The rising health disparities of the elderly population Dawn Targon RN NU 402 Community Health Nursing Professor Martha Bronstein ? Health disparity is defined as inequality in health or the gaps in the quality of health care across races, ethnic and socioeconomic groups.
Health disparities can also be defined as the significant differences between one population and another. The Minority Health and Health Disparities Research and Education Act of 2000 describe these disparities as differences in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates. It is necessary to narrow these gaps in health care which can be done with political and governmental changes or modifications. A worldwide trend that needs to address issues and concerns for quality medical care and protection of rights is in the geriatric population. As any other citizen, elderly patients have the same rights.
Elderly individuals are classified as a vulnerable population due to the inability to exercise their rights, provide performed consent, and protect their legal rights from being violated. The risk of vulnerability is based upon age, ineffective communication skills, functional status, changes in financial or social circumstances, health, and chronic or terminal illness. This paper will discuss healthcare disparities of the elderly, the need for community support, government programs, primary, secondary, and tertiary prevention, Minnesota wheel, and proposed legislation in place to assist the elderly population. Health Disparities The American population is predicted to double within the next 25 years for individuals age 65 and older due to increased life expectancies and the aging of the baby boomers. All the while the population is becoming more diverse which increases the issues of health disparities. The elderly population has various functions and physiological reactions of their bodies which gradually slow down. They have an increased risk for developing chronic illnesses and disabilities that are related.
These chronic conditions include but are not limited to, Diabetes mellitus, arthritis, congestive heart failure, and dementia. Chronic conditions are the leading cause of death and disability among the elderly. They lose the ability to live independently at home.
Increased hospitalizations, nursing home admissions, and low quality of care are current issues that are concerns of an elderly individual??™s family and community. There are many elderly individuals that experience poorer care which is controlled by other compounding factors including income, insurance, health status, and severity of disease. Health disparities goes hand in hand with social injustice in which individuals are being denied their human rights based on the perception of a greater power and influence.
Social injustice can be applied to all areas of health care, particularly access, diagnosis and provision of all health care needs. Several factors related to health disparities and social injustice may influence the increased rates of injury, disease, disability, and death. Elderly individuals are a minority group that have been inadequately educated, have a lack of health insurance coverage, and limited availability of medical care. Advocates for social injustice and health disparities have established the need to provide widespread health care services that would assist every individual, regardless of income, racial identification, and geographic location (Kramarow, p 1420). This mission is even more urgent for Americas elderly population, as reflected by the nations primary policies in health care (Kramarow, p 1420). The Healthy People Report of 2010 identifies eliminating health disparities and improving quality and years of life as the two central goals of the nations health care agenda. These issues remain of critical importance in the Healthy People 2020 initiative (Healthy People 2010). Community supportThere are many aspects that are involved in taking care of elderly individuals.
It starts with having awareness about various needs and requirements of the elders and is extremely important for those people who have a responsibility of taking care of their aged family members. Community support in these situations will assist the families in keeping the aged individual cared for. Every senior is different they may only need assistance for a short period of time or could end up being lifelong. Many seniors begin to have difficulty with driving, cleaning, grocery shopping, laundry and other complicated tasks. They may be totally independent with their self care but forget to turn the stove off for instance.
Elders face a loss of independence which can lead to loneliness and depression. Community resources and services can make it easier for this transition. Transportation to doctor??™s appointments or grocery shopping with no cost allows the elderly to get things done without the worry of how they will get there.
Home safety checks can be done and adaptive appliances can be in place. Medical alert systems, poor lighting, stairs without railings and scatter rugs are a few hazards that can be averted with these checks. Fall prevention for elders who have difficulty walking from decreased strength and balance are at risk for falls, and nursing services can be offered to make sure appropriate medical equipment for safety is being supplied and used. Managed care can be implemented to assist the elders with their health needs, making appointments, and making sure all medical needs are met. Elderly day care is a community program that is designed to provide a break for the main caregiver so they may continue to care for the elderly patient at home. Home care services can provide housekeeping, laundry, transportation, personal care, and prescription medication and grocery delivery.
Community services can also provide opportunities for social interaction, exercise, recreation, and leisure time activities. Activities and events are meaningful for elders especially those cannot get around as well as they used to. Without community support elders will not have a quality of life, and would not be able to remain in their homes or participate in family or community activities. Community services also reduces the heavy reliance on institutions as a way to care for the elderly population, prevent excessive restrictions on their freedom, reduce unnecessary public expense of caring for the needs of frail individuals. Elderly programs There are many private, government and religious organizations across the country that provides supportive services for elderly people. Many services assist in helping people stay in their homes and avoid having to live in a nursing home. Many community services are in place to help elderly individuals remain independent; many community aging programs are viewed as long term care programs. The Centre for Disease Control and Prevention (CDC, 2012) have found health status and health behaviours are different among the elderly and have programs that highlight the reduction if health disparities.
This program is the CDC??™s Healthy aging program which focuses on injury prevention, disability prevention, along with adult immunizations. The goals to this program are to enhance the ability of states and communities to identify and implement effective strategies, policies, and programs to promote and protect the health of older adults (CDC, 2012). Expand the efforts to integrate public health and aging services and enhance outreach for health promotion and disease prevention for older adults (CDC, 2012). Promote health and preserve health related quality of life for older adults within healthcare and other systems (CDC, 2012).
Another program is the Healthy People 2020, which are concerned with the health services for elderly, quality of life, injury prevention with a concern for caregivers. Quality of life addresses chronic illnesses through programs to combat existing health disparities. It is believed that the ability to complete basic daily activities may decrease if illness, chronic diseases, or injury will limit physical and mental activities (HealthyPeople, 2013). Unfortunately, less than 20 percent of older adults engage in enough physical activity, and fewer do strength training (CDC, 2004). The Robert Wood Johnson Foundation (RWJF) is devoted exclusively to health and health care, which raises money to give grants for health education. It has donated $150,000.00 to ten states to improve long term care and supportive services for vulnerable older adults along with their caregivers. Another program working to advance excellence in health care is the Agency for Healthcare Research and Quality (AHRQ).
This program researches patient centred outcomes to improve health care quality by providing patients and healthcare providers with evidence based information on which medical treatments work best in any given situation. Used to help families and patients understand and evaluate treatment options and risks for the elderly. Government Programs Government support for aging services comes from the Older Americans Act (OAA), passed in 1965 (National Care Planning Counsel). This act has produced a large network of care providers and local government managers called Area Agencies on Aging (National Care Planning Counsel). This network also includes federal agencies, state agencies as well as local area agencies and is called the national aging network.
The OAA provides benefits to all Americans over the age of 60. Due to an extreme lack of funding services for older Americans have to be rationed. Congress has recognized this dilemma, which are now targeting certain needy individuals. These individuals are defined as people having the greatest economic need and or social need. Economic needs means inadequate income, and the social need can include people who are frail and homebound, have severe disabilities, institutionalized, live in disadvantaged areas, suffer from cognitive impairment, have language barriers, and are members of a minority group. State level of government for New York State Office of the Aging, was created by Executive order of the governor in 1961 and was one of the first units on aging in the nation which plan and coordinate programs and services for the aging at all levels of both public and private sectors.
These programs include home health aides, skilled nursing, home delivered meals, household chores, transportation, counselling and patient advocacy. Elderly can also contact their State Health Insurance Assistance Program (SHIP) to speak with a counsellor for objective information and guidance regarding the public and private health insurance options available in their state. Prescription assistance programs to assist low income elderly and disabled residents to pay for their prescription medications. Senior housing assistance programs are available to help seniors with housing needs. The majority of these programs are sponsored by the federal government.
These go along with home repair and modification assistance to provide necessary home repairs, or to make modifications to their homes to make it handicapped accessible. This is a very high demand with very limited funds. Heating and Energy assistance are federal funds available to pay for a portion of the winter heating and summer cooling costs. This program is supervised on the state level, and administered at the county level. This program is are limited in funding and based on need. Program of All inclusive Care for the Elderly (PACE) is a program that is available in 28 states which offers Medicare and Medicaid benefits and provides medical, social, and long term care services to the frail elderly in order to improve their quality of life and ensure that they have professional support and care when needed. Medicare and Medicaid are federal programs which provides medical and hospital insurance benefits and also offers optional prescription drug coverage and managed care plans. Supplemental Security Income (SSI) is a federal government program that provides a monthly cash benefit to assist with financial obligations when no longer able to work.
Primary, secondary, and tertiary prevention Primary prevention prevents disease from occurring by removing its causes. Examples of primary prevention include immunizations for many communicable diseases, promoting exercise, counselling with regards to a healthy diet and suggesting safety concerns (Kramarow p. 1420). In addition to these individual activities, communities may provide primary prevention through water treatment services and the provision of public safety services. Secondary prevention detects disease when it is asymptomatic and when early treatment can stop it from progressing (Kramarow , p 1420). Mammograms, Pap smears, and fecal occult blood testing are frequently performed examples. Community screening programs to detect hypertension and glaucoma are also examples. Tertiary prevention refers to attempts to prevent further deterioration or reduce complications after a disease has become apparent.
Examples of tertiary prevention include the comprehensive management of diabetes in order to reduce complications and prolong functional status, and the institution of medications after myocardial infarction to reduce the incidence of reinfarction (Roth, p18). Maximizing the quality of life is one of the key goals within the framework of any tertiary prevention strategy. Prevention strategies are based on an individual functional status and the patient??™s life goals rather than on chronological age.
Putting prevention into practice in the geriatric population requires a comprehensive approach to the older person. The most satisfying prevention activities are those that prevent disabling conditions, and these should be emphasized with geriatric patients as early as possible (Roth p.18). Application of Minnesota Wheel The Minnesota Wheel depicts the use of Public Health Interventions at various levels of practice. Public health nurses use the Nursing intervention Wheel to define the scope of public health intervention. Using the wheel for elderly care, case management can be used to oversee the patient and all the services needed. The elderly can be screened for illness and disease that can be treated before debilitating.
The case manager can reach out to other services such as meals on wheels, senior citizen programs, transportation for appointments. Day care services and respites can be utilized to relieve the family stress of taking care of an elderly relative. An elderly individual needs an advocate to make sure they are not being financial taken advantage of, and to make sure they are receiving all services available. Collaboration between services is important so the elderly individual can live a community and family rich life. Proposed LegislationOn October 8, 2012 a bill backed by Rep. Allyson Schwartz, D-Pa, and Senator John Kerry, D-Mass, promote better coordination between medical and social services for elderly people by building on the Older Americans Act. This will establish a variety of services for seniors such as home delivered meals, transportation and legal assistance.
For example this act would ensure that a diabetic would be provided meals in collaboration with their doctor to make sure they are metabolically compatible. Elders are at risk of abuse, whether it is physical, mental, sexual or financial, so an Elder Abuse Legislation to stop or at least try to prevent this from happening. In Ohio a proposed legislation would add bankers, pharmacists, and county humane society agents to the list of required under law to report elder abuse. This legislation??™s goal is to strengthen the existing adult protective services law to improve the response to cases of elder abuse and encourage more reporting. State legislation is proposing to ensure sex offenders don??™t work at elder health care facilities. Dangerous sex offenders are predators who look for opportunities to abuse people of all ages, especially those most vulnerable.
These individuals should never be allowed to work in any adult home or assisted living residence. There can be many more definitions and ways to assist the elderly and to keep their care controlled and assistive, instead of dismissing the elderly population since they are just getting older. One of the biggest decisions many families are faced with is how to care for the elders in their families, when those elders can no longer live independently. Families figure out many different strategies for handling their loved ones needs but the assistance of community services will assist in these concerns. Making it easier to keep the elderly in a home environment, instead of placing them in a nursing home. Many different factors need to consider when caring for the elderly including finding ways to access the needs, locating resources, financial management, and the teaching of transitioning elders. Appropriate care and support will make an elders life changes that can be so detrimental easy and transitional.
More elder care programs need to in place and more community resources need to be geared toward this ever so growing population. Resources 1. Administration on Aging. (2010) Elder abuse prevention. Retrieved from http://www.
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