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)

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)

Arthritis and Heart Disease

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.

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)

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)

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)

Falls

Falls are frequent occurrence both in and out of the hospital

30 – 40% of falls in the hospital result in injury

(Fenton, 2008)

Consequences of Falls

Injuries Reduced confidence Reduction in mobility Reduced independence

(Fenton, 2008)

Dementia and Alzheimer’s affect patients, families and

caregivers 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

(Murray & Boyd, 2009)

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)

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)

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)

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)

Stereotypical beliefs, prejudices, and Stereotypical beliefs, prejudices, and obstacles that can lead to health obstacles that can lead to health

disparities in the elderly.disparities in the elderly.

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

Seeing people as a homogenous entity:– Senile– Mentally incapacitated– Asexual– Unemployable– Condition of dependence and deterioration

Phelan, 2008

Ageism includes:

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

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)

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)

Types of Abuse

Physical abuse Emotional Abuse Sexual Abuse Exploitation Neglect Abandonment Financial

(National Center on Elder Abuse, 2005; Neno & Neno, 2005)

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)

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)

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

Other signs

Belittling, threats, uses of power and control by spouse (or caregiver)

Strained or tense relationships

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

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)

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)