A Diverse & Aging California Health Issues

1. 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

2. 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

3. Growing Diversity of Elderly Source: California Department of Finance, May 2004 www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Projections/P3/P3.asp

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

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

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

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

8. California health disparities from a Public Health Perspective

9. 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

10. Incontinence past month, women 65+ Source: 2003 California Health Interview Survey

11. Multiple falls past year, age 65+ Source: 2003 Califorian Health Interview Survey

12. Poor mental health past month, age 60+ Source: 2003 California Health Interview Survey

13. 7 or more prescriptions, age 65+ Elders w/7+ prescriptions average 1+ inappropriate medications Source: 2004 MEPS

14. Could not afford needed dental care past year, age 60+ Source: 2003 California Health Interview Survey

15. 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.

16. Availability of someone to help w/daily chores when sick ,age 60+ (not shown: a little, sometimes) Source: 2003 California Health Interview Survey

17. Neighbors are afraid to go out at night , by % poverty, age 60+ Source: 2003 California Health Interview Survey

18. Latino elderly mortality is a paradox Many geriatric conditions that do not contribute to death rates exhibit disparities among elders Geriatric Issues - Summary

19. 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

20. 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

21. 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

22. 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

23. Medical care disparities • No usual source of care • Problem understanding the doctor • Satisfaction with care

24. No usual source of care, age 60+ Source: 2003 California Health Interview Survey

25. Hard time understanding doctor last visit, by language spoken at home, age 60+ Source: 2003 California Health Interview Survey

26. Hard time getting needed health care past 12 months, by language spoken at home, age 60+ Source: 2003 California Health Interview Survey

27. 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

28. 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

29. 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.

30. www.rcmar.ucla.edu

31. 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

32. CHIS Topics • Health Status • Health Condition • Health Behavior • Cancer • Medical & Dental insurance • Access & Use of Health Care • SES, neighborhood & housing, immigration

33. www.chis.ucla.edu

35. http://swallace.bol.ucla.edu