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Health Disparities Among Older People

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Title: Health Disparities Among Older People


1
Health Disparities Among Older People
  • Presentation for
  • Minnesota Gerontological Society
  • Webinar
  • October 19, 2009
  • LaRhae Knatterud, MAPA

2
Definition of Health Disparity
  • Differences in health status between a defined
    portion of the population and the majority.
    Disparities can exist because of socioeconomic
    status, age, geographic area, gender, race or
    ethnicity, language, customs and other cultural
    factors, disability or special health need. (MN
    Dept of Health)
  • There is considerable dispute globally regarding
    what is avoidable disparities and what is not,
    e.g., unequal access to clean air and water. U.S.
    tends not to distinguish between these, and most
    disparities are considered avoidable.

3
Factors in Health Disparities
  • Individual Factors
  • Age
  • Genetics
  • Health behaviors
  • Chronic illness
  • Community Factors
  • Education
  • Health care access
  • Community norms
  • Neighborhoods
  • System Factors
  • Health care
  • Local public health
  • Social services
  • Social, economic and health systems

4
Approach to Measuring Disparity
  • Most common method is to compare health of one
    group defined as a reference group with the
    health of other groups.
  • Examples of common measures of health disparities
    for older people are
  • Life expectancy
  • Chronic disease prevalence and incidence rates
  • Utilization of health care services

5
Most Frequent Disparities Found
  • For all ages, including the older population, the
    most frequent disparities are in health status
    and health care utilization for elders in ethnic,
    immigrant and tribal communities.
  • While these non-white groups of elders are still
    a small proportion of Minnesotas 65 population,
    they are growing.
  • Between 2000 and 2030, nonwhite elders will grow
    from 2 to 7 of 65 population.

6
Example of Health Disparity/Not
  • Cancer
  • Breast cancer mortality rate in Minnesota is 50
    higher in black women than in white non-Hispanic
    women even though the incidence rates are
    similar. More black women have cancer diagnosed
    at a later, less treatable stage.
  • Arthritis (Not considered a health disparity)
  • Risk factors associated with increased risk are
    not modifiable and include gender, age and
    genetic predisposition.

7
  • Some Specific Disparities
  • in Minnesotas Older Population

8
Common Health Disparity Elements
  • Disease rates
  • Obesity rates, physical activity rates and
    tobacco use
  • Injury rates
  • Health insurance coverage rates
  • Health care utilization rates
  • Rates of mental health impairments (Alzheimers)

9
Fall-related Injuries and Death
  • By location MN rural elders are more likely to
    be hospitalized from falls than urban elderly
    (48.5 vs 44.44)
  • By gender 70 of those treated for falls are
    older women, 30 are older men
  • By age group - patients aged 75 to 84 years old
    accounted for the largest proportion of injurious
    fall-related ED visits among the elderly (40.3
    percent), followed by patients 85 years and older
    (32.4 percent) and patients 65 to 74 years (27.3
    percent).
  • By race - White elders are more likely to
    experience falls
  • Housebound status and living alone are risk
    factors
  • Deaths from motor vehicle crashes are much
    higher in rural than urban Minnesota -25.8 vs
    17.2 per 100,000

10
Health Care Access and Use
  • By location fewer rural elders say their health
    is excellent than urban elders (22 vs 27)
  • By gender women use health care more than men
    (true for all ages)
  • By age access and use increase with age
  • By race access and use is more limited for
    nonwhite elders in Medicaid, there are still
    access and use issues tied to cultural competence

11
Health Literacy
  • By gender older men are more likely to have
    health literacy issues than women
  • By race - up to 20 percent of Spanish-speaking
    Latinos do not seek medical advice due to
    language barriers. Asians and Hispanics often
    report difficulties understanding written
    information from doctor's offices and
    instructions on prescription bottles. Up to 40
    percent of African-Americans have problems
    reading
  • By education two-thirds of elders 60 have low
    to marginal reading skills. Adults with poor
    literacy are likely to have three times as many
    prescriptions filled as adults with higher
    literacy

12
Rates of Chronic Conditions
  • By location MN rural elders had higher
    mortality rates in all top leading causes of
    death than urban elders (926.2 vs 633.6 per
    100,000)
  • By gender men die at higher rates than women in
    all leading causes of death
  • By race death rates from top leading causes of
    death are higher for African-American (40 higher
    for men and 20 higher for women). While death
    rates for Hispanic, Asian and Indian are lower
    than these, they experience higher mortality from
    cancers due to later diagnosis and shorter
    survival periods. Current and cumulative lifetime
    exposure to avoidable and unavoidable risk
    factors and risk behaviors have major impact on
    poor health outcomes
  • Heart disease, cancer, stroke, injury and COPD

13
Alzheimers and Related Conditions
  • Gender women more likely than men because the
    live longer than men (16 vs 11 of persons 71)
  • Age prevalence in older age groups is higher.
    13 of persons 65 have Alzheimers, and 50 of
    those are 85
  • Education those with lt12 yrs of education have
    35 greater risk of developing dementia than
    those with gt15 yrs of education
  • Race African-Americans are reported to be more
    likely than whites to have the disease, but
    further analysis shows that the differences are
    largely explained by factors other than race

Source http//alz.org/national/documents/report_a
lzfactsfigures2009.pdf
14
  • National and State Resources
  • on Health Disparities of Older People

15
National Report Card on Healthy Aging
  • Provides state-by-state report card on 15
    indicators of healthy aging
  • Examples include (and MN rankings are)
  • health status (lower third in disability)
  • health behaviors (top in regular physical
    activity, but lower third in obesity)
  • Preventive care and screening (best ranked state)
  • Injuries (lower third)

16
Minnesota Department of Health
  • Health Promotion and Chronic Disease Division
  • http//www.health.state.mn.us/divs/hpcd
  • Eliminating Health Disparities Initiative (EHDI)
  • http//www.health.state.mn.us/ommh
  • Behavioral Risk Factor Surveillance system
    (BRFSS)
  • http//www.health.state.mn.us/divs/idepc/diseases/
    flu/brfssmn.html
  • Statewide Health Improvement Program (SHIP)
  • http//www.health.state.mn.us/healthreform/ship

17
Data from Minnesota BRFSSHow is your general
health? (2008)
18
University of Minnesota
  • Health Disparities Working Group
  • http//www.sph.umn.edu/faculty/research/hdwg/train
    ing.html
  • http//www.sph.umn.edu/faculty/research/hdwg/home.
    html
  • Center on Aging/MN Chair in LTC and Aging
  • http//www.hpm.umn.edu/coa

19
Minnesota Board on Aging and Area Agencies on
Aging
  • Chronic Disease Self- Management
  • Partnership with MDH and local public health
    agencies
  • Group education of older people at two-hour
    sessions for six weeks to improve health literacy
    and provide support as individuals learn better
    methods for self-management
  • Collecting data on improvement in health and
    change in behaviors
  • Working with older people in ethnic, immigrant
    and tribal communities

20
Minnesota Board on Aging andArea Agencies on
Aging
  • A Matter of Balance
  • Project to reduce fear of falling and increase
    behaviors to reduce falling among older people
  • Partnership between aging and local health
    networks (and AoA/MBA and MDH)
  • Trainers in all areas of state, including tribal
    organizations, to train organizations serving
    older persons in education and assessment of risk

21
Minnesota Dept of Human Services
  • Disparities and Barriers to Utilization Among
    Minnesota Health Care Program Enrollees,
    describes findings based on a statewide survey of
    4,626 enrollees.
  • About 7 of those surveyed were 65 enrollees,
    many of whom are members of ethnic, immigrant and
    tribal communities.
  • They reported their main problems with language,
    culture and religion in the receipt of services,
    as well as worries that they would not be able to
    afford services or services would not be covered.
  • Strategies to address these issues include making
    programs and related paperwork simpler and less
    complex to reduce misunderstandings.
  • http//edocs.dhs.state.mn.us/lfserver/Legacy/DHS-5
    852-ENG

22
Minnesota Dept of Human Services
  • Profiles of elders from ethnic, immigrant and
    tribal communities enrolled in Minnesota Senior
    Health Options indicate that less than 50 of
    elder enrollees speak English, and that they
    speak 24 non-English languages.
  • There are many ways that cultural differences
    require accommodations in how care is delivered,
    what services are provided or not provided, and
    how delicate or taboo subjects are discussed.

23
Minnesota Dept of Human Services
  • Strategies that are successful in increasing
    access to quality care
  • Many experts are concluding that the model of
    health care home is a very effective strategy for
    providing quality health care to elders in
    ethnic, immigrant and tribal communities.
  • It allows key care providers to spend more time
    with elder and focus on their special needs and
    their unique cultural/religious situation.
  • Primary prevention is effective strategy for
    whole populations.

24
Hennepin County SHAPE
  • SHAPE is a series of surveys collecting
    information on the health of Hennepin County
    residents and factors that affect it. More than
    10,000 households in the county participated in
    the SHAPE 2006 survey, providing information on
    8,000 adults and 4,000 children.
  • SHAPE is a project of the Hennepin County Human
    Services and Public Health Department, with
    University of Minnesota.
  • Interactive Adult Data Book is online and provide
    cross tabs on results by 10 small geographic
    areas in the county and for selected racial and
    ethnic groups.
  • Data is available for 1998, 2002 and 2006
    surveys.
  • http//www.co.hennepin.mn.us and search for SHAPE.

25
Conclusions
  • The most important determinant of health is
    environmental conditions, followed by lifestyle.
  • Medical care ranks third as a determinant of
    health.
  • The chief underlying cause of health disparities
    is increasingly understood to be social and
    economic inequality i.e., social bias, racism,
    limited education, poverty, and related
    environmental conditions that either directly
    produce ill health or promote unhealthy behaviors
    that lead to poor health.
  • In order to reduce the occurrence of health
    disparities, instead of just treating already
    high rates of disease, preventive action must
    also occur at the systems level.
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