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Health and The Elderly

Health and The Elderly. Mark Abdelmalak Hany Fahim Ricken Patel Dheeraj Muddasani Darshan Vaidya . What Is the Problem?. The elderly African American population has a disproportionately higher risk for negative health outcomes in comparison to Americans of European descent.

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Health and The Elderly

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  1. Health and The Elderly Mark Abdelmalak Hany Fahim Ricken Patel Dheeraj Muddasani Darshan Vaidya

  2. What Is the Problem? • The elderly African American population has a disproportionately higher risk for negative health outcomes in comparison to Americans of European descent

  3. The Question • What factors contribute to the disparity between the health status of African Americans versus the elderly of other races? • Need to explore this from a life-course framework

  4. Population Distribution • In 2000, persons of age 65+ numbered 35 million, or 12.4% of the U.S. Population • 16.4% of the 35 million elderly were minorities, with a distribution as shown

  5. Leading Causes of Death Among African Americans Age 65+ • 1)      Heart Disease • 2)      Cancer • 3)      Stroke • 4)      Diabetes • 5) Pneumonia /Influenza

  6. Truth may be hard to accept… • African Americans are two times more likely than whites to have diabetes • Higher lung and prostate cancer incidence and mortality than whites in all age groups • 30% more likely to die of heart disease (1 in 3  hypertension) • Highest overall risk of kidney disease • Stroke death rate 33% higher than white women • Rate of CV disease 80% higher than rate for white women

  7. “When America Gets a Cold, African Americans Get Pneumonia!!” • 47% of elderly African-Americans received the flu vaccine in 1998 vs. 66% of elderly whites • 26% of elderly African-Americans received the pneumonia vaccine in 1998 compared with 50% of elderly whites

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

  9. Dr. John Ayanian’s Findings • 32% of black pneumonia patients given antibiotics w/in 6 hrs. of admission, compared with 53% of other Medicare patients • Blacks less likely to have had blood cultures collected on 1st or 2nd day of hospitalization • Disparities = 1 additional death per 200 patients treated

  10. Cardiovascular Disease vCardiovascular disease is one of the leading causes of mortality today. vCoronary heart disease accounts for 70 to 80 % of deaths in men and women in adults over 60 years of age. vCongestive Heart Failure (CHF), is the most common cause of hospitalization in the elderly. vCardiovascular disease is an important public health problem in African Americans. In 1998, cardiovascular disease accounted for 34% of deaths in black men and 41% of deaths in black women African Americans have a disproportionately high rate of hypertension.

  11. Diabetes Mellitus • When tested, Diabetes mellitus occurred in 127 of 1150 whites (11%), in 93 of 444 African-Americans (21%), and in 4 of 28 Asians (14%). • The prevalence of diabetes mellitus in 2003 older persons seen in an academic hospital-based geriatrics practice was 17% and was greater in African-Americans than in whites

  12. Who Lives Longer? Life Expectancy by Age Group and Race, in Years, 1997 Source: Administration on Aging, 2000

  13. Life Expectancy • Life expectancy at birth has historically been shorter for African Americans than older Americans, but the differences disappear or reverse themselves at older ages, creating the “Crossover Phenomenon.” • As of 1997, Black women in the U.S. has a life expectancy at birth of 74.7 years, and Black men 67.2 years. • At age 85, life expectancy for Black women is 6.7 years and 5.7 years for Black men.

  14. Population growth and distribution • There has been continuous growth in the overall population of blacks in the United states since 1790. • In 1970 there were 22 millions blacks in the United states, of whom approximately 1.5 million or 7 % were 65 years of age or older. Since 1970 there has been considerable growth in the population of blacks 65 and over.

  15. Health History • There is a general agreement that blacks elders have traditionally been treated with great respect in their families. • This tradition extends from known cutoms of proslavery civilization on the African continent through modern customs African Americans families and kinship groups in the United States.

  16. Health History Cont’d • African American elders tend to precieve their health as more problematic than do white elders. • 17% of African American rate their health as poor, as compared with 7% of white elders.

  17. Life Course framework • Blacks who grew old in the United States had to withstand a variety of psychologically, physically and socially degrading experiences resulting from the political economy of race relations in the United States. (i.e. slavery, CRM, social maltreatment, Tuskegee experiment….) • Among the determinates of the treatment of elderly Blacks in the social history of the U.S., economic factors had a significant bearing.

  18. Crossover Phenomenon • Despite lower life expectancies for African Americans from birth, a mortality crossover phenomenon occurs at the age of 73 for black males and age 85 for black females. • Since many African American elders have had to cope with stress and few economic resources throughout their lifetimes; therefore, negative outcomes in older age may appear less serious.

  19. Crossover Phenomenon Cont’d • Also, it might be because the elders may simply have developed a more reliable set of coping strategies to deal with the stresses of old age.

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

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

  22. Mortality • Death rates from all Causes for Elders 65-74 and 75-84 are higher among Black elders than any of the other racial ad ethnic groups. • Those who are 85 and over, the rates are higher among whites and second highest among Blacks. • Older African Americans are less likely than white elders to have health insurance or to have seen a doctor in the pervious year.

  23. Family Roles • African American families have developed and retain distinctive models of family interaction that combine traditional patterns of roles and responsibilities with adaptations called forth by American experience. • The Black kinship system tends to more extensive and cohesive that the family system of whites.

  24. Living Arrangements • Among Community dwelling elders, African Americans men were more likely to live alone (approximately 24%) and less likely to live with spouse (approximately 52%) than men from any of the four other older racial/ethnic populations. • Historically, African Americans have resided in nursing homes at about half of rate of white elders.

  25. Cultural Biases and Misdiagnoses • Cultural bias about health and illness, and beliefs about which individuals and/or groups are most susceptible to one or another disorder are key among these factors. • It is also believed among some psychiatrists that African Americans, as a group, tended to have low rates of depression because of their historical social and educational oppression.

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

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

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

  29. Specialized Procedures in Cardiac Care • Numerous studies in the late 1980s and 1990s found that African Americans are less likely to undergo cardiac catheterization and coronary-artery bypass graft surgery than their white counterparts. • Our findings suggest that a patient’s race and sex may influence a physician’s recommendation with respect to a cardiac catheterization regardless that patient’s clinical characterization.

  30. End of Life Care • Some African American families may request that certain diagnoses or disease prognoses be withheld from the patient to shelter them from disturbing information • Other patients and families favor forthright discussion of all medical issues and treatment plans.

  31. Care giving • Comparisons of informal care giving by black and White older adults showed that blacks are more likely to be caregivers and more likely to assist friends. • Blacks have frequent contact with family, relatives, friends and neighbors, although they utilize the members of their network differently for emergency and non-emergency situations.

  32. Minority Population • Minority Americans today comprise 14% of the nation's elderly and 16% of the total Medicare population. • The minority population is projected to more than double by 2025 and will represent one in three seniors..

  33. Minority Population Con’t

  34. Poverty Rates • In 1990, the poverty rate for older African Americans was 30.7% and only 9.6% for older white Americans. • One of every 11 elderly Caucasian persons lived in poverty in 1998, compared with 26.4% of elderly African Americans and 21% of elderly Hispanics.

  35. Poverty Rates Con’t • About 1/3 of African American beneficiaries have incomes below the poverty level, which is more than three times the share of whites. • Moreover, nearly two-thirds of African American beneficiaries have income below twice the poverty level compared with 41 percent of whites.

  36. Poverty Rates Con’t

  37. Characteristics of Minority Medicare Beneficiaries

  38. Disparities in Health Insurance Coverage • A quarter of African American beneficiaries have no supplemental coverage, compared with 10 percent of all whites. • 2/3 of all white beneficiaries have Medigap or employer sponsored retiree benefits, compared with only a third of African Americans.

  39. Disparities in Health Insurance coverage con’t

  40. Causes of Disparities in Health Insurance Coverage • Unemployment • The national unemployment rate for African Americans rose to 10.1 percent, up .3 percent from October, and up a 1.3 percentage from September. The unemployment rate for the white population was at 5.1 percent in November   almost half of the African-American unemployment rate.

  41. Causes of Disparities in Health Insurance Coverage • The high rate of unemployment for Blacks has several causes. • First, inferior quality inner-city schools yield both more drop-outs and students without the skills needed in today's high tech labor market. • Second, shifts away from manufacturing and central city employment have deprived Blacks of traditional sources of employment.

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

  43. Health Insurance Coverage • How unemployment and underemployment affects Health Insurance Coverage… • Social Security • Out of Pocket spending

  44. Health Care Is Driven by Economics • Most health policy for the elderly fails to take into account the distinctive health and SES statuses of racial and ethnic minority elderly. In fact, changes in the U.S. economy leads to a scapegoating of minorities which jeopardizes the fulfillment of their healthcare needs

  45. Hudson County Elderly 2000 Statistics • Greater than 11 percent of the County’s population was 65 years or older. Of this percentage, 8 percent were African American. Source: Department of Labor, Population and Labor Force Projections for New Jersey: 1995 to 2030, January, 1994; 1980 Census, 1990 Census

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