Journal of Gerontological Nursing

Guest Editorial Free

Toward an Equitable Society for Every Generation

Boeun Kim, RN, MSN; Basia Belza, PhD, RN, FAAN


Click here to read a Letter to the Editor about this article.


Click here to read a Letter to the Editor about this article.

Helping older adults who are marginalized is beneficial not only to these individuals but also society. Three reasons are presented for why society should embrace this idea.

First, helping older adults who are marginalized to be healthy reduces social injustice. Health inequities exist in older adults, and those who are marginalized are more likely to have poorer health (Fernandez-Martinez et al., 2012; Zelle & Arms, 2015). Specifically, older adults with disabilities are likely to delay seeing a health care provider due to economic difficulties compared to older adults without disabilities (Lee, Hasnain-Wynia, & Lau, 2012). Low socioeconomic status is related to the increased possibility of a transition from good to bad health status and a decreased probability of recovery from poor health in later life (Adena & Myck, 2014). Moreover, low level of educational attainment is significantly linked to greater all-cause deaths and differential mortality in cardiovascular diseases among older women (Rostad, Schei, & Lund Nilsen, 2009). Low attainment of education is the largest attributable risk factor of Alzheimer's disease worldwide (Norton, Matthews, Barnes, Yaffe, & Brayne, 2014). Older adults who are marginalized experience greater social and economic disadvantages during the life course compared to those who are not marginalized. These structural oppressions are accumulated through the life course and adversely influence health. Maintaining and enjoying a high standard of health is a fundamental right of every individual. Social contextual factors, such as low educational attainment and poverty, along with individual factors such as biology and health behaviors, ultimately violate one's fundamental right. Therefore, these health inequities in older adults are a form of injustice and making an effort to reduce health inequities in older adults is beneficial to achieving an equitable society.

Second, helping older adults who are marginalized through elder–friendly communities is beneficial for individuals of all ages. These communities share common favorable features for future generations. An elder-friendly community is defined as an accessible, supportive, and complex place including infrastructure and services that meet the needs of older residents (Alley, Liebig, Pynoos, Banergee, & Choi, 2007). Elder-friendly infrastructure, for instance, includes improving the beauty of the city's natural landscape, repairing the condition of sidewalks, increasing green spaces and safety of pedestrian crossings, making outdoor spaces safer and transportation more accessible, and offering diverse services. The infrastructure of elder-friendly communities is supportive and useful for older adults, including those who are marginalized, as well as for children and adolescents. Specifically, lower perceived safety of their neighborhoods is related to lower physical activity in older adults (Brown, Werner, Smith, Tribby, & Miller, 2014). A neighborhood with physical activity facilities, high walkability, and high social cohesion is linked to increased physical activity in children (Zhao & Settles, 2014). Green spaces are also associated with more physical activity in children (Coombes, van Sluijs, & Jones, 2013). In addition, a neighborhood in close proximity to residential areas that have more parks is related to a lower proportion of obesity in adolescents (Colabianchi et al., 2014). Physical activity is crucial to managing and preventing obesity in individuals of all ages. Therefore, an elder-friendly community comprises neighborhoods that enhance physical activity for all populations and thereby reduces risks for obesity-related disorders, such as metabolic syndrome and cardiovascular disease (Malambo, Kengne, De Villiers, Lambert, & Puoane, 2016; Peterson, Charlson, Wells, & Altemus, 2014; Turi, Codogno, Fernandes, & Monteiro, 2016).

Third, helping older adults who are marginalized to engage in society increases social solidarity and decreases social burden, such as increasing health care costs and lack of workforce as the population ages. Many older adults experience declining physical function in balance, speed, mobility, and flexibility, as well as declining cognitive function. These physical and cognitive function changes may lead to decisions to cease driving for safety reasons. Driving cessation is associated with less social engagement and fewer social contacts (Chihuri et al., 2016). Older adults who are marginalized are more vulnerable because they face more societal and economic disadvantages and have less resources to adopt their functional changes as well as external societal challenges. For example, Korean immigrant older adults experience a lack of social networks and barriers on finding a part-time or full-time job (Rhee, Chi, & Yi, 2015). Lesbian, gay, bisexual, and transgender older adults are more likely to face discrimination, stigma, barriers to health care access, and limited resources for caregivers (Fredriksen-Goldsen, Jen, Bryan, & Goldsen, 2016). As a result, those who are marginalized can experience loneliness and involuntary isolation from society. This isolation leads to a lack of social solidarity. Furthermore, feelings of loneliness are significantly related to dementia (Holwerda et al., 2014), and fewer social relationships are linked to depression in late life (Schwarzbach, Luppa, Forstmeier, Konig, & Riedel-Heller, 2014). These negative influences on older adults' health lead to increased health care costs and demands of social services. Helping older adults, including disadvantaged older adults, through building walkable and accessible neighborhoods can contribute to increased social engagement.

In conclusion, nursing as a profession has shared accountability to reduce health disparities and guarantee the human right to be healthy regardless of socioeconomic status. Many gerontological nurses, researchers, and educators have been concerned about health inequities in older adults and have contributed to solving the inequalities. However, knowledge gaps regarding health inequities in older adults remain, and this population has been relatively excluded in clinical trials compared to younger individuals. This exclusion may be due to challenges such as ageism during research and implementing policies for older adults who are disadvantaged. Helping older adults is beneficial for individuals of all ages. Resources for health care professionals as well as marginalized older adults are included in the table. Recognizing these benefits not only for older adults but also for other generations will help eliminate stereotypes against older adults and build a more equitable society.

Resources for Health Care Professionals and Marginalized Older Adults


Resources for Health Care Professionals and Marginalized Older Adults


  • Adena, M. & Myck, M. (2014). Poverty and transitions in health in later life. Social Science & Medicine, 116, 202–210. doi:10.1016/j.socscimed.2014.06.045 [CrossRef]
  • Alley, D., Liebig, P., Pynoos, J., Banerjee, T. & Choi, I.H. (2007). Creating elder-friendly communities: Preparations for an aging society. Journal of Gerontological Social Work, 49, 1–18. doi:10.1300/J083v49n01_01 [CrossRef]
  • Brown, B.B., Werner, C.M., Smith, K.R., Tribby, C.P. & Miller, H.J. (2014). Physical activity mediates the relationship between perceived crime safety and obesity. Preventive Medicine, 66, 140–144. doi:10.1016/j.ypmed.2014.06.021 [CrossRef]
  • Chihuri, S., Mielenz, T.J., DiMaggio, C.J., Betz, M.E., DiGuiseppi, C., Jones, V.C. & Li, G. (2016). Driving cessation and health outcomes in older adults. Journal of the American Geriatrics Society, 64, 332–341. doi:10.1111/jgs.13931 [CrossRef]
  • Colabianchi, N., Coulton, C.J., Hibbert, J.D., McClure, S.M., Ievers-Landis, C.E. & Davis, E.M. (2014). Adolescent self-defined neighborhoods and activity spaces: Spatial overlap and relations to physical activity and obesity. Health & Place, 27, 22–29. doi:10.1016/j.healthplace.2014.01.004 [CrossRef]
  • Coombes, E., van Sluijs, E. & Jones, A. (2013). Is environmental setting associated with the intensity and duration of children's physical activity? Findings from the SPEEDY GPS study. Health & Place, 20, 62–65. doi:10.1016/j.healthplace.2012.11.008 [CrossRef]
  • Fernandez-Martinez, B., Prieto-Flores, M.E., Forjaz, M.J., Fernández-Mayoralas, G., Rojo-Pérez, F. & Martínez-Martín, P. (2012). Self-perceived health status in older adults: Regional and sociodemographic inequalities in Spain. Revista de Saude Publica, 46, 310–319. doi:10.1590/S0034-89102012000200013 [CrossRef]
  • Fredriksen-Goldsen, K.I., Jen, S., Bryan, A.E. & Goldsen, J. (2016). Cognitive impairment, Alzheimer's disease, and other dementias in the lives of lesbian, gay, bi-sexual and transgender (LGBT) older adults and their caregivers. Journal of Applied Gerontology, 733464816672047. doi:10.1177/0733464816672047 [CrossRef]
  • Holwerda, T.J., Deeg, D.J., Beekman, A.T., van Tilburg, T.G., Stek, M.L., Jonker, C. & Schoevers, R.A. (2014). Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology, Neurosurgery, and Psychiatry, 85, 135–142. doi:10.1136/jnnp-2012-302755 [CrossRef]
  • Lee, J.C., Hasnain-Wynia, R. & Lau, D.T. (2012). Delay in seeing a doctor due to cost: Disparity between older adults with and without disabilities in the United States. Health Services Research, 47, 698–720. doi:10.1111/j.1475-6773.2011.01346.x [CrossRef]
  • Malambo, P., Kengne, A.P., De Villiers, A., Lambert, E.V. & Puoane, T. (2016). Built environment, selected risk factors and major cardiovascular disease outcomes: A systematic review. PLoS One, 11, e0166846. doi:10.1371/journal.pone.0166846 [CrossRef]
  • Norton, S., Matthews, F.E., Barnes, D.E., Yaffe, K. & Brayne, C. (2014). Potential for primary prevention of Alzheimer's disease: An analysis of population-based data. Lancet Neurology, 13, 788–794. doi:10.1016/S1474-4422(14)70136-X [CrossRef]
  • Peterson, J.C., Charlson, M.E., Wells, M.T. & Altemus, M. (2014). Depression, coronary artery disease, and physical activity: How much exercise is enough?Clinical Therapeutics, 36, 1518–1530. doi:10.1016/j.clinthera.2014.10.003 [CrossRef]
  • Rhee, M.K., Chi, I. & Yi, J. (2015). Understanding employment barriers among older Korean immigrants. The Gerontologist, 55, 472–482. doi:10.1093/geront/gnt113 [CrossRef]
  • Rostad, B., Schei, B. & Lund Nilsen, T.I. (2009). Social inequalities in mortality in older women cannot be explained by biological and health behavioural factors: Results from a Norwegian health survey (the HUNT Study). Scandinavian Journal of Public Health, 37, 401–408. doi:10.1177/1403494809102777 [CrossRef]
  • Schwarzbach, M., Luppa, M., Forstmeier, S., Konig, H.H. & Riedel-Heller, S.G. (2014). Social relations and depression in late life: A systematic review. International Journal of Geriatric Psychiatry, 29, 1–21. doi:10.1002/gps.3971 [CrossRef]
  • Turi, B.C., Codogno, J.S., Fernandes, R.A. & Monteiro, H.L. (2016). Low levels of physical activity and metabolic syndrome: Cross-sectional study in the Brazilian public health system. Ciencia & Saude Coletiva, 21, 1043–1050. doi:10.1590/1413-81232015214.23042015 [CrossRef]
  • Zelle, A. & Arms, T. (2015). Psychosocial effects of health disparities of lesbian, gay, bisexual, and transgender older adults. Journal of Psychosocial Nursing and Mental Health Services, 53(7), 25–30. doi:10.3928/02793695-20150623-04 [CrossRef]
  • Zhao, J. & Settles, B.H. (2014). Environmental correlates of children's physical activity and obesity. American Journal of Health Behavior, 38, 124–133. doi:10.5993/AJHB.38.1.13 [CrossRef]

Resources for Health Care Professionals and Marginalized Older Adults

Resource URL
AARP Real Possibilities <ext-link ext-link-type="uri" xlink:href="" xlink:type="simple" xmlns:xlink=""></ext-link>
Community Living Connections <ext-link ext-link-type="uri" xlink:href="" xlink:type="simple" xmlns:xlink=""></ext-link>
FrameWorks Institute <ext-link ext-link-type="uri" xlink:href="" xlink:type="simple" xmlns:xlink=""></ext-link>
Institute for Healthcare Improvement: Creating Age Friendly Health Systems <ext-link ext-link-type="uri" xlink:href="" xlink:type="simple" xmlns:xlink=""></ext-link>
National Academies of Science, Engineering, and Medicine: Forum on Aging, Disability and Independence <ext-link ext-link-type="uri" xlink:href="" xlink:type="simple" xmlns:xlink=""></ext-link>

Boeun Kim, RN, MSN

PhD in Nursing Science Student

Basia Belza, PhD, RN, FAAN

Interim Associate Dean for Academic


Aljoya Endowed Professor in Aging

Lead, Coordinating Center, Healthy Brain

Research Network

School of Nursing, University of Washington

Seattle, Washington 

The authors have disclosed no potential conflicts of interest, financial or otherwise. The first author received a University of Washington School of Nursing Top Scholar Award and a School of Nursing scholarship from the Pfeiffer Endowed Fund. The authors thank Eunice Soh for providing helpful feedback on this guest editorial.


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