1. Unit IV
Patient populations

2. Chapter 8 Health care for special populationsBy
Jahangir Moini, M.D., M.P.H.
and
Morvarid Moini, D.M.D., M.P.H.

3. Overview
Some special populations have less access to health care services:
Higher risk of poor health
Underprivileged people’s situations due to:
Economic conditions
Geographic conditions
Social conditions

4. Overview Special populations include: Children Women Minorities
Elderly
HIV/AIDS patients
Chronically ill
Homeless
Uninsured

5. Children More than 53% covered by private insurance
More than 38% covered by Medicaid
If below poverty level:
They receive less health care
Schooling is often impacted

6. Children Unique factors: Adults must assist with: Illnesses
Dependency
Developmental vulnerability
New morbidities
Adults must assist with:
Illnesses
Social circumstances
Emotional disorders
Alcohol or drug abuse
Injuries
Disrupted family units
Learning difficulties
Violence

7. Children
Demographics and socioeconomic factors impact their oral health care
Family income is closely related
Poor oral health often results in:
Missed school
Emergency department visits
Lowered quality of life

8. Divisions of child health programs
Personal medical and preventive services
Primary, specialty;
Mostly private insurance, out-of-pocket, or Medicaid
Population-based community health services
Disease prevention/health promotion, immunization, screening, abuse/neglect
Mostly federally funded
Health-related support services
Nutrition education, family support, early intervention, rehabilitation

9. Women Usually live 4.8 years longer than men
Have increased morbidity and poorer health
Though men have higher occurrence, more women die from heart disease or stroke
Higher annual charges for all types of care
Receive more intensive services
More likely to delay care than men

10. Figure 8-1: A waiting room with more female patients than male patients

11. Women Death related to alcohol abuse is higher than in men
Older women = much higher degrees of Alzheimer’s
Many programs focus on women’s health issues
Women are more often dependents under their husbands’ plans

12. Ethnic minorities Minorities make up more than 36% of population White
Black
American Indian, Alaska native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiians, other Pacific Islanders
Some other race
Minorities make up more than 36% of population

13. Percentages of larger minority groups in the USA
Hispanics or Latinos %
Blacks (African Americans) %
Asians %
Two or more races %
American Indians, Alaska Natives 0.7%
Native Hawaiians, other Pacific
Islanders %

14. Culturally competent care
Provision of care that is sensitive to patient values
Ethnic or religious backgrounds
Specificity in cross-cultural clinical interactions between patients and providers
Culturally competent care can be more successful

15. Hispanics or Latinos Fastest-growing minority in U.S.
About 57 million people in the country
1 in 4 live below the federal poverty level
Barriers to care include language
Generally less educated or job-skilled
More likely to be uninsured or underinsured

16. Blacks (African Americans)
Usually less economically advantaged
Poorer health
Shorter life expectancies
Increased age-adjusted death rates
Increased mortality rates for:
Pregnant women
Infants
Young children
Much higher percentages of low-birth-weight babies

17. Asians About 16.5 million Asians in the U.S.
Generally higher education levels, higher wages
Poor preventive care for Asian women, due to cultural beliefs
Overall lowest smoking rates
Except for Korean Americans
Asian Indians more than twice as likely to have diabetes than white Americans

18. American Indians and Alaska Natives
Among lowest socioeconomic classes in U.S.
3 of 4 live outside of reservations or trust lands
High rates of:
Diabetes mellitus
Hypertension
Chemical dependency
AIDS/HIV mortality
Death from alcoholism
Tuberculosis
Homicides
Injuries
Infant mortality and morbidity
Suicides

19. American Indians and Alaska Natives
Health is improving
Life expectancy 4.6 years less than overall population
Government is expanding their health services
However, less access to treatment
Partially because of geography

20. Native Hawaiians and other Pacific Islanders
Government funds health centers for Native Hawaiians
Barriers to care = cultural, financial, geographic, social
More than 1.4 million people in this group
21.5% more likely to live in poverty than total population
They have more:
Cancer deaths
Infant mortality
Diabetes mellitus
Obesity
Smoking
Alcohol use

21. Elderly Chronic diseases mean future disabilities, related care
May require increasing amounts of assistance for:
Hypertension
Arthritis
Heart disease
Cancer
Diabetes
Hearing impairment
Visual impairment
Dementia
Stroke
Hip fractures

22. Figure 8-2: An elderly woman

23. Elderly For the oldest-old Americans
Hospital and nursing home stays are common
After age 65, about 1.6 million in institutional settings
Medicare and Medicaid cover many elderly people
Need for long-term care is increasing
Costs are rising
Not enough caregivers

24. Elderly
Program of All-Inclusive Care for the Elderly (PACE) helps them remain in their communities:
Day care
Physical therapy
Occupational therapy
Recreational therapy
Nutrition counseling
Personal care
Social services
Medical care
Meals
Home care
Hospital care
Nursing home care

25. Elder abuse Intentional harmful or negligent acts:
Causing harm to vulnerable elderly:
Bruises, broken bones, abrasions, burns, pressure marks
Withdrawal, changes in alertness, unusual depression
Sudden financial changes
Bedsores, unattended needs, poor hygiene, weight loss
Spousal threats or uses of power, control
Strained relationships, arguments (patient / caregiver)

26. People with disabilities
15% of worldwide population
Lack of access = higher vulnerability to conditions
Barriers:
Excessive costs (especially transportation)
Physical barriers
Limited availability of services
Inadequate skills of providers

27. Levels of disability Level Description I (affects 2% of adults)
Can’t perform basic activities of daily living (ADLs) without help (walking, eating, etc)
II (affects 3% of adults)
Can’t perform instrumental activities of daily living (IADLs) without help (mobility, preparing meals)
III (affects 4% of adults)
Can’t perform 1+ activities, or difficulty with 2 ADLs, but not needing help
IV (affects 5% of adults)
Can perform, but with difficulty, 2 or more activities
V (affects 8% of adults)
Can perform, but with difficulty, only 1 activity
VI (affects 78% of adults)
No functional limitations
Childhood (4% of children)
Long-lasting conditions limiting physical abilities, or mental/emotional conditions affecting regular schoolwork

28. People with disabilities
Most are under 65, and still work
Elderly more likely to be disabled, often severely
Five common work-limiting conditions:
Mental retardation
Lung or bronchial cancer
Multiple sclerosis
Absence of a leg or legs
Blindness in both eyes

29. People with disabilities
Many health care options available
Level I through V disabled =
2 of every 3 people have private insurance
1 in 5 have public coverage
About 17% have no insurance

30. HIV/AIDS Human immunodeficiency virus (HIV)
Development of acquired immune deficiency syndrome (AIDS)
Deaths decreasing due to better treatments
Number of AIDS patients increasing
Black males have highest rates

31. Reported AIDS cases in various groups, in the U.S. (as of 2010)
Reported Number of Cases
Males, 13 and older
810,676
Females, 13 and older
198,544
Children under 13
9,209
Ethnic groups
Black
473,229
White
429,804
Hispanic
197,449
Asian
8,759
American Indian/Alaska Native
3,721
Native Hawaiian or other Pacific Islander
870

32. HIV/AIDS Antiretroviral therapy Women Top 2 methods of exposure:
Reduces mother-to-fetus transmission
Women
Quickly growing population for HIV/AIDS
Top 2 methods of exposure:
Heterosexual contact
Injected drug use

33. HIV/AIDS Highest risk groups: Homosexual men Inner-city young adults
Poorer women
Substance abusers that have left treatment

34. HIV/AIDS Slow overall response to the HIV epidemic No cure
Due to homophobia
No cure
Transmission is not affected by current treatments
Patients require increased care as AIDS progresses
Often involving government coverage

35. Chronically ill 7 of 10 deaths are from chronic diseases
They are now a leading cause of death
Heart disease, cancer, and stroke
Cause more than 50% of annual deaths
More than 1 in 4 adults has 1 or more chronic illness

36. Modifiable risk factors for chronic disease
Physical activity
Only 1 in 5 Americans get enough
Nutrition
Less than 1 in 4 eat enough fruits and vegetables daily
Smoking
1 in 5 smoke tobacco cigarettes
Alcohol – #1 drug problem in the country
3 of 4 Americans consume alcohol
Only 6% are actually alcoholics

37. Homeless About 3.5 million homeless, of all ages Most are men
1.35 million are children
Most are men
Second most are families with children
Significant cause:
Domestic violence
Linked to 18% of families

38. Homeless Poor access to health care, often uninsured
Leads to additional health problems
More likely to:
Be hospitalized
Receive outpatient care
Often provided without compensation

39. Uninsured Adult Americans usually have less insurance
Minorities more likely to be uninsured
Most uninsured are:
Younger workers
Lacking a college degree
Uninsured people are usually in poorer health

40. Uninsured percentages of various Americans
Hispanics or Latinos %
Blacks (African Americans) 17.8%
Asians %
Whites %

41. Illegal immigrants Often poor, seeking better opportunities here
Such as farmworkers
Estimated 12 million illegal immigrants
75% of migrant workers born in Mexico or Central America

42. Illegal immigrants Migrant workers not considered “legal”
Work in jobs of which the government is aware
More than half receive public assistance
Significant health problems:
Obesity
Tuberculosis
HIV/AIDS