A Diverse

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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

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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

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Growing Diversity of Elderly
Source California Department of Finance, May
2004 www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Pr
ojections/P3/P3.asp
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Source http//www.healthpolicy.ucla.edu/pubs/pub
lication.asp?pubID77
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Source http//www.healthpolicy.ucla.edu/pubs/pub
lication.asp?pubID77
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Source http//www.healthpolicy.ucla.edu/pubs/pub
lication.asp?pubID77
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Source http//www.healthpolicy.ucla.edu/pubs/pub
lication.asp?pubID77
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California health disparities from a Public
Health Perspective
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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. 292(2005)
  http//www.generationsjournal.org/generations/gen2
  9-2/article_thepublichealth.cfm

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Incontinence past month, women 65
Source 2003 California Health Interview Survey
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Multiple falls past year, age 65
Source 2003 Califorian Health Interview Survey
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Poor mental health past month, age 60
Source 2003 California Health Interview Survey
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7 or more prescriptions, age 65
Elders w/7 prescriptions average 1
inappropriate medications
Source 2004 MEPS
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Could not afford needed dental care past year,
age 60
Source 2003 California Health Interview Survey
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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
50378-81.
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Availability of someone to help w/daily chores
when sick ,age 60
(not shown a little, sometimes)
Source 2003 California Health Interview Survey
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Neighbors are afraid to go out at night , by
poverty, age 60
Source 2003 California Health Interview Survey
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Geriatric Issues - Summary

• Latino elderly mortality is a paradox
• Many geriatric conditions that do not contribute
  to death rates exhibit disparities among elders

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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

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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

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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
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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

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Medical care disparities

• No usual source of care
• Problem understanding the doctor
• Satisfaction with care

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No usual source of care, age 60
Source 2003 California Health Interview Survey
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Hard time understanding doctor last visit, by
language spoken at home, age 60
Source 2003 California Health Interview Survey
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Hard time getting needed health care past 12
months, by language spoken at home, age 60
Source 2003 California Health Interview Survey
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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
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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

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• 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.

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www.rcmar.ucla.edu
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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

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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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www.chis.ucla.edu
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(No Transcript)
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http//swallace.bol.ucla.edu