Health and The ElderlyHealth and The Elderly

Mark AbdelmalakMark Abdelmalak

Hany Fahim Hany Fahim

Ricken Patel Ricken Patel

Dheeraj MuddasaniDheeraj Muddasani

Darshan VaidyaDarshan Vaidya

What Is the Problem?What Is the Problem?

The elderly African American population has a The elderly African American population has a disproportionately higher risk for negative health disproportionately higher risk for negative health outcomes in comparison to Americans of outcomes in comparison to Americans of European descentEuropean descent

The QuestionThe Question

What factors contribute What factors contribute to the disparity to the disparity between the health between the health status of African status of African Americans versus the Americans versus the elderly of other races?elderly of other races?

Need to explore this from a Need to explore this from a life-course frameworklife-course framework

Population DistributionPopulation Distribution

In 2000, persons of In 2000, persons of age 65+ numbered 35 age 65+ numbered 35 million, or 12.4% of the million, or 12.4% of the U.S. PopulationU.S. Population

16.4% of the 35 million 16.4% of the 35 million elderly were minorities, elderly were minorities, with a distribution as with a distribution as shownshown

African Americans

Asian/Pacific Islander

American Indian / Native Alaskan

Hispanic Orign

Other

Leading Causes of Death Among Leading Causes of Death Among African Americans Age 65+African Americans Age 65+

1)      Heart Disease 1)      Heart Disease 2)      Cancer2)      Cancer 3)      Stroke3)      Stroke 4)      Diabetes4)      Diabetes 5) Pneumonia /Influenza 5) Pneumonia /Influenza

Truth may be hard to accept…Truth may be hard to accept…

African Americans are two times more likely than African Americans are two times more likely than whites to have diabeteswhites to have diabetes

Higher lung and prostate cancer incidence and Higher lung and prostate cancer incidence and mortality than whites in all age groupsmortality than whites in all age groups

30% more likely to die of heart disease (1 in 3 30% more likely to die of heart disease (1 in 3 hypertension)hypertension)

Highest overall risk of kidney diseaseHighest overall risk of kidney disease Stroke death rate 33% higher than white womenStroke death rate 33% higher than white women Rate of CV disease 80% higher than rate for white Rate of CV disease 80% higher than rate for white

womenwomen

““When America Gets a Cold, African When America Gets a Cold, African Americans Get Pneumonia!!”Americans Get Pneumonia!!”

47% of elderly African-Americans received 47% of elderly African-Americans received the flu vaccine in 1998 vs. 66% of elderly the flu vaccine in 1998 vs. 66% of elderly whiteswhites

26% of elderly African-Americans received 26% of elderly African-Americans received the pneumonia vaccine in 1998 compared the pneumonia vaccine in 1998 compared with 50% of elderly whiteswith 50% of elderly whites

Discriminatory Hospital Care for Seriously Ill Discriminatory Hospital Care for Seriously Ill Elderly BlacksElderly Blacks

• • Dr. John Z. Ayanian asserts, “black Dr. John Z. Ayanian asserts, “black Medicare patients hospitalized for heart Medicare patients hospitalized for heart failure or pneumonia in three large States failure or pneumonia in three large States received poorer overall quality of care than received poorer overall quality of care than other Medicare patients treated for the same other Medicare patients treated for the same illnesses.”illnesses.”

Dr. John Ayanian’s FindingsDr. John Ayanian’s Findings

32% of black pneumonia patients given 32% of black pneumonia patients given antibiotics w/in 6 hrs. of admission, antibiotics w/in 6 hrs. of admission, compared with 53% of other Medicare compared with 53% of other Medicare patientspatients

Blacks less likely to have had blood cultures Blacks less likely to have had blood cultures collected on 1collected on 1stst or 2 or 2ndnd day of hospitalization day of hospitalization

Disparities = 1 additional death per 200 Disparities = 1 additional death per 200 patients treatedpatients treated

Cardiovascular DiseaseCardiovascular Disease

      Cardiovascular disease is one of the leading causes of mortality today.

       Coronary heart disease accounts for 70 to 80 % of deaths in men and women in adults over 60 years of age.

      Congestive Heart Failure (CHF), is the most common cause of hospitalization in the elderly.

      Cardiovascular disease is an important public health problem in AfricanAmericans. In 1998, cardiovascular disease accounted for 34% of deaths inblack men and 41% of deaths in black women

African Americans have a disproportionately high rate of hypertension.

Diabetes Mellitus Diabetes Mellitus

When tested, Diabetes mellitus occurred in When tested, Diabetes mellitus occurred in 127 of 1150 whites (11%), in 93 of 444 127 of 1150 whites (11%), in 93 of 444 African-Americans (21%), and in 4 of 28 African-Americans (21%), and in 4 of 28 Asians (14%). Asians (14%).

The prevalence of diabetes mellitus in 2003 The prevalence of diabetes mellitus in 2003 older persons seen in an academic hospital-older persons seen in an academic hospital-based geriatrics practice was 17% and was based geriatrics practice was 17% and was greater in African-Americans than in whites greater in African-Americans than in whites

Life Expectancy by Age Group and Race, in Years, 1997

Life Expectancy White Black

At Birth 77.1 71.1

At Age 65 17.8 16.1

At Age 85 6.2 6.4*

Source: Administration on Aging, 2000

Who Lives Longer?Who Lives Longer?

Life ExpectancyLife Expectancy

Life expectancy at birth has historically been Life expectancy at birth has historically been shorter for African Americans than older shorter for African Americans than older Americans, but the differences disappear or Americans, but the differences disappear or reverse themselves at older ages, creating the reverse themselves at older ages, creating the “Crossover Phenomenon.”“Crossover Phenomenon.”

As of 1997, Black women in the U.S. has a life As of 1997, Black women in the U.S. has a life expectancy at birth of 74.7 years, and Black men expectancy at birth of 74.7 years, and Black men 67.2 years. 67.2 years.

At age 85, life expectancy for Black women is 6.7 At age 85, life expectancy for Black women is 6.7 years and 5.7 years for Black men. years and 5.7 years for Black men.

Population growth and Population growth and distributiondistribution

There has been continuous growth in the There has been continuous growth in the overall population of blacks in the United overall population of blacks in the United states since 1790.states since 1790.

In 1970 there were 22 millions blacks in the In 1970 there were 22 millions blacks in the United states, of whom approximately 1.5 United states, of whom approximately 1.5 million or 7 % were 65 years of age or older. million or 7 % were 65 years of age or older. Since 1970 there has been considerable Since 1970 there has been considerable growth in the population of blacks 65 and growth in the population of blacks 65 and over.over.

Health HistoryHealth History

There is a general agreement that blacks There is a general agreement that blacks elders have traditionally been treated with elders have traditionally been treated with great respect in their families.great respect in their families.

This tradition extends from known cutoms of This tradition extends from known cutoms of proslavery civilization on the African proslavery civilization on the African continent through modern customs African continent through modern customs African Americans families and kinship groups in Americans families and kinship groups in the United States.the United States.

Health History Cont’dHealth History Cont’d

African American elders tend to precieve African American elders tend to precieve their health as more problematic than do their health as more problematic than do white elders.white elders.

17% of African American rate their health as 17% of African American rate their health as poor, as compared with 7% of white elders.poor, as compared with 7% of white elders.

Life Course frameworkLife Course framework

Blacks who grew old in the United States had to Blacks who grew old in the United States had to withstand a variety of psychologically, physically withstand a variety of psychologically, physically and socially degrading experiences resulting from and socially degrading experiences resulting from the political economy of race relations in the the political economy of race relations in the United States. (i.e. slavery, CRM, social United States. (i.e. slavery, CRM, social maltreatment, Tuskegee experiment….)maltreatment, Tuskegee experiment….)

Among the determinates of the treatment of Among the determinates of the treatment of elderly Blacks in the social history of the U.S., elderly Blacks in the social history of the U.S., economic factors had a significant bearing.economic factors had a significant bearing.

Crossover PhenomenonCrossover Phenomenon

Despite lower life expectancies for African Despite lower life expectancies for African Americans from birth, a mortality crossover Americans from birth, a mortality crossover phenomenon occurs at the age of 73 for phenomenon occurs at the age of 73 for black males and age 85 for black females.black males and age 85 for black females.

Since many African American elders have Since many African American elders have had to cope with stress and few economic had to cope with stress and few economic resources throughout their lifetimes; resources throughout their lifetimes; therefore, negative outcomes in older age therefore, negative outcomes in older age may appear less serious.may appear less serious.

Crossover Phenomenon Cont’dCrossover Phenomenon Cont’d

Also, it might be because the elders may Also, it might be because the elders may simply have developed a more reliable set simply have developed a more reliable set of coping strategies to deal with the stresses of coping strategies to deal with the stresses of old age.of old age.

EducationEducation

The Administration of aging (2000) reported The Administration of aging (2000) reported that in 1998, 44% of non-Hispanic black that in 1998, 44% of non-Hispanic black Americans age 65 and over had graduated Americans age 65 and over had graduated from High school and 7% had bachelor’s from High school and 7% had bachelor’s Degree or Higher.Degree or Higher.

Patters of Health RiskPatters of Health Risk

Many Morbidity and mortality rates are Many Morbidity and mortality rates are higher among African American elders than higher among African American elders than in the general population. Because of in the general population. Because of decreased educational levels and decreases decreased educational levels and decreases in personal resources, the awareness of in personal resources, the awareness of health problems, knowledge of causes and health problems, knowledge of causes and risk factors, and capacity to access medical risk factors, and capacity to access medical care maybe greatly decreased.care maybe greatly decreased.

MortalityMortality

Death rates from all Causes for Elders 65-74 and Death rates from all Causes for Elders 65-74 and 75-84 are higher among Black elders than any of 75-84 are higher among Black elders than any of the other racial ad ethnic groups.the other racial ad ethnic groups.

Those who are 85 and over, the rates are higher Those who are 85 and over, the rates are higher among whites and second highest among Blacks.among whites and second highest among Blacks.

Older African Americans are less likely than white Older African Americans are less likely than white elders to have health insurance or to have seen a elders to have health insurance or to have seen a doctor in the pervious year.doctor in the pervious year.

Family RolesFamily Roles

African American families have developed African American families have developed and retain distinctive models of family and retain distinctive models of family interaction that combine traditional patterns interaction that combine traditional patterns of roles and responsibilities with adaptations of roles and responsibilities with adaptations called forth by American experience.called forth by American experience.

The Black kinship system tends to more The Black kinship system tends to more extensive and cohesive that the family extensive and cohesive that the family system of whites. system of whites.

Living ArrangementsLiving Arrangements

Among Community dwelling elders, African Among Community dwelling elders, African Americans men were more likely to live Americans men were more likely to live alone (approximately 24%) and less likely to alone (approximately 24%) and less likely to live with spouse (approximately 52%) than live with spouse (approximately 52%) than men from any of the four other older men from any of the four other older racial/ethnic populations.racial/ethnic populations.

Historically, African Americans have resided Historically, African Americans have resided in nursing homes at about half of rate of in nursing homes at about half of rate of white elders.white elders.

Cultural Biases and MisdiagnosesCultural Biases and Misdiagnoses

Cultural bias about health and illness, and beliefs Cultural bias about health and illness, and beliefs about which individuals and/or groups are most about which individuals and/or groups are most susceptible to one or another disorder are key susceptible to one or another disorder are key among these factors.among these factors.

It is also believed among some psychiatrists that It is also believed among some psychiatrists that African Americans, as a group, tended to have low African Americans, as a group, tended to have low rates of depression because of their historical rates of depression because of their historical social and educational oppression.social and educational oppression.

Cultural Biases and Misdiagnoses Cultural Biases and Misdiagnoses Cont’d Cont’d

Epidemiological and etiological research Epidemiological and etiological research have subsequently shown that depression have subsequently shown that depression and other illnesses are much more complex and other illnesses are much more complex disorders than that suggested by the disorders than that suggested by the foregoing statements and must be carefully foregoing statements and must be carefully studied, including cross-cultural variations in studied, including cross-cultural variations in symptoms of disorders before drawing symptoms of disorders before drawing conclusions and formulating treatment plansconclusions and formulating treatment plans

Showing Respect!!!!Showing Respect!!!!

Particularly because of the experience of Particularly because of the experience of many african American elders who grew up many african American elders who grew up with segregated health care and social with segregated health care and social service systems in which they faced service systems in which they faced continual discrimination, it is extremly continual discrimination, it is extremly important to show respect to them in clinical important to show respect to them in clinical settings in order to put them at ease and settings in order to put them at ease and establish rapport.establish rapport.

Adapting Assessments Techniques Adapting Assessments Techniques to Skin Colorto Skin Color

Since African American elders have a wide Since African American elders have a wide range of skin color, it is very important for range of skin color, it is very important for nurses and physicians to use appropriate nurses and physicians to use appropriate assessments that reflect skin tone changes assessments that reflect skin tone changes for conditions such as cyanosis.for conditions such as cyanosis.

Specialized Procedures in Cardiac Specialized Procedures in Cardiac CareCare

Numerous studies in the late 1980s and 1990s Numerous studies in the late 1980s and 1990s found that African Americans are less likely to found that African Americans are less likely to undergo cardiac catheterization and coronary-undergo cardiac catheterization and coronary-artery bypass graft surgery than their white artery bypass graft surgery than their white counterparts.counterparts.

Our findings suggest that a patient’s race and sex Our findings suggest that a patient’s race and sex may influence a physician’s recommendation with may influence a physician’s recommendation with respect to a cardiac catheterization regardless that respect to a cardiac catheterization regardless that patient’s clinical characterization.patient’s clinical characterization.

End of Life CareEnd of Life Care

Some African American families may Some African American families may request that certain diagnoses or disease request that certain diagnoses or disease prognoses be withheld from the patient to prognoses be withheld from the patient to shelter them from disturbing informationshelter them from disturbing information

Other patients and families favor forthright Other patients and families favor forthright discussion of all medical issues and discussion of all medical issues and treatment plans.treatment plans.

Care givingCare giving

Comparisons of informal care giving by Comparisons of informal care giving by black and White older adults showed that black and White older adults showed that blacks are more likely to be caregivers and blacks are more likely to be caregivers and more likely to assist friends.more likely to assist friends.

Blacks have frequent contact with family, Blacks have frequent contact with family, relatives, friends and neighbors, although relatives, friends and neighbors, although they utilize the members of their network they utilize the members of their network differently for emergency and non-differently for emergency and non-emergency situations.emergency situations.

Minority PopulationMinority Population

Minority Americans today comprise 14% of Minority Americans today comprise 14% of the nation's elderly and 16% of the total the nation's elderly and 16% of the total Medicare population. Medicare population.

The minority population is projected to more The minority population is projected to more than double by 2025 and will represent one than double by 2025 and will represent one in three seniors.. in three seniors..

Minority Population Con’tMinority Population Con’t

Poverty RatesPoverty Rates

In 1990, the poverty rate for older African In 1990, the poverty rate for older African Americans was 30.7% and only 9.6% for Americans was 30.7% and only 9.6% for older white Americans.older white Americans.

One of every 11 elderly Caucasian persons One of every 11 elderly Caucasian persons lived in poverty in 1998, compared with lived in poverty in 1998, compared with 26.4% of elderly African Americans and 26.4% of elderly African Americans and 21% of elderly Hispanics.21% of elderly Hispanics.

Poverty Rates Con’tPoverty Rates Con’t

About 1/3 of African American beneficiaries About 1/3 of African American beneficiaries have incomes below the poverty level, which have incomes below the poverty level, which is more than three times the share of whites.is more than three times the share of whites.

Moreover, nearly two-thirds of African Moreover, nearly two-thirds of African American beneficiaries have income below American beneficiaries have income below twice the poverty level compared with 41 twice the poverty level compared with 41 percent of whites. percent of whites.

Poverty Rates Con’tPoverty Rates Con’t

Characteristics of Minority Medicare Characteristics of Minority Medicare BeneficiariesBeneficiaries

Disparities in Health Insurance Disparities in Health Insurance CoverageCoverage

• A quarter of African American beneficiaries A quarter of African American beneficiaries have no supplemental coverage, compared have no supplemental coverage, compared with 10 percent of all whites.with 10 percent of all whites.

• 2/3 of all white beneficiaries have Medigap 2/3 of all white beneficiaries have Medigap or employer sponsored retiree benefits, or employer sponsored retiree benefits, compared with only a third of African compared with only a third of African Americans. Americans.

Disparities in Health Insurance Disparities in Health Insurance coverage con’tcoverage con’t

Causes of Disparities in Health Causes of Disparities in Health Insurance CoverageInsurance Coverage

UnemploymentUnemployment– The national unemployment rate for African The national unemployment rate for African

Americans rose to 10.1 percent, up .3 percent from Americans rose to 10.1 percent, up .3 percent from October, and up a 1.3 percentage from September. October, and up a 1.3 percentage from September. The unemployment rate for the white population was The unemployment rate for the white population was at 5.1 percent in November   almost half of the at 5.1 percent in November   almost half of the African-American unemployment rate.African-American unemployment rate.

Causes of Disparities in Health Causes of Disparities in Health Insurance CoverageInsurance Coverage

The high rate of unemployment for Blacks has The high rate of unemployment for Blacks has several causes. several causes.

First, inferior quality inner-city schools yield First, inferior quality inner-city schools yield both more drop-outs and students without the both more drop-outs and students without the skills needed in today's high tech labor market. skills needed in today's high tech labor market.

Second, shifts away from manufacturing and Second, shifts away from manufacturing and central city employment have deprived Blacks central city employment have deprived Blacks of traditional sources of employment. of traditional sources of employment.

Causes of Disparities in Health Causes of Disparities in Health Insurance CoverageInsurance Coverage

Last but not least, discrimination is still a reality Last but not least, discrimination is still a reality adversely affecting the employment prospects of adversely affecting the employment prospects of Blacks - especially in smaller firms where many Blacks - especially in smaller firms where many of today's jobs are being created. of today's jobs are being created.

Health Insurance CoverageHealth Insurance Coverage

How unemployment and How unemployment and underemployment affects Health underemployment affects Health Insurance Coverage…Insurance Coverage…– Social SecuritySocial Security– Out of Pocket spendingOut of Pocket spending

Health Care Is Driven by Health Care Is Driven by EconomicsEconomics

Most health policy for the elderly fails to take Most health policy for the elderly fails to take into account the distinctive health and SES into account the distinctive health and SES statuses of racial and ethnic minority elderly. statuses of racial and ethnic minority elderly. In fact, changes in the U.S. economy leads In fact, changes in the U.S. economy leads to a scapegoating of minorities which to a scapegoating of minorities which jeopardizes the fulfillment of their healthcare jeopardizes the fulfillment of their healthcare needsneeds

Hudson County ElderlyHudson County Elderly

2000 Statistics2000 Statistics

Greater than 11 percent of the Greater than 11 percent of the County’s population was 65 County’s population was 65 years or older. Of this years or older. Of this percentage, 8 percent were percentage, 8 percent were African American.African American.

Source: Department of Labor, Population and Source: Department of Labor, Population and Labor Force Projections for New Jersey: 1995 Labor Force Projections for New Jersey: 1995 to 2030, January, 1994; 1980 Census, 1990 to 2030, January, 1994; 1980 Census, 1990 CensusCensus

Racial & Ethnic Composition

African American

Asian / Pacific Islander

American Indian / Native Alaskan

Other

Poverty among Elderly in Hudson CountyPoverty among Elderly in Hudson County

Much of the elderly population in Hudson Much of the elderly population in Hudson County is poorCounty is poor

Over 22.5 percent of the County’s frail Over 22.5 percent of the County’s frail elderly (aged 75 and over) have been living elderly (aged 75 and over) have been living in poverty since 1990in poverty since 1990

In comparison, 12.7 percent of the frail In comparison, 12.7 percent of the frail elderly is living in poverty Statewideelderly is living in poverty Statewide

Expected Increase in ElderlyExpected Increase in Elderly

The elderly population is expected to increase as The elderly population is expected to increase as the Baby Boom Generation (persons born from the Baby Boom Generation (persons born from 1946 to 1964) grows older.1946 to 1964) grows older.

This will in turn increase the demand for services This will in turn increase the demand for services to the elderly in Hudson County.to the elderly in Hudson County.

Elderly Services in Hudson CountyElderly Services in Hudson County

Programs Used:Programs Used:– Social Service Block GrantsSocial Service Block Grants– Medicaid ProgramsMedicaid Programs– Home Health ServicesHome Health Services– Community Care for the Elderly and Disabled (CCPED) programCommunity Care for the Elderly and Disabled (CCPED) program

Services Provided:Services Provided:– Providing MealsProviding Meals– Homemaker ServicesHomemaker Services– HousekeepingHousekeeping– TransportationTransportation– Adult Day CareAdult Day Care

Meals-On-WheelsMeals-On-Wheels

Meals-On-Wheels is a service that brings nutritional food Meals-On-Wheels is a service that brings nutritional food straight to the homes of elderlystraight to the homes of elderly

One of the best services for Hudson County’s elderly One of the best services for Hudson County’s elderly residents and can also be seen in many cities throughout residents and can also be seen in many cities throughout the United Statesthe United States

Three agencies help to administer this program in Hudson Three agencies help to administer this program in Hudson CountyCounty

Life Expectancy in AustraliaLife Expectancy in Australia

Australians are living Australians are living longer than in the past.longer than in the past.

The proportion of The proportion of people over 65 is 12% people over 65 is 12% today and is expected today and is expected to reach 20% by 2030.to reach 20% by 2030.

6874

7984

0

1020

30

40

5060

70

8090

1960 2030

Life Expectancy in Australia

Men

Women

Hudson County vs. AustraliaHudson County vs. Australia

Hudson County (and the rest of the US) Hudson County (and the rest of the US) provide nearly universal health insurance provide nearly universal health insurance coverage for its 65+ populationcoverage for its 65+ population

1998 survey found much higher rates of 1998 survey found much higher rates of access difficulties and costs concerns in the access difficulties and costs concerns in the US, compared to the universal coverage in US, compared to the universal coverage in AustraliaAustralia

Health Care AccessHealth Care Access

12 percent of elderly in Hudson County said 12 percent of elderly in Hudson County said it was “extremely,” “very,” or “somewhat” it was “extremely,” “very,” or “somewhat” difficult to get needed medical care, difficult to get needed medical care, compared with 6 percent in Australia.compared with 6 percent in Australia.

10 percent of the elderly in Hudson County 10 percent of the elderly in Hudson County did not visit a doctor in the past year, did not visit a doctor in the past year, compared with 2 percent in Australiacompared with 2 percent in Australia

Mature-age Employment ProgramsMature-age Employment Programs

The goals of Mature-age Employment Programs are to The goals of Mature-age Employment Programs are to improve job opportunities and also employability of older improve job opportunities and also employability of older people seeking employment.people seeking employment.

New South Wales Mature Workers ProgramNew South Wales Mature Workers Program– Has been operating in Australia since 1990. Has been operating in Australia since 1990. – This program has two services: This program has two services:

employment (operated through community-based organizations)employment (operated through community-based organizations) trainingtraining

– Evaluation after five years showed that 50% of past clients were Evaluation after five years showed that 50% of past clients were still employed at the time of the survey, and most attributed this to still employed at the time of the survey, and most attributed this to the program.the program.

Home and Community Care (HACC)Home and Community Care (HACC)

HACC is an Australian program that funds a wide variety of HACC is an Australian program that funds a wide variety of service agencies to provide a variety of support services for service agencies to provide a variety of support services for the elderly including:the elderly including:– Home help: cooking, cleaning, washing, ironing, or bankingHome help: cooking, cleaning, washing, ironing, or banking– Transport: for medical, social, or other reasonsTransport: for medical, social, or other reasons– Food services: meals-on-wheels, congregate meals, or help with Food services: meals-on-wheels, congregate meals, or help with

grocery shoppinggrocery shopping– Personal care: bathing and dressingPersonal care: bathing and dressing– Health services: home nursing, physiotherapy, or podiatryHealth services: home nursing, physiotherapy, or podiatry– Home maintenance: help around the house with small tasks and Home maintenance: help around the house with small tasks and

gardeninggardening

Health PromotionHealth Promotion

Programs to encourage healthier lifestyles and improved Programs to encourage healthier lifestyles and improved population health:population health:– Active AustraliaActive Australia– The Food and Nutrition PolicyThe Food and Nutrition Policy– Strategic Framework for the Prevention of Chronic DiseaseStrategic Framework for the Prevention of Chronic Disease

In recognition that falling accounts for 30% of all hospital In recognition that falling accounts for 30% of all hospital admissions among the elderly, Australians have also admissions among the elderly, Australians have also developed a coordinated strategy to reduce falls among developed a coordinated strategy to reduce falls among elderlyelderly

Stay on Your Feet (SOYF)Stay on Your Feet (SOYF)

In recognition that falling accounts for 30% of all hospital In recognition that falling accounts for 30% of all hospital admissions among the elderly, Australians have also admissions among the elderly, Australians have also developed a coordinated strategy to reduce falls among developed a coordinated strategy to reduce falls among elderly.elderly.

The program addressed the following risk factors:The program addressed the following risk factors:– Physical inactivity, poor balance and gait, chronic illness, poor Physical inactivity, poor balance and gait, chronic illness, poor

vision, unsafe footwear, medication misuse, and unsafe home and vision, unsafe footwear, medication misuse, and unsafe home and public environmentspublic environments

The initiative resulted in a 20% reduction in hospitalization The initiative resulted in a 20% reduction in hospitalization due to falls among the elderlydue to falls among the elderly

What Solutions Can Be What Solutions Can Be Implemented ???Implemented ???

HHS & ABC Radio Team UpHHS & ABC Radio Team Up ““Closing the Health Gap” campaignClosing the Health Gap” campaign

– designed to inform, educate, challenge and empower designed to inform, educate, challenge and empower African Americans to change behaviors through African Americans to change behaviors through providing lifestyle tips and info on local sources of health providing lifestyle tips and info on local sources of health care and public health programscare and public health programs

All 240 of ABC radio’s urban advantage network All 240 of ABC radio’s urban advantage network affiliates will air messages from 10 sec. – 1min affiliates will air messages from 10 sec. – 1min intervalsintervals

HHS sec. Tommy Thompson and U.S. Surgeon HHS sec. Tommy Thompson and U.S. Surgeon general David Satcher will narrate other spotsgeneral David Satcher will narrate other spots

Center for Family and Community Center for Family and Community Health (Berkeley, CA)Health (Berkeley, CA)

People disadvantaged economically, People disadvantaged economically, educationally, and politically are at high risk educationally, and politically are at high risk

Objectives:Objectives:

1) Developed a plan for a volunteer-run 1) Developed a plan for a volunteer-run medical clinic to provide free, urgent caremedical clinic to provide free, urgent care

2)Secured space for the clinic from a local 2)Secured space for the clinic from a local hospitalhospital

3)Promote more free clinics nationwide3)Promote more free clinics nationwide

Univ. Of Alabama Center for Helath Univ. Of Alabama Center for Helath PromotionPromotion

Trained community advisorsTrained community advisors Created a cookbook of favorite recipes modified Created a cookbook of favorite recipes modified

for heart health and encouraged low-fat meals at for heart health and encouraged low-fat meals at church dinnerschurch dinners

Food Stamp programs to buy fresh produceFood Stamp programs to buy fresh produce Walking groups & nutrition/exercise activityWalking groups & nutrition/exercise activity Broadcasted educational and health promotion Broadcasted educational and health promotion

messages on radio and cablemessages on radio and cable Exercise room built in Community Life CenterExercise room built in Community Life Center

Modified MD Protocol?Modified MD Protocol?

Must examine your own beliefs, stereotypes, Must examine your own beliefs, stereotypes, and values about African Americansand values about African Americans

Are my attitudes toward African Americans Are my attitudes toward African Americans open, welcoming, and unbiased?open, welcoming, and unbiased?

Am I well-versed in the historical Am I well-versed in the historical background and contributions of African background and contributions of African Americans to society?Americans to society?

Am I aware of the heterogeneity and Am I aware of the heterogeneity and diversity within this group?diversity within this group?

Protocol Continued….Protocol Continued…. Can I disagree with an African American without Can I disagree with an African American without

feeling intimidated or guilty?feeling intimidated or guilty? Am I treating African Americans with respect and Am I treating African Americans with respect and

building a level of trust with them?building a level of trust with them? Am I aware of their traditions, religious beliefs, and Am I aware of their traditions, religious beliefs, and

alternative medicinal remedies?alternative medicinal remedies?DON’T MAKE AFRICAN AMERICAN PATIENTS DON’T MAKE AFRICAN AMERICAN PATIENTS

LOSE FAITH IN EQUALITY IN HEALTHCARE..BE LOSE FAITH IN EQUALITY IN HEALTHCARE..BE SENSITIVE TO EACH INDIVIDUAL AND HIS/HER SENSITIVE TO EACH INDIVIDUAL AND HIS/HER NEEDSNEEDS

They should not have to be a “disappointment They should not have to be a “disappointment generation”generation”

Meharry Consortium Geriatric Meharry Consortium Geriatric Education Center (MCGEC)Education Center (MCGEC)

Main Goals:Main Goals:

1. Provide healthcare and for minority 1. Provide healthcare and for minority elderlyelderly

2. Recruit and retain students of all health 2. Recruit and retain students of all health professions in geriatricsprofessions in geriatrics

3. Educate minority elderly of their needs 3. Educate minority elderly of their needs and opportunities available to themand opportunities available to them

MCGEC Goals Continued…MCGEC Goals Continued…

4. Teach classes to health care professionals 4. Teach classes to health care professionals about the health care needs of elderly about the health care needs of elderly peoplepeople

5. Emphasize the importance of elderly in our 5. Emphasize the importance of elderly in our diverse populationdiverse population

6. Need-based research and gathering of data6. Need-based research and gathering of data7. Distribute courses for health care 7. Distribute courses for health care

professionals that focus on minorities and professionals that focus on minorities and underserved populations of older adultsunderserved populations of older adults

Church Involvement Is a MustChurch Involvement Is a Must

-Have programs that provide food and clothing-Have programs that provide food and clothing

-Organized visits of the sick as well as elderly -Organized visits of the sick as well as elderly shutinsshutins

-Church plays a significant role in promoting -Church plays a significant role in promoting self worth and self esteem through self worth and self esteem through validation of shared beliefs and attitudes validation of shared beliefs and attitudes held by the congregationheld by the congregation

More Church Influence…More Church Influence…

African Americans believe in traditional African Americans believe in traditional medicine or folk medicinemedicine or folk medicine

Illness is broken down into one of three Illness is broken down into one of three categories: natural, occult, and spiritualcategories: natural, occult, and spiritual

The only cure for the latter two categories is The only cure for the latter two categories is God. Faith or spiritual leaders are regarded God. Faith or spiritual leaders are regarded as divine, possessing the powerful gift of as divine, possessing the powerful gift of healing from God.healing from God.

General Solution AgendaGeneral Solution Agenda

Ideally Includes:Ideally Includes:– Training advisorsTraining advisors– Community-run activities, exercise sessions, interactive Community-run activities, exercise sessions, interactive

activitiesactivities– Increase awareness about nutrition, health risks, and Increase awareness about nutrition, health risks, and

available opportunitiesavailable opportunities– ““Meals on Wheels”Meals on Wheels”– DRTS (Demand Responsive Transportation System in DRTS (Demand Responsive Transportation System in

Finland)Finland)– EACH (Extended Aged Care at Home in Australia)EACH (Extended Aged Care at Home in Australia)– Church InfluenceChurch Influence