Published on January 16, 2008
Health Disparities in Late Adulthood: Health Disparities in Late Adulthood May L. Wykle, PhD, RN, FAAN, FGSA Dean and Florence Cellar Professor Cleveland, Ohio University of Washington School of Nursing February 21, 2007 Program Outline: Program Outline Slide3: “The cumulative effects of poverty, segregation, discrimination, racism, official neglect, and exclusionary immigration laws, experienced over a lifetime, sometimes for generations, have left their mark on the older members of minority groups now living in the United States. Generally poorer physical health and greater disability, compared to that of White persons of the same age and gender, give mute evidence of disadvantages endured.” Amasa B. Ford Vulnerable Populations: Vulnerable Populations Increased Life Expectancy: Increased Life Expectancy Source: Centers for Disease Control and Prevention (http://www.cdc.gov/) Slide10: Increased Life Expectancy Projections: Projections From 1990-2020 the elderly population is projected to increase to 54 million persons Beginning in 2011 the first members of the Baby-Boom will reach age 65 In 2020, about 1 in 6 Americans will be elderly The population of persons 85+ will increase from 4.3 million in 1990 to over 7 million by 2020 Source: U.S. Bureau of the Census Population Increase among Ethnic Minority Elderly 65+: 1990 to 2020: Population Increase among Ethnic Minority Elderly 65+: 1990 to 2020 Nursing Leadership:Challenging Unequal Health Care Among Older Adults: Nursing Leadership: Challenging Unequal Health Care Among Older Adults Slide20: 80 Percent of Older Adults Living at Home Suffer from at Least One Chronic Disease Home Care Slide21: Percent with Difficulty and Receiving Help with Selected Activities by Age Slide22: Selected Chronic Health Conditions Causing Limitation of Activity Among Working-Age Adults by Age: 2000-2002 Number of persons with limitation of activity caused by selected chronic health conditions per 1,000 population Slide23: High Risks for Minority Elders Heart disease Stroke High blood pressure Diabetes Cancer Cirrhosis of the liver African Americans Heart disease Malignant neoplasm Diabetes Chronic liver disease Cirrhosis Pneumonia / influenza American Indians/ Alaskan Natives High blood pressure Diabetes Hispanics Heart disease High blood pressure Diabetes Cancer Pacific Islanders/ Asian Americans Source: Burggraf, 2000 Co-Morbidity: Co-Morbidity Co-Morbidity (cont.): Co-Morbidity (cont.) Co-Morbidity (cont.): Co-Morbidity (cont.) Co-Morbidity (cont.): Co-Morbidity (cont.) Other Societal Trends: Other Societal Trends Caregiving as a Career Transition in Caregiving over Time: Caregiving as a Career Transition in Caregiving over Time Stage 1: Role Acquisition Recognition of need Assumption of responsibilities Stage 2: Role Enactment Performing Caregiving tasks Adopting caregiver concerns Stage 3: Role Disengagement Bereavement Social readjustment Positive Impacts of Family Caregiving: Positive Impacts of Family Caregiving Negative Impacts of Family Caregiving: Negative Impacts of Family Caregiving Outcomes: Outcomes Minority Caregivers: Minority Caregivers Minority Elders: Minority Elders Slide36: Minority Elders “Minorities have poorer health and higher death rates than whites at all age levels until very old age, when genetics are presumed to dominate longevity outcomes” (Wykle & Kaskel, 1991) Minority elders (over 65) include: Blacks Hispanics Asians and Pacific Islanders American Indians Particularly affected by the process of aging, which inflicts psychosocial changes that influence health experiences and perception of control of everyday lives Slide37: Health Care for Minority Elders Minority elders face jeopardy situations in: Age Racial and/or ethnic discrimination Income and poverty Gender (for women) Dependence on government programs Other barriers (language, culture, access to health care services, etc.) Minority elder women have higher poverty rate (12.8%) than their male counterparts (7.2%) Only 7% of practicing physicians are African American, Hispanic, or American/Alaskan Native Slide38: Factors Influencing Minority Health Status and Use of Health Care Reliance on kinship networks Preference for traditional medicines and faith healing Reliance on religious beliefs over health care system Lack of understanding and denial of illness symptoms Unwillingness to adopt the “sick role” Experience of racial segregation Suspicion of dominant culture and its institutions (Edmonds, 1990) Slide39: Factors Influencing Minority Health Status and Use of Health Care (cont.) Inadequate health care information Unrealistic perception of health status Poverty leading to inadequate health insurance, transportation, and nutrition Insensitivity of health care planners and policy makers Inadequate number of trustworthy health care practitioners Perceived or real unequal treatment in health care system (Edmonds, 1990) Slide40: Double Jeopardy Faced by African Americans as they reach elder status Indicates “the accumulation of specific disadvantages, due to old age on the one hand and minority status on the other” and is based on “greater stresses, including a long history of racism, endured by this group” (Kahana et.al., 1999) Alternatively, cultural traditions of African American elders may provide valuable coping skills Slide41: Successful Aging Stress-Theory-Based Model of Successful Aging Defined as proactive, preventive, and corrective adaptations by elders to enhance their well-being despite stressful life events Social factors such as race and culture have influence on successful aging (B. Kahana & E. Kahana, 1998) Major stressors include illness, social losses, and person-environment incongruence Factors That Influence Health: Factors That Influence Health Factors That Influence Health : Factors That Influence Health Failing health key stressor in elderly difficulties of daily activities bring stress Environment Education Factors That Influence Health: Factors That Influence Health Factors That Influence Health: Factors That Influence Health “Meaningful relationships are important in self-care education because ‘Meaning in life is ultimately linked to health’” Factors Associated with the Self Care of Home-Dwelling Elderly: Factors Associated with the Self Care of Home-Dwelling Elderly Self-Care of Home Dwelling Elderly Life Satisfaction Slide47: Health Literacy: The Hidden Key to Wellbeing and Quality of Life Slide48: Defining What We Mean Definitions of health literacy: The ability to read, understand, and act on health care information “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2010) Improves quality of life of African Americans Ensures survival of families and communities Slide49: Functional Literacy: Definition and Scope The ability to read, write, speak, and compute and solve problems at levels of proficiency necessary to: function on the job and in society achieve one’s goals develop one’s knowledge and potential Source: National Literacy Act of 1991 Slide50: Health Literacy and African Americans Health literacy is key factor to minorities’ well-being and quality of life Health information improvements that would benefit African Americans: Be more clear Include culturally sensitive text Use simple visuals Be more relevant Pay special attention to health/social needs of elders Slide51: Literacy Related Tasks for Disease Management Give information for assessments and diagnosis Monitor and describe signs and symptoms Measure and calibrate medicine Schedule and time medicines and other treatments Recognize and describe changes Understand disease, symptoms, and chronicity Understand and negotiate treatment options Slide52: A National Concern Health materials must: Be clear Display accurate information Be easy to read In the U.S.: 1 in 5 adults read at 5th grade level 2 in 5 older adults read between 1st and 5th grades Average adult reads at 8th grade level Slide53: Health Literacy Findings to Date Most health materials have been assessed at above high school level A variety of health related outcomes are linked to patients’ reading skills Knowledge Screening Following regimen Hospitalization Glucose measures in diabetes patients Slide54: Importance of Minority Health Literacy to Survival of the Family Health literacy is essential to family survival Family caregivers with low literacy skills tend to: Make more errors with medication Fail to comply with medication treatments and regimens Delay help seeking behaviors Miss opportunities for self-empowerment and decision-making in the healthcare system Patients with low literacy skills are: At higher risk for hospitalization Less able to manage their self-care when at home Slide55: Example: Asthma & Health Literacy Among African Americans Some important findings:* Limited knowledge leads to low self-care Those with low skills in using inhalers were at more risk for health complications Patients with low literacy had more ER visits Poor knowledge leads to higher use of health care services Low literacy patients without asthma symptoms did not know to continue seeking care Low literacy patients had low self-esteem Low quality of life led to higher mortality/morbidity Health disparities were experienced in this group * SOURCE: Williams, Baker, Honig, Lee, & Nowlan, 1998 Conclusions: Conclusions
Factors That Influence Health• Attitudes/Self-Concept Judgment of self“Elders who believe their health is good are less likely to interpret their ...
Now playing: "Cindy" Most Photos by Okey L. King Wykle Reunion 2007. The old homeplace Hobert Wykle is being restored.....On Saturday, June 30, 2007, some ...