitment, retention, and assessment. Building upon our experiences with research, we will critically examine approaches to recruiting and retaining racially and ethnically diverse older adults during the course of this study and discuss lessons learned that may be translated to practice. We provide a modified, multi-faceted model of recruitment and retention strategies (Authors, 2014). Additionally, we offer results and new insights from a Rasch analysis which examines similarities and differences in conceptual meanings of an assessment tool often used in research. Findings reveal that translation/adaptation of assessments to languages and cultures for which they were not originally developed may be problematic in both research and practice. Rather than providing answers to the disparities dilemma in occupational science research, we invite the audience to join us in what Laliberte Rudman (2013) termed “enacting the ‘critical potential’ of occupational science” (p. 300) by “questioning the ‘way things are’, or what has come to be taken-for-granted, within and outside occupational science, regarding occupation and occupational inequities” (p. 310). We believe that the present moment is a critical time to interrogate our beliefs about older adults’ research experiences, considering power relations, social structures, and methodological approaches that may better support an increasingly diverse aging population. Word count: 499 Keywords: Health disparities, older adults, translational research Targeted conference themes: Translation of occupational science; Methodologies to advance the study of occupation Objectives for presentation: Open a critical dialogue on addressing older adults’ health disparities considering pertinent theoretical and methodological framings in occupational science Raise consciousness in the occupational science community about older adults’ health disparities in the United States Interpret evidence and critically examine a translational research program conducted with a racially and ethnically diverse older adult populatio