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A Diverse & Aging California Health Issues . Steven P. Wallace, Ph.D. Professor, UCLA School of Public Health Assoc. Dir., UCLA Center for Health Policy Research Co-PI, Resource Centers for Minority Aging Research Coordinating Center CCGG 2007 Annual Meeting. Outline.

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a diverse aging california health issues

A Diverse & Aging California Health Issues

Steven P. Wallace, Ph.D.

Professor, UCLA School of Public Health

Assoc. Dir., UCLA Center for Health Policy Research

Co-PI, Resource Centers for Minority Aging Research Coordinating Center

CCGG 2007 Annual Meeting

outline
Outline
  • Demographics of California
  • Overview of health disparities from a public health perspective
  • What we need to consider for the future
  • Sources of information on health status of elders of color
growing diversity of elderly
Growing Diversity of Elderly

Source: California Department of Finance, May 2004

www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Projections/P3/P3.asp

slide4
Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

slide5
Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

slide6
Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

slide7
Source:

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

geriatric issues
Geriatric Issues
  • Chronic conditions: Urinary incontinence, Falls, Depression
  • Health care: Polypharmacy, Oral health access, “Healthy” Death
  • Environment: Social support, Healthy communities

See Wallace, Steven P. “The Public Health Perspective on Aging.” Generations. 29:2(2005) http://www.generationsjournal.org/generations/gen29-2/article_thepublichealth.cfm

incontinence past month women 65
Incontinence past month, women 65+

Source: 2003 California Health Interview Survey

multiple falls past year age 65
Multiple falls past year, age 65+

Source: 2003 Califorian Health Interview Survey

poor mental health past month age 60
Poor mental health past month, age 60+

Source: 2003 California Health Interview Survey

7 or more prescriptions age 65
7 or more prescriptions, age 65+

Elders w/7+ prescriptions average 1+ inappropriate medications

Source: 2004 MEPS

could not afford needed dental care past year age 60
Could not afford needed dental care past year, age 60+

Source: 2003 California Health Interview Survey

advance directives of nursing home residents odds ratios
Advance directives of nursing home residents (odds ratios)

Controlling for age, gender, education, LOS, chronic diseases, dementia, physical function, cognitive status, depression

*

*

*

Source: Degenholtz, et al. Persistence of racial disparities in advance care plan documents among nursing home residents. J Am Geriatr Soc. 2002; 50:378-81.

availability of someone to help w daily chores when sick age 60
Availability of someone to help w/daily chores when sick ,age 60+

(not shown: a little, sometimes)

Source: 2003 California Health Interview Survey

neighbors are afraid to go out at night by poverty age 60
Neighbors are afraid to go out at night , by % poverty, age 60+

Source: 2003 California Health Interview Survey

geriatric issues summary
Latino elderly mortality is a paradox

Many geriatric conditions that do not contribute to death rates exhibit disparities among elders

Geriatric Issues - Summary
public health is
Public health is
  • Assuring the conditions under which people can be healthy (Institute of Medicine, Committee for the Study of the Future of Public Health. The future of public health. Washington, DC: National Academy Press, 1988)
  • Population / community / system focus
  • Interest in prevention vs. cure
  • Emphasis on health vs. disease
types of prevention
Types of prevention
  • Primary – prevent problem from happening, e.g. immunizations
  • Secondary – detect problem early and treat before serious harm results, e.g. breast cancer screening
  • Tertiary – after a health problem has happened, maximize independence & quality of life, e.g. rehab, in-home supportive services
health focus versus disease
Health focus versus disease
  • Health is not just absence of disease
  • But limited funding for non-disease programs

Photo credit: U.S. Administration on Aging

falls a public health approach
Falls - a public health approach
  • Primary – Promote physical activity, monitor for polypharmacy effects, universal housing design (all older adults)
  • Secondary - Strength training, environmental modifications (at risk older adults)
  • Tertiary – Counseling to decrease fear of falling, improve primary care ID/treatment of falls, social support interventions
medical care disparities
Medical care disparities
  • No usual source of care
  • Problem understanding the doctor
  • Satisfaction with care
no usual source of care age 60
No usual source of care, age 60+

Source: 2003 California Health Interview Survey

hard time understanding doctor last visit by language spoken at home age 60
Hard time understanding doctor last visit, by language spoken at home, age 60+

Source: 2003 California Health Interview Survey

hard time getting needed health care past 12 months by language spoken at home age 60
Hard time getting needed health care past 12 months, by language spoken at home, age 60+

Source: 2003 California Health Interview Survey

highest rating of health care past 12 months 10 on scale 1 10 by language spoken at home age 60
Highest rating of health care past 12 months (10, on scale 1-10), by language spoken at home, age 60+

Source: 2003 California Health Interview Survey

conclusions
Conclusions
  • Important disparities in geriatric health exist for elders of color
  • Health care access is problematic for Latino elders; important to not only look at satisfaction as outcome for Latinos
  • Public health approaches to prevention using multilevel interventions are possible to reduce those disparities
slide29
Funded by NIA since 1997, its mission is to:
  • Increase the number of researchers who focus on the health of minority elders.
  • Enhance the diversity in the professional workforce by mentoring minority academic researchers for careers in minority elders health research.
  • Improve recruitment & retention methods used to enlist minority elders in studies so that research can accurately identify and work toward solutions to health disparities.
  • Create culturally sensitive health measures that assess the health status of minority elders with greater precision, and increase the effectiveness of interventions designed to improve their health and well-being.
california health interview survey chis
California Health Interview Survey (CHIS)
  • Conducted every two years since 2001
  • Telephone survey of 42,000+ households in Spanish, 4 Asian languages, and English
  • Approximately 1000 Latino respondents age 60 and over
  • CA has ¼ of all Latino elders nationally
  • Cross sectional survey years can be combined to improve sample sizes
chis topics
CHIS Topics
  • Health Status
  • Health Condition
  • Health Behavior
  • Cancer
  • Medical & Dental insurance
  • Access & Use of Health Care
  • SES, neighborhood & housing, immigration
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