MIDLIFE WOMEN’S HEALTH

1. MIDLIFE WOMEN’S HEALTH DHHS OFFICE ON WOMEN’S HEALTH WOMEN’S POLICY, INC. CONGRESSIONAL CAUCUS FOR WOMEN’S ISSUES WOMEN’S HEALTH TASK FORCE

2. Women’s Health and Healthy Aging:Living Longer, Living Better Darlene Yee-Melichar, EdD, CHES Professor and Coordinator, Gerontology Program San Francisco State University dyee@sfsu.edu

3. Overview • Demographic Imperatives Aging in America Feminization of America Diversity in Aging America • Health Indicators Life Expectancy Leading Causes of Death Multiple Chronic Conditions Activity Limitations and Disabilities • Health Care Challenges Healthcare Access for Midlife Women Multi-Level Approach to Healthy Aging Consumer Health and Health Literacy Comprehensive Geriatric Assessment Midlife Women and Caregiving

4. Aging in Americahttp://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf

5. Feminization of Americahttp://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf

6. Diversity in Aging

7. Diversity in America

8. Life Expectancy

9. Leading Causes of Death for White American Women http://www.4woman.gov/owh/pub/minority/table1.htm

10. Leading Causes of Death for African American/Black Womenhttp://www.4woman.gov/owh/pub/minority/table1.htm

11. Leading Causes of Death for Hispanic Women http://www.4woman.gov/owh/pub/minority/table1.htm

12. Leading Causes of Death forAsian/Pacific Islander Women http://www.4woman.gov/owh/pub/minority/table1.htm

13. Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over the Past 10 Years 1999–2000 2009–2010 Age in years Percent SE Percent SE 45–64 Total 16.1 0.3 21.0 0.4 Men 15.2 0.5 20.6 0.6 Women 16.9 0.4 21.3 0.5 65 and over Total 37.2 0.5 45.3 0.6 Men 39.2 0.8 49.0 0.9 Women 35.8 0.6 42.5 0.8 NOTE: SE is standard error. SOURCE: CDC/NCHS, National Health Interview Survey.

14. Activity Limitations and Disabilitieshttp://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf

15. Healthcare Access for Midlife Women Access to health care for midlife women is a challenge: • Cost: may not have health insurance and often can’t afford it • Transportation: have no way to get to a doctor or other health care providers • Sandwich generation: have major caregiving duties for younger and/or older family members • Low health literacy: don’t understand the language and/or the health information

16. Multi-Level Approach to Healthy Agingand Continuum of Health Care • Primary Prevention (health promotion and disease prevention) • Secondary Screening (monitoring and tracking the disease) • Tertiary Treatment (rehabilitation and treatment)

17. Consumer Health and Health Literacy • The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions (U.S. DHHS, 2000). • Low health literacy is a widespread problem, affecting more than 90 million adults in the U.S. • Results in patients’ inadequate engagement in, and benefit from, health care advances as well as medical errors. • Is likely to be a major contributor of adverse health outcomes.

18. Comprehensive Geriatric Assessment and Geriatric Care Coordination • History and Physical Examination • Functional Assessment • Mental Assessment • Psychological Assessment • Social Assessment • Values Assessment • Health Promotion and Disability Prevention

19. Midlife Women and Caregiving • Estimates of the percentage of family or informal caregivers who are women range from 59% to 75%. • The average caregiver is age 46, female, married and working outside the home earning an annual income of $35,000. • Although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers. • One study concluded that the caregiving time burden falls most heavily on lower-income women: 52% of women caregivers with incomes at or below the national median of $35,000 spend 20+ hours each week providing care. Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480

20. Midlife Women and Eldercare One national study on women and caregiving highlighted the conflicting demands of work and eldercare. The study found that: • 33% of working women decreased work hours • 29% passed up a job promotion, training or assignment • 22% took a leave of absence • 20% switched from full-time to part-time employment • 16% quit their jobs • 13% retired early Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480

21. Negative Health Effects of Caregivingon Midlife Women • As many as two out of three older women do not take advantage of preventive health services due to lack of information and high out-of-pocket costs. • 25% of women caregivers have health problems as a result of their caregiving activities. • Coronary heart disease (CHD) is one physical risk factor of caregiving. Women who spend nine or more hours a week caring for an ill or disabled spouse increase their CHD risk twofold. • Other health effects include elevated blood pressure and increased risk of developing hypertension; lower perceived health status; poorer immune function; slower wound healing; and an increased risk of mortality. Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480

22. A Call for Action • Call attention to the importance of midlife women’s health and its contribution to overall (family) health, the need for increased access to health care for midlife women, and the need for more research and training funds targeting women’s health and healthy aging. • Increase funding for women’s health research, especially for subpopulations of women, including midlife women, older women, and women of color. • Expand women’s health services and the education and training of geriatric physicians, gerontologists and other women’s health professionals. • Reinforce the important need for the Consumer Bill of Rights in relation to improving consumer health and health literacy which are essential to midlife women’s health and healthy aging.

23. Resources AoA website http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf CDC website http://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf DHHS-OWH websites http://www.womenshealth.gov/ http://www.4woman.gov/owh/pub/minority/index.htm http://www.4woman.gov/owh/pub/minority/table1.htm Family Caregiver Alliance http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480 HRSA website http://mchb.hrsa.gov/whusa08/index.html NIH-ORWH websites http://www4.od.nih.gov/orwh http://www4.od.nih.gov/orwh/decade-2.pdf Women of Color Health Data Book http://orwh.od.nih.gov/pubs/WomenofColor2006.pdf

24. Resources (continued) Agenda for Research on Women's Health for the 21st Century, Volume 7 (This is a brief summary of an 8 volume set. Volume 8 is available in Spanish) http://www4.od.nih.gov/orwh/agenda-vol7.pdf NIH Publications on Women's Health Issues (Contains women's health publications and contact information for each NIH Institute or Center) http://www4.od.nih.gov/orwh/NIHPubs.pdf Science Meets Reality: Recruitment and Retention of Women in Clinical Studies, and the Critical Role of Relevance (Proceedings from a national meeting looking at lessons learned, continuing challenges and ethical and policy issues in recruiting and retaining clinical research participants). http://www4.od.nih.gov/orwh/SMR_Final.pdf

25. Resources (continued) Yee-Melichar, D., Flores, C.M., and Cabigao, E.P. Long-Term Care Administration and Management: Options, Issues and Trends in Effective Elder Care. New York, Springer Publishing Company. (pending) Yee-Melichar, D. (2010). Resilience in Aging: Cultural and Ethnic Perspectives. In Resilience in Aging. Edited by Barbara Resnick, Lisa Gwyther and Karen A. Roberts. New York, NY: Springer-Verlag New York, Inc. Yee-Melichar, D., Renwanz-Boyle, A. and Flores, C. (2010). Assisted Living Administration and Management: Effective Practices and Model Programs in Elder Care. New York, Springer Publishing Company. Yee-Melichar, D. (2010). Key Moment in History—1987: GSA Launches Minority Issues Task Force. Gerontology News, 6(1), 7. Yee-Melichar, D. (2010). Housing: Experts Corner—Assisted Living. In The Aging Network: A Guide to Programs and Services for Older Americans by K. Niles-Yokum and D.L. Wagner. New York, Springer Publishing Company.

26. Resources (continued) Yee, D. (2004) “Aging Asian Americans and Health Disparities.” In Closing the Gap: Improving the Health of Minority Elders in the New Millennium. Gerontological Society of America, Washington, DC. Markson, E. and Yee, D. (2004). The Older Woman. In AGHE brief bibliography: A selective annotated bibliography for gerontology instruction [CD-ROM]. Washington, DC: Association for Gerontology in Higher Education. Yee, D. “Overview of Asian American Women As Research Subjects.” In Proceedings of the First National Clinical Trials and Asian American Women Summit. Washington, DC: National Institutes of Health, 3(3):1-12, 1998. Yee, D. "Issues and Trends Affecting Asian Americans, Women and Aging." In Women and Aging: A Research Guide. Edited by Jean M. Coyle. Westport, CT: Greenwood Publishing Group, Inc., 1997.

27. Comments? Questions? Thank You. Dr. Darlene Yee-Melichar Professor and Coordinator Gerontology Program College of Health and Social Sciences San Francisco State University 1600 Holloway Avenue San Francisco, CA 94132 (415) 338-3558 dyee@sfsu.edu