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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
13.3%18.0%
21.8%27.5%
41.3%
10.0% 13.0% 14.9% 15.8% 17.1% 17.9%
5.5% 5.6% 5.3% 5.2%
70.2%
60.1%54.6%
47.5%
38.3%31.2%
35.4%
5.1% 5.5%
2000 2010 2020 2030 2040 2050year
Latino Asian African American nonLatino white
Source: California Department of Finance, May 2004www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Projections/P3/P3.asp
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Source:
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77
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Source:
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77
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Source:
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77
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Source:
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77
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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. 29:2(2005) http://www.generationsjournal.org/generations/gen29-2/article_thepublichealth.cfm
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Incontinence past month, women 65+
33.0%
25.7%
12.4%
25.9%
Latino AfricanAmerican
Asian nonLatinoWhite
Source: 2003 California Health Interview Survey
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Multiple falls past year, age 65+
16.7%
11.3%
7.6%
11.5%
Latino AfricanAmerican
Asian nonLatinoWhite
Source: 2003 Califorian Health Interview Survey
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Poor mental health past month, age 60+
29.7%27.3% 27.0%
18.2%19.1%
11.1%13.5%
7.7%
Latino AfricanAmerican
Asian nonLatinoWhite
Downhearted/sad, *all/most of the timeCalm/peaceful, *little/none of the time
Source: 2003 California Health Interview Survey
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7 or more prescriptions, age 65+
69.7%
75.3%
70.6%
79.3%
Latino AfricanAmerican
Asian nonLatinoWhite
Source: 2004 MEPS
Elders w/7+ prescriptions average 1+ inappropriate medications
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Could not afford needed dental care past year, age 60+
22.4%
17.2%15.9%
8.2%
Latino AfricanAmerican
Asian nonLatinoWhite
Source: 2003 California Health Interview Survey
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Advance directives of nursing home residents (odds ratios)
0.64
0.07
1.05
0.340.22
0.41
living will DNR do nothospitalize
Latino African American nonLatino White
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.
Controlling for age, gender, education, LOS, chronic diseases, dementia, physical function, cognitive status, depression
* * *
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Availability of someone to help w/daily chores when sick ,age 60+
48.8% 51.9%
38.2%
62.9%
25.8%19.6%
30.0%
16.3%
Latino AfricanAmerican
Asian nonLatinoWhite
always, mostly never
Source: 2003 California Health Interview Survey
(not shown: a little, sometimes)
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Neighbors are afraid to go out at night , by % poverty, age 60+
49.6%44.1% 44.2%
34.8%31.4%
22.3%
32.1%
14.2%
Latino AfricanAmerican
Asian nonLatinoWhite
<200% FPL >200% FPL
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+
6.9%
2.0%
4.4%
2.8%
Latino AfricanAmerican
Asian nonLatinoWhite
Source: 2003 California Health Interview Survey
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Hard time understanding doctor last visit, by language spoken at home,
age 60+
17.9%
8.9%
2.6%
9.3%
3.1%5.0%
Latino AfricanAmerican
Asian nonLatinoWhite
Spanish only English & Spanish English only
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+
10.8%
15.7%
9.3%
14.7%
11.8%
14.1%
Latino AfricanAmerican
Asian nonLatinoWhite
Spanish only English & Spanish English only
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+
59.6%
40.4%44.8%
33.0%41.2%38.5%
Latino AfricanAmerican
Asian nonLatinoWhite
Spanish only English & Spanish English only
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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http://swallace.bol.ucla.edu