1. 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

2. 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

3. Growing Diversity of Elderly Source: California Department of Finance, May 2004 www.dof.ca.gov/HTML/DEMOGRAP/ReportsPapers/Projections/P3/P3.asp

4. Source: http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

5. Source: http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

6. Source: http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

7. Source: http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=77

8. California health disparities from a Public Health Perspective

9. 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 http://www.generationsjournal.org/generations/gen29-2/article_thepublichealth.cfm

10. Incontinence past month, women 65+ Source: 2003 California Health Interview Survey

11. Multiple falls past year, age 65+ Source: 2003 Califorian Health Interview Survey

12. Poor mental health past month, age 60+ Source: 2003 California Health Interview Survey

13. 7 or more prescriptions, age 65+ Source: 2004 MEPS Elders w/7+ prescriptions average 1+ inappropriate medications

14. Could not afford needed dental care past year, age 60+ Source: 2003 California Health Interview Survey

15. Advance directives of nursing home residents (odds ratios) 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 * * *

16. Availability of someone to help w/daily chores when sick,age 60+ Source: 2003 California Health Interview Survey (not shown: a little, sometimes)

17. Neighbors are afraid to go out at night, by % poverty, age 60+ Source: 2003 California Health Interview Survey

18. Geriatric Issues - Summary Latino elderly mortality is a paradox Many geriatric conditions that do not contribute to death rates exhibit disparities among elders

19. 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

20. 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

21. 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

22. 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

23. Medical care disparities No usual source of care Problem understanding the doctor Satisfaction with care

24. No usual source of care, age 60+ Source: 2003 California Health Interview Survey

25. Hard time understanding doctor last visit, by language spoken at home, age 60+ Source: 2003 California Health Interview Survey

26. Hard time getting needed health care past 12 months, by language spoken at home, age 60+ Source: 2003 California Health Interview Survey

27. 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

28. 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

29. 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.

30. www.rcmar.ucla.edu

31. 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

32. CHIS Topics Health Status Health Condition Health Behavior Cancer Medical & Dental insurance Access & Use of Health Care SES, neighborhood & housing, immigration

33. www.chis.ucla.edu

35. http://swallace.bol.ucla.edu