The Barriers that Deter the Geriatric Population From Receiving Quality Healthcare

Graduate Program in Biomedical Sciences—School of Health Sciences Jacquelyn Smith, Anne Egan D.O. and Denah Appelt, PhD

Barrier of Healthcare Rural Setting Urban Setting

Cultural Perceptions Negative Less Negative

Getting to Doctor’s Office (Lack of Transportation or Distance)

Difficult Less Difficult

Absence of Services Yes No

Financial Burden Yes Yes—Less Disparity

Online Services (Telemedicine) Less Common—Lack of Internet Access Less Common—New Field of Medicine

(Douthit et al. 2015).

ABSTRACT

In the United States, the geriatric population is considered to include individuals that are 65 years or older.In 2016, there was an estimated 49.2 million elderly Americans (Roberts et al. 2018). Since the advancesof modern medicine are prospering, this number is expected to increase drastically. Furthermore, thegeriatric population is projected to double, from 2010 to 2030, to 20% or 72 million Americans (Horton andJohnson 2010). Looking further into the future, the American geriatric population is expected to be 83.7million in 2050 (Ortman et al. 2014). In a 2016 Center for Disease Control and Prevention (CDC) report,the American geriatric population self-reported the highest percentage of “fair” or “poor” overall health(Center for Disease Control and Prevention 2018b). In response, the United States Department of Healthand Human Services set up additional programs and resources to improve this rating; however, with themany health complications that older Americans face, there has been a surprising inconsistent quality ofcare for this population. The disparity becomes significant since many geriatric patients deal with chronichealth complications. Previous studies show that there are both tangible and intangible factors as to whythe geriatric population face issues with access to healthcare or the quality of care. This retrospectiveanalysis looked at the different types of barriers for the geriatric population in the United States. Thisstudy investigated the barriers in rural settings, urban settings, and more specifically Philadelphia, wherethe medical field is expanding to better care for this population. Physicians’ behavior and attitude towardspatients, “difficulty in getting to the doctor, the absence of services, lack of career progressionopportunities for physicians, and the increased financial burden” are the many barriers, which geriatricpatients face when trying to access quality healthcare (Douthit et al. 2015). One might think tangiblebarriers, such as the cost of medical care, would be the major barrier facing this population. However,studies concluded that the perceived behavior and attitude of the physician is the most significant barrierthat deters the geriatric population from wanting to receive medical care. Possible solutions to this issueinclude reform of healthcare policy and focusing on patient-centered care.

METHODS

This literature review helped understood why the geriatric population face tangible and intangible barrierswhen trying to access high-quality healthcare in different settings: rural, urban, and more specifically thecity of Philadelphia. Possible associations between the barriers of healthcare for the geriatric populationwere made based on the analysis.

REFERENCES

Beard, Dr. J .R., Officer, A., de Carvalho, Dr. I. A., Sadana, R., Pot, A. M., Michel, J. P., Llyod-Sherlock, P., Epping-Jordan, J. E., Peeters, G. M. E. E., Mahanani, W. R., Thiyagarajan, J. A., & Chatterji, S. (2016).The World Report on Ageing and Health: A Policy Framework for Healthy Ageing. The Lancet, 387, 2145 - 2154. https://doi.org/10.1016/S0140-6736(15)00516-4

Buttigieg, S. C., Ilinca, S., de Sao Jose, J. M. S., & Larsson, A. T. (2018). Researching Ageism in Health-Care and Long Term Care. In International Perspectives on Aging: Contemporary Perspectives onAgeism(29). Retrieved from https://link.springer.com/content/pdf/10.1007%2F978-3-319-73820-8.pdf

Center for Disease Control and Prevention: Behavioral Risk Factor Surveillance System. (2018, September 4). Healthy Aging Data: Overall Health: Pennsylvania. Retrieved fromhttps://nccd.cdc.gov/aging_data/rdPage.aspx?rdReport=DPH_HAP.ExploreByLocation&rdRequestForwarding=Form

Center for Disease Control and Prevention: Behavioral Risk Factor Surveillance System. (2018, September 4). Healthy Aging Data: Overall Health: United States, DC, and Territories. Retrieved fromhttps://nccd.cdc.gov/aging_data/rdPage.aspx?rdReport=DPH_HAP.ExploreByLocation&rdRequestForwarding=Form

Cox, C. (2014, December). Older Americans Report More Difficulty Affording Care than Seniors in Comparable Countries. [Website]. Retrieved from https://www.healthsystemtracker.org/brief/older-americans-report-more-difficulty-affording-care-than-seniors-in-comparable-countries/#item-start

Douthit, N., Dwolatzky, T., Biswas, S. (2015) Exposing Some Important Barriers to Health Care Access in the Rural USA. Public Health, 129, 611-620. https://https://doi.org/10.1016/j.puhe.2015.04.001

Fernandez, D. M., Larson, J. L., & Zikmund-Fisher, B. J. (2016). Associations Between Health Literacy and Preventative Health Behaviors Among Older Adults: Findings from the Health and Retirement Study.BioMedCentral: Public Health, 16, n.p. https://doi.org/10.1186/s12889-016-3267-7.

Giordano, R. (2018, December 18). Where Do You Live? It May Give Clues to How Old You’ll Grow, Federal Data Suggests. The Philadelphia Inquirer. Retrieved from https://www.philly.com/

Horton, S. & Johnson, R. J. (2010). Improving Access to Health Care for Uninsured Elderly Patients. Public Health Nursing, 27, 362-370. https://doi.org/10.1111/j.1525-1446.2010.00866.x

Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. Journal of the American GeriatricsSociety, 64, 1-7. https://doi.org/10.1111/jgs.13873

Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014, May). An Aging Nation: The Older Population in the United States. Retrieved from http://bowchair.com/uploads/9/8/4/9/98495722/agingcensus.pdf

Roberts, A. W., Ogunwole, S. U., Blakeslee, L., & Rabe, M. A. (2018, October). The Population 65 Years and Older in the United States: 2016. Retrieved fromhttps://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf

Patient Safety Authority (2017, April 28). Pennsylvania Patient Safety Authority Annual Report. Retrieved from http://patientsafety.pa.gov/PatientSafetyAuthority/Documents/annual_report_2016.pdf

Philadelphia Corporation for Aging (2016, November). Facts About Philadelphians Over 55. Retrieved from https://www.phila.gov/media/20180914112000/Facts-About-Philadelphians-over-55.pdf

Sawyer, B. & Claxton, G. (2019, January). How Do Health Expenditures Vary Across the Population? [Website]. Retrieved from https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population

Sun, J.K. & Smith, J. (2017). Self-Perceptions of Aging and Perceived Barriers to Care: Reasons for Health Care Delay, The Gerontologist, 57, S216-S226. https://doi.org/10.1093/geront/gnx014

Weaver, K.E., Rowland, J.H., Bellizzi, K.M., & Aziz, N.M. (2010). Cancer: Journal of the American Cancer Society, 116, 3493-3504. https://doi.org/10.1002/cncr.25209

Tangible barriers• Cost

• Earning < $12,000 US dollars = 2.6x more likely to report barriers accessing health care (Horton andJohnson 2010)

• 2014: American seniors have more cost-related barriers when compared to seniors in otherindustrialized countries

• Skip needed medical care (19% vs. 6%)• Difficulty paying medical bills (11% vs. 3%)• Spent ≥ $2000 in out-of-pocket expenses (21% vs. 7%) (Cox 2014)

• Average health spending increases with age• Elderly patients: 36% (the highest percentage) of “health spending” (Sawyer and Claxton 2019)

• 19% of elderly Philadelphians live below 100% of the Federal Poverty level (Philadelphia Corporation forAging 2016)

• Health literacy• Government health care patients tend to lack knowledge to understand the programs’ rules and

regulations• 48% Medicare and Medicaid recipients felt the application was a major challenge

(Horton and Johnson 2010)• “Positive relationship between self-reported health literacy and health behaviors”…and perceptions of

social standing and control over health” among the elderly population (Fernandez et al. 2016)• Seen as incompetent due to inadequate health literacy (Fernandez et al. 2016)

• Considered an intangible barrier as well

Comparison of Rural and Urban Setting

Possible solutions • Intrinsic capacity: the overall health and well-being of an individual including social and economical

variables • Encompasses mobility, cognition, vitality, psycho-social, and neurosensorial

• World Health Organization (WHO) suggests an aim of functional ability and intrinsic capacity in the older population

• Integrative approach rather than treating specific diseases independently • Affordable • Comprehensive (Beard et al. 2016)

• Advancement should contribute to functional ability for healthy ageing• Meeting the basic needs• “Learn, grow, and make decisions; move around; build and maintain relationships; and

contribute” (Beard et al. 2016)• Patient/person-centered care (PCC):

• Favors personal choice and autonomy • Implementation of the patient’s “preferences, values, beliefs, and family or fictive kin into the

decisionmaking process related to daily life and care in clinical practice and in social serving settings” (Kogan et al. 2016)

• Greater effect on geriatric population

LITERATURE REVIEW ANALYSIS

Aging in the United States• 2016 Center for Disease Control and Prevention (CDC) report: American geriatric population self-reported

the highest percentage of “fair” or “poor” overall health (Center for Disease Control and Prevention 2018b).• Forgoing medical care is common among the 65 and older population (Weaver et al. 2010).

Aging in Pennsylvania• 2016 CDC report: elderly Pennsylvanians reported the second highest self-reported rating of having a

“fair” or “poor” health (Center of Disease Control and Prevention 2018a).• Highest proportion of hospital reports in the 65-74-year-old population

• Conclusion: elderly Pennsylvanians spend more time in the hospital and are less likelyto receive any preventative care (Patient Safety Authority 2017).

Aging in Philadelphia• Approximately 24% Philadelphians are ages 55 and older. Of this percentage, 53% are ages 65 years or

older (Philadelphia Corporation for Aging 2016).• The average life expectancy at birth greatly varies within Philadelphia

• Strawberry Mansion—64 years• Lower Merion—92 years• 10 point percentage increase in unemployment = 1.5 year loss of life• Decreased life expectancy linked to fewer elderly adults being insured (Giordano

2018)

Intangible barriers• Perceptions of physicians’ behaviors and attitude

• Health care professionals display ageism through neglect in routine care.• Due to use of ageist language and cheaper medical supplies on older patients (Buttigieg et al. 2018)

• Overtime healthcare professionals develop pattern of speech “referred to as… elderspeak” (Sun andSmith 2017)

• Healthcare professionals’ attitudes reinforced feelings of invisible/forgotten and feeling like objects(Buttigieg et al. 2018)

• “Psychosocial concerns”—significant in delay medical care• Sets stage for establishing elderly’s perception of aging (Sun and Smith 2017)

• Negative perceptions of aging means less likely to seek preventive medical care• Approximately 20% reported disliking going to the doctor

• Most cited reason for delaying care (Sun and Smith 2017)

(Patient Safety Authority 2017) (Sawyer and Claxton 2019)

(Patient Safety Authority 2017)(Center for Disease Control and Prevention 2018a)(Center for Disease Control and Prevention 2018b)