vulnerable population: the elderly by laurie brummett and susan goo california state university,...
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Vulnerable Population: The Elderly
by
Laurie Brummett and Susan Goo
California State University, Fullerton
Department of Nursing
N508: Advanced Practice Nursing
Vulnerable Populations
Objectives #1. Apply the Integrated Model of Health Disparities
Framework (Institute of Medicine) to identify factors that contribute to health disparities in the elderly.
#2. Identify stereotypical beliefs, prejudices, and
obstacles that can lead to health disparities in the elderly.
#3. Explore the role of culturally competent care in
reducing health disparities and promoting optimal health in the elderly.
DemographicsDemographics
Trends and statistics concerning the elderly population in the
United States
Statistics on 65+ in the U.S. In 2003, 35.9 million were over 65 or 12% of
the population. Between 2010 and 2030 Baby Boomers will
turn 65. By 2030 the older population will be twice as
large as 2000 (72 million!).
People are living longer
Life expectancy has increased – In 2000, life expectancy at birth was 76.9– In 1900, it was 47.3– Due to Improvements in medicine, science,
public health and technology
Disparities in life expectation
Gender gap– Female life expectancy higher than males at
most ages– Both White and Black women live longer
than males– Attributed to attitudes, behaviors, social
roles, and
biological risks.
In 2000, females life expectancy: 79.5; vs. males: 74.1
FACTORS THAT INFLUENCE BEFORE CARE, ACCESS TO CARE, AND HEALTHCARE DELIVERY IN THE ELDERLY
Health – Before Care Disparities Income levels, poverty, other social
conditions Safety and adequacy of housing Employment status and type of
employment Education levels Lifestyle choices – diet, exercise, tobacco
and alcohol use Environmental conditions
Living arrangements About 30.2% (10.9 million) of all
noninstitutionalized older persons in 2007 lived alone (7.9 million women, 2.9 million men).
Percentage of institutionalized elderly increases significantly with age:– 1% of persons 65-74 years– 4% of persons 75-84 years – 15% for persons 85+
Approximately 2%-5% lived in senior housing with at least one supportive service available
Living with a spouse
Over half (55.3%) the older noninstitutionalized persons lived with their spouse in 2007.
The proportion living with their spouse decreased with age, especially for women.
Only 30.1% of women 75+ years old lived with a spouse.
(Based on data from the Bureau of the Census including the 2007 Current Population Survey, Annual Social and Economic Supplement and the 2007 American Community Survey. See: March 2008 Current Population Survey Internet releases, Detailed Tables and unpublished data from the Centers for Medicare and Medicaid Services.)
Racial Gaps2000 Statistics
Blacks: life expectancy 71.7 compared to 77.4 for whites
National Center for Health Statistics (NCHS) does not produce official life tables for races other than Whites and Blacks
Problems with data quality does not allow comparisons for the Hispanic population.
U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging; U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.
Projected Distribution of 65+ by Race and Hispanic Origin
Projected Distribution of 65+ Population, by Race and Hispanic Origin2000 and 2050
8.1%12.2%
5.6%
83.5%
2.4%
40.0%
6.5%
16.4%
64.2%60.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Non-Hispanic White Non-Hispanic Black Non-HispanicAmerican, Indian
and Alaska Native
Non-HispanicAsian and Pacif ic
Islander
Hispanic
2000
2050
The Older Hispanic Population
The Hispanic older population was 2.5 million in 2007 and is projected to grow to over 17 million by 2050.
By 2019, the Hispanic population aged 65 and older is projected to be the largest racial/ethnic minority in this age group.
Percentage of 65+ Population Living in Poverty,by Selected Characteristics, 1998
10.5
16.0
21.026.4
8.2
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Total
Non-Hispanic White
Non-Hispanic Asian and Pacific Islander
Hispanic
Non-Hispanic Black
Poverty About 3.6 million elderly persons (9.7%)
were below the poverty level in 2007. Another 2.4 million or 6.4% of the elderly
were classified as "near-poor" (income between the poverty level and 125% of
this level). Current Population Survey, Annual Social and Economic Supplement, “Income,
Poverty and Health Insurance Coverage in the United States, 2007” by the U.S. Bureau of the Census, census bureau website.
Homelessness among the elderly
Many elderly have limited fixed incomes
In no state does Supplemental Security Income (SSI) pay enough to afford housing at the Free Market Rate
For every unit of affordable elderly housing there are 9 people waiting
(National Coalition for the Homeless, 2008)
Decreased Life Expectancy for Homeless Elderly
Poor aged 50 – 65 fall through the cracks, as not eligible for Medicare
Homeless aged 50 – 65 are more like 70 yr olds
Life expectancy of homeless is 42 – 52 yrs
Homeless elderly more likely to have depression and dementia
(National Coalition for the Homeless, 2008)
Homeless Elderly at High Risk for Victimization
Homeless elderly more likely to sleep on the streets because of:– Distrust of crowds– Inability to wait in long
lines for a bed– Inability to climb stairs of
shelter Police more likely to
ignore victimization of elderly homeless
(National Coalition for the Homeless, 2008)
Employment
In 2007, 5.8 million (16.0 %) Americans age 65 and over were in the labor force
Includes 3.2 million men (20.5%) and 2.6 million women (12.6%).
Employment rate for the 65-69 year olds has been continuing to rise slightly over the past several years.
Current Population Survey, U.S. Bureau of the Census, http://www.bls.gov/cps/home.htm
Education
The percentage of 65+ who had completed high school varied by race and ethnic origin in 2007: – 81.1% of Whites, – 71.7% of Asians and Pacific Islanders, – 57.4% of African-Americans, and – 42.2% of Hispanics
Health -Access to Care
Financial resources Availability and proximity of providers Access to transportation Insurance coverage Regular source of care Language barriers Legal barriers Prior experience with the health care system Cultural preferences Health literacy levels Diversity of the healthcare workforceKosoko-Lasaki, Cook & O’Brien, 2009
Elderly Health Insurance(Source:, "Income, Poverty, and Health Insurance Coverage in the United States: 2007," P60 235, issued August, 2008, by the U.S. Bureau of the Census. Medicare beneficiary data is from the Medicare Current Beneficiary Survey)
Figure 8:
That’s not the whole story…
In 2006 older consumers averaged out-of-pocket health care expenditures of $4,631, an increase of 62% since 1996.
The elderly spent 12.7% of their total expenditures on health, more than twice the proportion spent by all consumers (5.7%).
Sources: Data releases from the web sites of the National Center
for Health Statistics (including the Health Data Interactive data warehouse, accessed 12/30/2008); from the Agency for Healthcare Research and Quality and from the Bureau of Labor Statistics web site)
What about the undocumented elderly?
Who can apply for Social Security?-If you're a non-citizen applying to enter the U.S., you must:
-Request a Social Security number card as part of your immigrant visa application;
-Be age 18 or older when you arrive in the U.S.; and
- Be a lawfully admitted permanent resident. (www.socialsecurity.gov)
Health Literacy
Health Literacy
Common health problems of the elderly
In 2004-2005 – hypertension (48%), – diagnosed arthritis (47%), – all types of heart disease (32%), – any cancer (20%), – diabetes (16%), and – sinusitis (14%). Sources: Data releases from the web sites of the National Center for Health Statistics
(including the Health Data Interactive data warehouse, accessed 12/30/2008); from the Agency for Healthcare Research and Quality and from the Bureau of Labor Statistics web site
Prevalence of Hypertension
208.1
337.9 338.7
439.2
376.9
543.8
0
100
200
300
400
500
600pe
r 100
0
45-64 65-74 75+
Age
WhiteBlack
(NHIS, 1994)
Varying Risks for Heart Disease
Death Rate for Heart Disease by Sex, Race, and Age, US, 1996
1.00
2.50
1.63
2.42
0.00
1.00
2.00
3.00
Race
Ag
e A
dju
ste
d D
ea
ths
pe
r 1
00
,00
0
p
op
ula
tion
usi
ng
Wh
ites
as
Ind
ex
White Black Hispanic Native Americans
Health care access
In 2007, over 96% of older persons reported that they did have a usual place to go for medical care.
only 2.5% said that they failed to obtain needed medical care during the previous 12 months due to financial barriers.
Older persons averaged more office visits with doctors in 2005 than other ages
Sources: Data releases from the web sites of the National Center for Health Statistics (including the Health Data Interactive data warehouse, accessed 12/30/2008); from the Agency for Healthcare Research and Quality and from the Bureau of Labor Statistics web site
NutritionNutrition Screening Initiative (NSI) estimates malnutrition among
•40 – 60% of elderly in hospitals
•40 – 85% of nursing home residents
•20 – 60% of elderly home care patients
(DiMaria-Ghalili & Amella, 2005)
Causes of Malnutrition in the Elderly
• Inadequate intake
• Malabsorbtion
• Loss of nutrients r/t physiological disorders like:
• diarrhea• hemorrhage• renal failure
• Drug or alcohol addiction
• Infection
(DiMaria-Ghalili & Amella, 2005)
Emic Perspective
Perception of Health
Overall, in 2007, 39% of noninstitutionalized elderly saw their health as excellent or very good– Of African Americans: 23.7%– American Indians: 24.3%– Older Hispanics: 28.9%
Most elderly have at least one chronic condition Many have multiple conditionsSources: Data releases from the web sites of the National Center for Health Statistics
(including the Health Data Interactive data warehouse, accessed 12/30/2008); from the Agency for Healthcare Research and Quality and from the Bureau of Labor Statistics web site)
Satisfaction with Health CareSources: Data releases from the web sites of the National Center for Health Statistics (including
the Health Data Interactive data warehouse, accessed 12/30/2008); from the Agency for Healthcare Research and Quality and from the Bureau of Labor Statistics web site)
Total Non-Hispanic Non-Hispanic HispanicWhite Black
Percent Reporting Difficulty 2.3 2.1 3.8 2.9Obtaining CarePercent Reporting They 5.5 5.0 9.6 7.3Delayed Getting CareDue to CostPercent Reporting They 3.0 2.9 2.5 3.7Were Unsatisfied or VeryUnsatisfied with Health Care