Disparities in Health and Treatment

1. Disparities in Health and Treatment • Seniors who belong to more than one group at risk for lower socioeconomic status are at increased risk for illness and disability. • Older women are among the most disadvantaged population • Minorities are also at risk • Having a chronic disease, whether new or pre-existing, can have a significant impact (Murray & Boyd, 2009)

2. Common Chronic Conditions Among the Elderly • Heart disease • Diabetes • Arthritis • Decreased sensory acuity • Visual • Auditory • Loss of balance, resulting in falls • Dementia and Alzheimer’s (Center’s for Disease Control, 2009)

3. 26.9% of Americans have arthritis Risk for arthritis increases with age 60% of patients dx’d with arthritis are physically inactive (Centers for Disease Control, 2009) Having both heart disease and arthritis results in people being even less compliant with exercise instructions. People with both disorders are 30% less likely to be active than those who have heart disease alone. Arthritis and Heart Disease

4. Decreased Visual Acuity • Visually impaired elderly report a lower quality of life, and more moderate or severe problems, than the general elderly population or visually impaired young adults. (van Nispen, de Boer, Hoeijmakers, Ringen, & van Rens, 2009)

5. Co-morbid Conditions with Decreased Visual Acuity • Visually impaired elderly with conditions like diabetes, COPD, asthma, CVA’s, musculoskeletal conditions, cancer or gastrointestinal issues demonstrated a rapid decline in health related quality of life. (van Nispen et al., 2009)

6. Elderly May Have Increased Risks for Falling • Increased risks related to: • Gait and balance deficits • Dizziness • Poor vision • Confusion • Side effects of medications • Muscle weakness • Urinary incontinence • Overestimating abilities after a procedure or illness (Fenton, 2008)

7. Falls • Falls are frequent occurrence both in and out of the hospital • 30 – 40% of falls in the hospital result in injury (Fenton, 2008)

8. Consequences of Falls • Injuries • Reduced confidence • Reduction in mobility • Reduced independence (Fenton, 2008)

9. An estimated 5.1 million people in U.S. have Alzheimer’s (AD) Dx if there are deficits in 2 of these 3 areas: Memory Speech & communication Ability to plan Reasoning and performance of tasks Interpretation of visual input Dementia and Alzheimer’s affect patients, families and caregivers (Murray & Boyd, 2009)

10. Dementia & AD • Dementia and AD are progressive and disabling • Quality of life for victims of dementia and AD is influenced by how they are treated • Majority of healthcare providers do not follow existing guidelines for their care, if they did care would be greatly improved (Murray & Boyd, 2009)

11. Healthcare Complications with Dementia and AD • Fragmented and complicated system of services for people with dementia and AD • High rates of comorbid conditions • Treatment decisions for co-existing medical conditions can be influenced by presence of dementia and AD • Men with AD have higher risk of dying while hospitalized than other men (Murray & Boyd, 2009)

12. Historically Disadvantaged Groups With Dementia or Alzheimer’s • Cumulative damage of a lifetime of disadvantage and lack of opportunities • Need for long-term care • High out of pocket expenses (Murray & Boyd, 2009)

13. Alzheimer’s and Dementia • Those with Alzheimer’s and dementia are often left out of decisions, even early in their disease • Increasing number of deaths attributed to Alzheimer’s • Hospice care is uncommon for patients with Alzheimer’s or dementia • Nonpalliative care measures, like feeding tubes and restraints, are frequently used with this population (Murray & Boyd, 2009)

14. Stereotypical beliefs, prejudices, and obstacles that can lead to health disparities in the elderly.

15. Ageism Defined: The stereotyping and discrimination of older people because of age with a distinct valuing of younger age groups. - passed on through socialization - enacted within institutions Phelan, 2008

16. Ageism includes: • Seeing people as a homogenous entity: • Senile • Mentally incapacitated • Asexual • Unemployable • Condition of dependence and deterioration Phelan, 2008

17. Consequences of Ageism Apathy towards treatment of the elderly Decreased social and economic participation of the elderly May result in isolation, victimization, disempowerment Old age is associated with vulnerability Brockelhurst & Laurenson, 2008

18. Elder Abuse “Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” (Department of Health and Human Services, Administration on Aging, 2009)

19. Incidence • Comprehensive data on elder abuse is not collected nationally • Estimates: • 1 to 2 million elders are abused each year • Frequency of abuse is estimated between 2% and 10% • Only 1 in 14 cases come to the attention of the authorities • There may be at least 5 million financial abuse victims each year (National Center on Elder Abuse, 2005)

20. Types of Abuse Physical abuse Emotional Abuse Sexual Abuse Exploitation Neglect Abandonment Financial (National Center on Elder Abuse, 2005; Neno & Neno, 2005)

21. Who is most likely to commit elder abuse? • 46% of abusers are related to victim • Abuser is not likely to be primary caregiver • Paid workers are the most frequent abusers (Action on Elder Abuse, 2004)

22. Risk Factors for Elder Abuse • Social isolation • History of poor relationship with abuser • Pattern of family violence, with abuser often having been abused as a child • Dependence of the victim on the abuser • History of mental illness or addiction on part of abuser (Action on Elder Abuse, 2004)

23. Warning signs Bruises, pressure marks, broken bones, abrasions, burns Unexplained withdrawal from normal activities Bruises around breasts or genital area Sudden changes in financial situation Bedsores, unattended medical needs, poor hygiene, unexplained weight loss

24. Other signs Belittling, threats, uses of power and control by spouse (or caregiver) Strained or tense relationships

25. Reporting abuse If you suspect elder abuse, neglect, or exploitation, call1-800-677-1116. U.S. Administration on Aging, 2009 If in imminent danger call 911

26. Differences in Treatment for Older Smokers • Smoking cessation is important to prevent or decrease many adverse health conditions • Patients over 65 yrs are significantly less likely to be counseled or offered prescriptions to help them quit • Older women are even less likely to receive tx (Steinburg, Akincigil, Delnevo, Crystal, & Carson, 2006)

27. Why are Older Smokers Treated Differently? • Possible belief that too much damage has already been done • Inaccurate, as quitting at any age has been shown to increase life expectancy, decrease medical complications, and increase quality of life • Previous concerns about safety of cessation medications for this population have been proven to be unfounded • Ironically, older smokers may be even more motivated to quit than younger smokers (Steinberg et al., 2006)