Disparities in Health and Treatment  Seniors who belong to more than one group at risk for lower socioeconomic status are at increased risk for illness and disability. – Older women are among the most disadvantaged population – Minorities are also at risk – Having a chronic disease, whether new or pre- existing, can have a significant impact (Murray & Boyd, 2009)

Common Chronic Conditions Among the Elderly  Heart disease  Diabetes  Arthritis  Decreased sensory acuity – Visual – Auditory  Loss of balance, resulting in falls  Dementia and Alzheimer’s (Center’s for Disease Control, 2009)

Arthritis and Heart Disease  26.9% of Americans have arthritis  Risk for arthritis increases with age  60% of patients dx’d with arthritis are physically inactive (Centers for Disease Control, 2009)  Having both heart disease and arthritis results in people being even less compliant with exercise instructions.  People with both disorders are 30% less likely to be active than those who have heart disease alone.

Decreased Visual Acuity  Visually impaired elderly report a lower quality of life, and more moderate or severe problems, than the general elderly population or visually impaired young adults. (van Nispen, de Boer, Hoeijmakers, Ringen, & van Rens, 2009)

Co-morbid Conditions with Decreased Visual Acuity  Visually impaired elderly with conditions like diabetes, COPD, asthma, CVA’s, musculoskeletal conditions, cancer or gastrointestinal issues demonstrated a rapid decline in health related quality of life. (van Nispen et al., 2009)

Elderly May Have Increased Risks for Falling  Increased risks related to: – Gait and balance deficits – Dizziness – Poor vision – Confusion – Side effects of medications – Muscle weakness – Urinary incontinence – Overestimating abilities after a procedure or illness (Fenton, 2008)

Falls  Falls are frequent occurrence both in and out of the hospital  30 – 40% of falls in the hospital result in injury (Fenton, 2008)

Consequences of Falls  Injuries  Reduced confidence  Reduction in mobility  Reduced independence (Fenton, 2008)

Dementia and Alzheimer’s affect patients, families and caregivers  An estimated 5.1 million people in U.S. have Alzheimer’s (AD) – Dx if there are deficits in 2 of these 3 areas: Memory Speech & communication Ability to plan Reasoning and performance of tasks Interpretation of visual input (Murray & Boyd, 2009)

Dementia & AD  Dementia and AD are progressive and disabling  Quality of life for victims of dementia and AD is influenced by how they are treated  Majority of healthcare providers do not follow existing guidelines for their care, if they did care would be greatly improved (Murray & Boyd, 2009)

Healthcare Complications with Dementia and AD  Fragmented and complicated system of services for people with dementia and AD  High rates of comorbid conditions  Treatment decisions for co-existing medical conditions can be influenced by presence of dementia and AD  Men with AD have higher risk of dying while hospitalized than other men (Murray & Boyd, 2009)

Historically Disadvantaged Groups With Dementia or Alzheimer’s  Cumulative damage of a lifetime of disadvantage and lack of opportunities  Need for long-term care  High out of pocket expenses (Murray & Boyd, 2009)

Alzheimer’s and Dementia  Those with Alzheimer’s and dementia are often left out of decisions, even early in their disease  Increasing number of deaths attributed to Alzheimer’s  Hospice care is uncommon for patients with Alzheimer’s or dementia  Nonpalliative care measures, like feeding tubes and restraints, are frequently used with this population (Murray & Boyd, 2009)

Stereotypical beliefs, prejudices, and obstacles that can lead to health disparities in the elderly.

Ageism Defined: The stereotyping and discrimination of older people because of age with a distinct valuing of younger age groups. - passed on through socialization - enacted within institutions Phelan, 2008

 Seeing people as a homogenous entity: – Senile – Mentally incapacitated – Asexual – Unemployable – Condition of dependence and deterioration Phelan, 2008 Ageism includes:

Consequences of Ageism  Apathy towards treatment of the elderly  Decreased social and economic participation of the elderly  May result in isolation, victimization, disempowerment  Old age is associated with vulnerability Brockelhurst & Laurenson, 2008

Elder Abuse “Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” (Department of Health and Human Services, Administration on Aging, 2009)

Incidence  Comprehensive data on elder abuse is not collected nationally  Estimates: – 1 to 2 million elders are abused each year – Frequency of abuse is estimated between 2% and 10% – Only 1 in 14 cases come to the attention of the authorities – There may be at least 5 million financial abuse victims each year (National Center on Elder Abuse, 2005)

Types of Abuse  Physical abuse  Emotional Abuse  Sexual Abuse  Exploitation  Neglect  Abandonment  Financial (National Center on Elder Abuse, 2005; Neno & Neno, 2005)

Who is most likely to commit elder abuse?  46% of abusers are related to victim  Abuser is not likely to be primary caregiver  Paid workers are the most frequent abusers (Action on Elder Abuse, 2004)

Risk Factors for Elder Abuse  Social isolation  History of poor relationship with abuser  Pattern of family violence, with abuser often having been abused as a child  Dependence of the victim on the abuser  History of mental illness or addiction on part of abuser (Action on Elder Abuse, 2004)

Warning signs  Bruises, pressure marks, broken bones, abrasions, burns  Unexplained withdrawal from normal activities  Bruises around breasts or genital area  Sudden changes in financial situation  Bedsores, unattended medical needs, poor hygiene, unexplained weight loss

Other signs  Belittling, threats, uses of power and control by spouse (or caregiver)  Strained or tense relationships

Reporting abuse  If you suspect elder abuse, neglect, or exploitation, call U.S. Administration on Aging, 2009  If in imminent danger call 911

Differences in Treatment for Older Smokers  Smoking cessation is important to prevent or decrease many adverse health conditions  Patients over 65 yrs are significantly less likely to be counseled or offered prescriptions to help them quit  Older women are even less likely to receive tx (Steinburg, Akincigil, Delnevo, Crystal, & Carson, 2006)

Why are Older Smokers Treated Differently?  Possible belief that too much damage has already been done – Inaccurate, as quitting at any age has been shown to increase life expectancy, decrease medical complications, and increase quality of life  Previous concerns about safety of cessation medications for this population have been proven to be unfounded  Ironically, older smokers may be even more motivated to quit than younger smokers (Steinberg et al., 2006)