a diverse & aging california health issues steven p. wallace, ph.d. professor, ucla school of...

A Diverse & Aging California Health Issues

Steven P. Wallace, Ph.D.

Professor, UCLA School of Public Health

Assoc. Dir., UCLA Center for Health Policy Research

Co-PI, Resource Centers for Minority Aging Research Coordinating Center

CCGG 2007 Annual Meeting

Outline

• Demographics of California

• Overview of health disparities from a public health perspective

• What we need to consider for the future

• Sources of information on health status of elders of color

Growing Diversity of Elderly

13.3%18.0%

21.8%27.5%

41.3%

10.0% 13.0% 14.9% 15.8% 17.1% 17.9%

5.5% 5.6% 5.3% 5.2%

70.2%

60.1%54.6%

47.5%

38.3%31.2%

35.4%

5.1% 5.5%

2000 2010 2020 2030 2040 2050year

Latino Asian African American nonLatino white

Source: California Department of Finance, May 2004www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Projections/P3/P3.asp

Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

California health disparities from a Public Health

Perspective

Geriatric Issues

• Chronic conditions: Urinary incontinence, Falls, Depression

• Health care: Polypharmacy, Oral health access, “Healthy” Death

• Environment: Social support, Healthy communities

See Wallace, Steven P. “The Public Health Perspective on Aging.” Generations. 29:2(2005) http://www.generationsjournal.org/generations/gen29-2/article_thepublichealth.cfm

Incontinence past month, women 65+

33.0%

25.7%

12.4%

25.9%

Latino AfricanAmerican

Asian nonLatinoWhite

Source: 2003 California Health Interview Survey

Multiple falls past year, age 65+

16.7%

11.3%

7.6%

11.5%

Latino AfricanAmerican

Asian nonLatinoWhite

Source: 2003 Califorian Health Interview Survey

Poor mental health past month, age 60+

29.7%27.3% 27.0%

18.2%19.1%

11.1%13.5%

7.7%

Latino AfricanAmerican

Asian nonLatinoWhite

Downhearted/sad, *all/most of the timeCalm/peaceful, *little/none of the time

Source: 2003 California Health Interview Survey

7 or more prescriptions, age 65+

69.7%

75.3%

70.6%

79.3%

Latino AfricanAmerican

Asian nonLatinoWhite

Source: 2004 MEPS

Elders w/7+ prescriptions average 1+ inappropriate medications

Could not afford needed dental care past year, age 60+

22.4%

17.2%15.9%

8.2%

Latino AfricanAmerican

Asian nonLatinoWhite

Source: 2003 California Health Interview Survey

Advance directives of nursing home residents (odds ratios)

0.64

0.07

1.05

0.340.22

0.41

living will DNR do nothospitalize

Latino African American nonLatino White

Source: Degenholtz, et al. Persistence of racial disparities in advance care plan

documents among nursing home residents. J Am Geriatr Soc. 2002; 50:378-81.

Controlling for age, gender, education, LOS, chronic diseases, dementia, physical function, cognitive status, depression

* * *

Availability of someone to help w/daily chores when sick ,age 60+

48.8% 51.9%

38.2%

62.9%

25.8%19.6%

30.0%

16.3%

Latino AfricanAmerican

Asian nonLatinoWhite

always, mostly never

Source: 2003 California Health Interview Survey

(not shown: a little, sometimes)

Neighbors are afraid to go out at night , by % poverty, age 60+

49.6%44.1% 44.2%

34.8%31.4%

22.3%

32.1%

14.2%

Latino AfricanAmerican

Asian nonLatinoWhite

<200% FPL >200% FPL

Source: 2003 California Health Interview Survey

Geriatric Issues - Summary

• Latino elderly mortality is a paradox

• Many geriatric conditions that do not contribute to death rates exhibit disparities among elders

Public health is

• Assuring the conditions under which people can be healthy (Institute of Medicine, Committee for the Study of the Future of Public

Health. The future of public health. Washington, DC: National Academy Press, 1988)

• Population / community / system focus

• Interest in prevention vs. cure

• Emphasis on health vs. disease

Types of prevention

• Primary – prevent problem from happening, e.g. immunizations

• Secondary – detect problem early and treat before serious harm results, e.g. breast cancer screening

• Tertiary – after a health problem has happened, maximize independence & quality of life, e.g. rehab, in-home supportive services

Health focus versus disease

Health is not just absence of disease

But limited funding for non-disease

programs

Photo credit: U.S. Administration on Aging

Falls - a public health approach

• Primary – Promote physical activity, monitor for polypharmacy effects, universal housing design (all older adults)

• Secondary - Strength training, environmental modifications (at risk older adults)

• Tertiary – Counseling to decrease fear of falling, improve primary care ID/treatment of falls, social support interventions

Medical care disparities

• No usual source of care

• Problem understanding the doctor

• Satisfaction with care

No usual source of care, age 60+

6.9%

2.0%

4.4%

2.8%

Latino AfricanAmerican

Asian nonLatinoWhite

Source: 2003 California Health Interview Survey

Hard time understanding doctor last visit, by language spoken at home,

age 60+

17.9%

8.9%

2.6%

9.3%

3.1%5.0%

Latino AfricanAmerican

Asian nonLatinoWhite

Spanish only English & Spanish English only

Source: 2003 California Health Interview Survey

Hard time getting needed health care past 12 months, by language

spoken at home, age 60+

10.8%

15.7%

9.3%

14.7%

11.8%

14.1%

Latino AfricanAmerican

Asian nonLatinoWhite

Spanish only English & Spanish English only

Source: 2003 California Health Interview Survey

Highest rating of health care past 12 months (10, on scale 1-10), by

language spoken at home, age 60+

59.6%

40.4%44.8%

33.0%41.2%38.5%

Latino AfricanAmerican

Asian nonLatinoWhite

Spanish only English & Spanish English only

Source: 2003 California Health Interview Survey

Conclusions

• Important disparities in geriatric health exist for elders of color

• Health care access is problematic for Latino elders; important to not only look at satisfaction as outcome for Latinos

• Public health approaches to prevention using multilevel interventions are possible to reduce those disparities

Funded by NIA since 1997, its mission is to:• Increase the number of researchers who focus on the health of

minority elders. • Enhance the diversity in the professional workforce by

mentoring minority academic researchers for careers in minority elders health research.

• Improve recruitment & retention methods used to enlist minority elders in studies so that research can accurately identify and work toward solutions to health disparities.

• Create culturally sensitive health measures that assess the health status of minority elders with greater precision, and increase the effectiveness of interventions designed to improve their health and well-being.

www.rcmar.ucla.edu

California Health Interview Survey (CHIS)

• Conducted every two years since 2001

• Telephone survey of 42,000+ households in Spanish, 4 Asian languages, and English

• Approximately 1000 Latino respondents age 60 and over

• CA has ¼ of all Latino elders nationally

• Cross sectional survey years can be combined to improve sample sizes

CHIS Topics

• Health Status

• Health Condition

• Health Behavior

• Cancer

• Medical & Dental insurance

• Access & Use of Health Care

• SES, neighborhood & housing, immigration

www.chis.ucla.edu

http://swallace.bol.ucla.edu