Learning and Playing the Game: Living with Structural Racism and Diabetes throughout the Life Courses of Older African Americans

Despite being a manageable chronic condition, type 2 diabetes is among the leading causes of death and disability in the United States. Of the 29.1 million people who have diabetes in the U.S., almost half are adults ages 65 years and older, and 39% of older African Americans have the condition. African American seniors are more likely to experience diabetes-related complications compared to other racial groups. These complications lead to end stage renal disease, non-traumatic lower extremity amputations, heart disease and premature death at two to four times the rates of their non-Hispanic White counterparts. This studied utilized a constructivist grounded theory methodology to understand the potential relationships between African American older adults' experiences with structural racism across their life courses, and their experiences with type 2 diabetes in older age. The author's interpretation of the fit between participants' narratives about structural racism and diabetes was centered on the processes through which participants dealt with social- and health-related threats. The findings revealed narratives that clustered into three major constructs: Identifying Threats, Learning and Playing the Game, and Exercising Agency.