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Health and The Elderly

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Health and The Elderly Mark Abdelmalak Hany Fahim Ricken Patel Dheeraj Muddasani Darshan Vaidya What Is the Problem? The elderly African American population has a ... – PowerPoint PPT presentation

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Title: Health and The Elderly


1
Health and The Elderly
  • Mark Abdelmalak
  • Hany Fahim
  • Ricken Patel
  • Dheeraj Muddasani
  • Darshan Vaidya

2
What Is the Problem?
  • The elderly African American population has a
    disproportionately higher risk for negative
    health outcomes in comparison to Americans of
    European descent

3
The Question
  • What factors contribute to the disparity between
    the health status of African Americans versus the
    elderly of other races?
  • Need to explore this from a life-course framework

4
Population Distribution
  • In 2000, persons of age 65 numbered 35 million,
    or 12.4 of the U.S. Population
  • 16.4 of the 35 million elderly were minorities,
    with a distribution as shown

5
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6
Leading Causes of Death Among African Americans
Age 65
  • 1)      Heart Disease
  • 2)      Cancer
  • 3)      Stroke
  • 4)      Diabetes
  • 5) Pneumonia /Influenza

7
Truth may be hard to accept
  • African Americans are two times more likely than
    whites to have diabetes
  • Higher lung and prostate cancer incidence and
    mortality than whites in all age groups
  • 30 more likely to die of heart disease (1 in 3 ?
    hypertension)
  • Highest overall risk of kidney disease
  • Stroke death rate 33 higher than white women
  • Rate of CV disease 80 higher than rate for white
    women

8
When America Gets a Cold, African Americans Get
Pneumonia!!
  • 47 of elderly African-Americans received the flu
    vaccine in 1998 vs. 66 of elderly whites
  • 26 of elderly African-Americans received the
    pneumonia vaccine in 1998 compared with 50 of
    elderly whites

9
  • Discriminatory Hospital Care for Seriously Ill
    Elderly Blacks
  • Dr. John Z. Ayanian asserts, black Medicare
    patients hospitalized for heart failure or
    pneumonia in three large States received poorer
    overall quality of care than other Medicare
    patients treated for the same illnesses.

10
Dr. John Ayanians Findings
  • 32 of black pneumonia patients given antibiotics
    w/in 6 hrs. of admission, compared with 53 of
    other Medicare patients
  • Blacks less likely to have had blood cultures
    collected on 1st or 2nd day of hospitalization
  • Disparities 1 additional death per 200 patients
    treated

11
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12
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13
Cardiovascular Disease
v      Cardiovascular disease is one of the
leading causes of mortality today. v     
 Coronary heart disease accounts for 70 to 80
of deaths in men and women in adults over 60
years of age. v      Congestive Heart Failure
(CHF), is the most common cause of
hospitalization in the elderly. v     
Cardiovascular disease is an important public
health problem in African Americans. In 1998,
cardiovascular disease accounted for 34 of
deaths in black men and 41 of deaths in black
women African Americans have a
disproportionately high rate of hypertension.
14
Diabetes Mellitus
  • When tested, Diabetes mellitus occurred in 127 of
    1150 whites (11), in 93 of 444 African-Americans
    (21), and in 4 of 28 Asians (14).
  • The prevalence of diabetes mellitus in 2003 older
    persons seen in an academic hospital-based
    geriatrics practice was 17 and was greater in
    African-Americans than in whites

15
Who Lives Longer?
Life Expectancy by Age Group and Race, in Years,
1997
Source Administration on Aging, 2000
16
Life Expectancy
  • Life expectancy at birth has historically been
    shorter for African Americans than older
    Americans, but the differences disappear or
    reverse themselves at older ages, creating the
    Crossover Phenomenon.
  • As of 1997, Black women in the U.S. has a life
    expectancy at birth of 74.7 years, and Black men
    67.2 years.
  • At age 85, life expectancy for Black women is 6.7
    years and 5.7 years for Black men.

17
Population growth and distribution
  • There has been continuous growth in the overall
    population of blacks in the United states since
    1790.
  • In 1970 there were 22 millions blacks in the
    United states, of whom approximately 1.5 million
    or 7 were 65 years of age or older. Since 1970
    there has been considerable growth in the
    population of blacks 65 and over.

18
Health History
  • There is a general agreement that blacks elders
    have traditionally been treated with great
    respect in their families.
  • This tradition extends from known cutoms of
    proslavery civilization on the African continent
    through modern customs African Americans families
    and kinship groups in the United States.

19
Health History Contd
  • African American elders tend to precieve their
    health as more problematic than do white elders.
  • 17 of African American rate their health as
    poor, as compared with 7 of white elders.

20
Life Course framework
  • Blacks who grew old in the United States had to
    withstand a variety of psychologically,
    physically and socially degrading experiences
    resulting from the political economy of race
    relations in the United States. (i.e. slavery,
    CRM, social maltreatment, Tuskegee experiment.)
  • Among the determinates of the treatment of
    elderly Blacks in the social history of the U.S.,
    economic factors had a significant bearing.

21
Crossover Phenomenon
  • Despite lower life expectancies for African
    Americans from birth, a mortality crossover
    phenomenon occurs at the age of 73 for black
    males and age 85 for black females.
  • Since many African American elders have had to
    cope with stress and few economic resources
    throughout their lifetimes therefore, negative
    outcomes in older age may appear less serious.

22
Crossover Phenomenon Contd
  • Also, it might be because the elders may simply
    have developed a more reliable set of coping
    strategies to deal with the stresses of old age.

23
Education
  • The Administration of aging (2000) reported that
    in 1998, 44 of non-Hispanic black Americans age
    65 and over had graduated from High school and 7
    had bachelors Degree or Higher.

24
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25
Patters of Health Risk
  • Many Morbidity and mortality rates are higher
    among African American elders than in the general
    population. Because of decreased educational
    levels and decreases in personal resources, the
    awareness of health problems, knowledge of causes
    and risk factors, and capacity to access medical
    care maybe greatly decreased.

26
Mortality
  • Death rates from all Causes for Elders 65-74 and
    75-84 are higher among Black elders than any of
    the other racial ad ethnic groups.
  • Those who are 85 and over, the rates are higher
    among whites and second highest among Blacks.
  • Older African Americans are less likely than
    white elders to have health insurance or to have
    seen a doctor in the pervious year.

27
Family Roles
  • African American families have developed and
    retain distinctive models of family interaction
    that combine traditional patterns of roles and
    responsibilities with adaptations called forth by
    American experience.
  • The Black kinship system tends to more extensive
    and cohesive that the family system of whites.

28
Living Arrangements
  • Among Community dwelling elders, African
    Americans men were more likely to live alone
    (approximately 24) and less likely to live with
    spouse (approximately 52) than men from any of
    the four other older racial/ethnic populations.
  • Historically, African Americans have resided in
    nursing homes at about half of rate of white
    elders.

29
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30
Cultural Biases and Misdiagnoses
  • Cultural bias about health and illness, and
    beliefs about which individuals and/or groups are
    most susceptible to one or another disorder are
    key among these factors.
  • It is also believed among some psychiatrists that
    African Americans, as a group, tended to have low
    rates of depression because of their historical
    social and educational oppression.

31
Cultural Biases and Misdiagnoses Contd
  • Epidemiological and etiological research have
    subsequently shown that depression and other
    illnesses are much more complex disorders than
    that suggested by the foregoing statements and
    must be carefully studied, including
    cross-cultural variations in symptoms of
    disorders before drawing conclusions and
    formulating treatment plans

32
Showing Respect!!!!
  • Particularly because of the experience of many
    african American elders who grew up with
    segregated health care and social service systems
    in which they faced continual discrimination, it
    is extremly important to show respect to them in
    clinical settings in order to put them at ease
    and establish rapport.

33
Adapting Assessments Techniques to Skin Color
  • Since African American elders have a wide range
    of skin color, it is very important for nurses
    and physicians to use appropriate assessments
    that reflect skin tone changes for conditions
    such as cyanosis.

34
Specialized Procedures in Cardiac Care
  • Numerous studies in the late 1980s and 1990s
    found that African Americans are less likely to
    undergo cardiac catheterization and
    coronary-artery bypass graft surgery than their
    white counterparts.
  • Our findings suggest that a patients race and
    sex may influence a physicians recommendation
    with respect to a cardiac catheterization
    regardless that patients clinical
    characterization.

35
End of Life Care
  • Some African American families may request that
    certain diagnoses or disease prognoses be
    withheld from the patient to shelter them from
    disturbing information
  • Other patients and families favor forthright
    discussion of all medical issues and treatment
    plans.

36
Care giving
  • Comparisons of informal care giving by black and
    White older adults showed that blacks are more
    likely to be caregivers and more likely to assist
    friends.
  • Blacks have frequent contact with family,
    relatives, friends and neighbors, although they
    utilize the members of their network differently
    for emergency and non-emergency situations.

37
Minority Population
  • Minority Americans today comprise 14 of the
    nation's elderly and 16 of the total Medicare
    population.
  • The minority population is projected to more than
    double by 2025 and will represent one in three
    seniors..

38
Minority Population Cont
39
Poverty Rates
  • In 1990, the poverty rate for older African
    Americans was 30.7 and only 9.6 for older white
    Americans.
  • One of every 11 elderly Caucasian persons lived
    in poverty in 1998, compared with 26.4 of
    elderly African Americans and 21 of elderly
    Hispanics.

40
Poverty Rates Cont
  • About 1/3 of African American beneficiaries have
    incomes below the poverty level, which is more
    than three times the share of whites.
  • Moreover, nearly two-thirds of African American
    beneficiaries have income below twice the poverty
    level compared with 41 percent of whites.

41
Poverty Rates Cont
42
Characteristics of Minority Medicare Beneficiaries
43
Disparities in Health Insurance Coverage
  • A quarter of African American beneficiaries have
    no supplemental coverage, compared with 10
    percent of all whites.
  • 2/3 of all white beneficiaries have Medigap or
    employer sponsored retiree benefits, compared
    with only a third of African Americans.

44
Disparities in Health Insurance coverage cont
45
Causes of Disparities in Health Insurance Coverage
  • Unemployment
  • The national unemployment rate for African
    Americans rose to 10.1 percent, up .3 percent
    from October, and up a 1.3 percentage from
    September. The unemployment rate for the white
    population was at 5.1 percent in November  
    almost half of the African-American unemployment
    rate.

46
Causes of Disparities in Health Insurance Coverage
  • The high rate of unemployment for Blacks has
    several causes.
  • First, inferior quality inner-city schools yield
    both more drop-outs and students without the
    skills needed in today's high tech labor market.
  • Second, shifts away from manufacturing and
    central city employment have deprived Blacks of
    traditional sources of employment.

47
Causes of Disparities in Health Insurance Coverage
  • Last but not least, discrimination is still a
    reality adversely affecting the employment
    prospects of Blacks - especially in smaller firms
    where many of today's jobs are being created.

48
Health Insurance Coverage
  • How unemployment and underemployment affects
    Health Insurance Coverage
  • Social Security
  • Out of Pocket spending

49
Health Care Is Driven by Economics
  • Most health policy for the elderly fails to take
    into account the distinctive health and SES
    statuses of racial and ethnic minority elderly.
    In fact, changes in the U.S. economy leads to a
    scapegoating of minorities which jeopardizes the
    fulfillment of their healthcare needs

50
Hudson County Elderly
  • 2000 Statistics
  • Greater than 11 percent of the Countys
    population was 65 years or older. Of this
    percentage, 8 percent were African American.
  • Source Department of Labor, Population and
    Labor Force Projections for New Jersey 1995 to
    2030, January, 1994 1980 Census, 1990 Census

51
Poverty among Elderly in Hudson County
  • Much of the elderly population in Hudson County
    is poor
  • Over 22.5 percent of the Countys frail elderly
    (aged 75 and over) have been living in poverty
    since 1990
  • In comparison, 12.7 percent of the frail elderly
    is living in poverty Statewide

52
Expected Increase in Elderly
  • The elderly population is expected to increase as
    the Baby Boom Generation (persons born from 1946
    to 1964) grows older.
  • This will in turn increase the demand for
    services to the elderly in Hudson County.

53
Elderly Services in Hudson County
  • Programs Used
  • Social Service Block Grants
  • Medicaid Programs
  • Home Health Services
  • Community Care for the Elderly and Disabled
    (CCPED) program
  • Services Provided
  • Providing Meals
  • Homemaker Services
  • Housekeeping
  • Transportation
  • Adult Day Care

54
Meals-On-Wheels
  • Meals-On-Wheels is a service that brings
    nutritional food straight to the homes of elderly
  • One of the best services for Hudson Countys
    elderly residents and can also be seen in many
    cities throughout the United States
  • Three agencies help to administer this program in
    Hudson County

55
Life Expectancy in Australia
  • Australians are living longer than in the past.
  • The proportion of people over 65 is 12 today and
    is expected to reach 20 by 2030.

56
Hudson County vs. Australia
  • Hudson County (and the rest of the US) provide
    nearly universal health insurance coverage for
    its 65 population
  • 1998 survey found much higher rates of access
    difficulties and costs concerns in the US,
    compared to the universal coverage in Australia

57
Health Care Access
  • 12 percent of elderly in Hudson County said it
    was extremely, very, or somewhat difficult
    to get needed medical care, compared with 6
    percent in Australia.
  • 10 percent of the elderly in Hudson County did
    not visit a doctor in the past year, compared
    with 2 percent in Australia

58
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60
Mature-age Employment Programs
  • The goals of Mature-age Employment Programs are
    to improve job opportunities and also
    employability of older people seeking employment.
  • New South Wales Mature Workers Program
  • Has been operating in Australia since 1990.
  • This program has two services
  • employment (operated through community-based
    organizations)
  • training
  • Evaluation after five years showed that 50 of
    past clients were still employed at the time of
    the survey, and most attributed this to the
    program.

61
Home and Community Care (HACC)
  • HACC is an Australian program that funds a wide
    variety of service agencies to provide a variety
    of support services for the elderly including
  • Home help cooking, cleaning, washing, ironing,
    or banking
  • Transport for medical, social, or other reasons
  • Food services meals-on-wheels, congregate meals,
    or help with grocery shopping
  • Personal care bathing and dressing
  • Health services home nursing, physiotherapy, or
    podiatry
  • Home maintenance help around the house with
    small tasks and gardening

62
Health Promotion
  • Programs to encourage healthier lifestyles and
    improved population health
  • Active Australia
  • The Food and Nutrition Policy
  • Strategic Framework for the Prevention of Chronic
    Disease
  • In recognition that falling accounts for 30 of
    all hospital admissions among the elderly,
    Australians have also developed a coordinated
    strategy to reduce falls among elderly

63
Stay on Your Feet (SOYF)
  • In recognition that falling accounts for 30 of
    all hospital admissions among the elderly,
    Australians have also developed a coordinated
    strategy to reduce falls among elderly.
  • The program addressed the following risk factors
  • Physical inactivity, poor balance and gait,
    chronic illness, poor vision, unsafe footwear,
    medication misuse, and unsafe home and public
    environments
  • The initiative resulted in a 20 reduction in
    hospitalization due to falls among the elderly

64
What Solutions Can Be Implemented ???
65
HHS ABC Radio Team Up
  • Closing the Health Gap campaign
  • designed to inform, educate, challenge and
    empower African Americans to change behaviors
    through providing lifestyle tips and info on
    local sources of health care and public health
    programs
  • All 240 of ABC radios urban advantage network
    affiliates will air messages from 10 sec. 1min
    intervals
  • HHS sec. Tommy Thompson and U.S. Surgeon general
    David Satcher will narrate other spots

66
Center for Family and Community Health (Berkeley,
CA)
  • People disadvantaged economically, educationally,
    and politically are at high risk
  • Objectives
  • 1) Developed a plan for a volunteer-run medical
    clinic to provide free, urgent care
  • 2)Secured space for the clinic from a local
    hospital
  • 3)Promote more free clinics nationwide

67
Univ. Of Alabama Center for Helath Promotion
  • Trained community advisors
  • Created a cookbook of favorite recipes modified
    for heart health and encouraged low-fat meals at
    church dinners
  • Food Stamp programs to buy fresh produce
  • Walking groups nutrition/exercise activity
  • Broadcasted educational and health promotion
    messages on radio and cable
  • Exercise room built in Community Life Center

68
Modified MD Protocol?
  • Must examine your own beliefs, stereotypes, and
    values about African Americans
  • Are my attitudes toward African Americans open,
    welcoming, and unbiased?
  • Am I well-versed in the historical background and
    contributions of African Americans to society?
  • Am I aware of the heterogeneity and diversity
    within this group?

69
Protocol Continued.
  • Can I disagree with an African American without
    feeling intimidated or guilty?
  • Am I treating African Americans with respect and
    building a level of trust with them?
  • Am I aware of their traditions, religious
    beliefs, and alternative medicinal remedies?
  • DONT MAKE AFRICAN AMERICAN PATIENTS LOSE FAITH
    IN EQUALITY IN HEALTHCARE..BE SENSITIVE TO EACH
    INDIVIDUAL AND HIS/HER NEEDS
  • They should not have to be a disappointment
    generation

70
Meharry Consortium Geriatric Education Center
(MCGEC)
  • Main Goals
  • 1. Provide healthcare and for minority elderly
  • 2. Recruit and retain students of all health
    professions in geriatrics
  • 3. Educate minority elderly of their needs and
    opportunities available to them

71
MCGEC Goals Continued
  • 4. Teach classes to health care professionals
    about the health care needs of elderly people
  • 5. Emphasize the importance of elderly in our
    diverse population
  • 6. Need-based research and gathering of data
  • 7. Distribute courses for health care
    professionals that focus on minorities and
    underserved populations of older adults

72
Church Involvement Is a Must
  • -Have programs that provide food and clothing
  • -Organized visits of the sick as well as elderly
    shutins
  • -Church plays a significant role in promoting
    self worth and self esteem through validation of
    shared beliefs and attitudes held by the
    congregation

73
More Church Influence
  • African Americans believe in traditional medicine
    or folk medicine
  • Illness is broken down into one of three
    categories natural, occult, and spiritual
  • The only cure for the latter two categories is
    God. Faith or spiritual leaders are regarded as
    divine, possessing the powerful gift of healing
    from God.

74
General Solution Agenda
  • Ideally Includes
  • Training advisors
  • Community-run activities, exercise sessions,
    interactive activities
  • Increase awareness about nutrition, health risks,
    and available opportunities
  • Meals on Wheels
  • DRTS (Demand Responsive Transportation System in
    Finland)
  • EACH (Extended Aged Care at Home in Australia)
  • Church Influence
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