Health of Older People
The population of Americans aged 60 and older has been increasing from 35 million and at 12% in 2000 (Rodgers: (2002) (Online) (Accessed 18 August 2009). This was projected to leap to more than twice at 20% or 54 million in 2050. The population of those aged 85 and older is also faster-growing than any other age group. This older group is living longer, better educated and enjoys better fortune than earlier generations. Despite the advantage, disparities exist on account of gender, race and income. As of 2000, 1.1% of those aged 65-74; 4.7% of those aged 75-84; and 18.2% of those 85 and older were found living in nursing homes. Most of the older population is found in the South, which currently has 12 million persons aged 65 and older. They represent almost 20% of the rural population and 15% of the urban population. Rural dwellers, however, have different needs in health care delivery, transportation and access to social services. Rural areas have limited health care resources. Those who need more comprehensive and updated resources must travel to far-flung metropolitan centers to obtain these resources.
These facts and figures are of specific relevance and significance to decision-makers in the health care system. Those aged 85 and older tend to develop poorer health and need more health care than those who are younger (Rodgers). Are their health requirements adequately met?
Risks of developing certain diseases and disorders increase with age (Rodgers: (2002) (Online) (Accessed 18 August 2009). Many older Americans develop chronic conditions, such as arthritis, diabetes and heart disease. These conditions hamper physical functioning, exact financial costs and affect the diet and nutritional requirements of older people. Heart disease and cancer have been the leading causes of death among Americans aged 65 and older for the last two decades. Health care expenses required especially in this age bracket include the cost of physician services, hospitalizations, home health care, nursing home care, medications and other products and services for treatment and prevention. Expenditures and services for older people depend on age and their level of disability. Health care is a major expense for them and a financial drain on those who have limited income. Older people need long-term care obtained in nursing homes, home health care and assistance in their own homes. Nursing home care has recently been increasingly replaced by other forms of health care and service, such as assisted-living facilities and home health care. These facilities do not provide skilled nursing care but assist in daily activities, such as bathing, dressing and movements (Rodgers).
Inadequate Nutrition and Poor Dietary Habits
Poor nutritional status and improper dietary habits are common among community-dwelling and hospitalized elderly (Marshall (2001). (Online) (Accessed 18 August 2009). A recent study was conducted to determine the dietary habits and nutrient intakes of a sampling of 420 respondents, 79 years and older rural dwellers in Iowa. The Food and Nutrition Board of the National Academy of Science compared their nutrient intakes with their ages and gender and based on the minimum requirements of the Food Guide Pyramid. Of the total number of respondents, 22 said they complied with these minimum requirements. Male respondents ate more energy food than female. The intake of protein, fiber and fat was comparable between the genders. About 20% of them took nutrient supplements. These were multivitamins with minerals in 11%; multivitamins in 2%; and single, multiple or combination supplements. Less than 20% of them consumed 16 or more of the 19 nutrients. While supplements increased their intake of nutrients, the intake of 34% of them remained low with only 13 or more nutrients (Marshall).
The study revealed that the nutrient intake of rural, community-dwelling older population was inadequate ((Marshall (2001). (Online) (Accessed 18 August 2009). The respondents did not meet the requirements for folate, vitamin D, Vitamin E, calcium or magnesium at 60%. More than 25% of them consumed insufficient vitamin B6, vitamin C or zinc. Many of the respondents did not take supplements, although they could have benefited from these. The study concluded and recommended the use of multivitamin/mineral supplements with additional nutrients for older people in order to attain adequate nutrient intake (Marshall).
Year 2000 statistics showed that 354, 000 un-insured persons 65 years old and older did not have insurance coverage (Champlin (2004). (Online) (Accessed 18 August 2009). They represented 1.1% of the national population. They were mostly aged 65 to 74; unmarried, divorced or widowed; and African-American, Asian-American or Hispanic.
The false assumption was that the Medicare program provided health insurance coverage to older Americans. The truth was that, as far back as 2000, 72.3% of the un-insured belonged to the 65-74 age bracket; 24.3% were in the 75-84 age group; and 3.4% were aged 85 and older. Of the un-insured were 55.5% women and 57.5% men. They were more likely to be widowed or never married at 40.1%. Figures also reflected that 60.8% were Caucasian; 35.8% were Hispanic; 16.6% African-American; and 13.4% were Asian and Pacific Islanders. More than half of them at 55.8% were born outside the U.S., 51.3% were U.S. citizens. These un-insured were less likely to use office-based care, home health care, and phone advice and hospital admission. About 16.1% of them did not receive or seek out needed medical care on account of cost (Champlin).
The lack of insurance among the older old of the population has been attributed to the large number of un-insured children and working adults in addition to the assumption that Medicare covers those 65-year-old and older persons (Champlin (2004). (Online) (Accessed 18 August 2009). Unfortunately, these older persons are those most in need of medical care resources and also the fastest growing sector in the population. Researchers urged policy makers to review decisions affecting the increasing numbers of disenfranchised Americans, older people in particular (Champlin).
Depression and Functional Impairment among Older Persons
Contrary to previous assumptions, elderly persons living in urban areas were more prone to depression than those in the rural areas (Schulman, et al. (2002).(Online) (Accessed 18 August 2009). Rural-dwelling elders could be finding more challenges, which produced a more enduring attitude towards negative life developments. They became better accepting of problems and limitations as normal part of aging (Schulman, et al.). Depression is the most common mental health problem at this time of life and afflicts 20% of those 65 years old and older in the U.S. (Cummings, et al. (2003) (Online) (Accessed 18 August 2009). Previous studies showed that the condition is highest among institutionalized older people at 15% of community dwellers. Other studies revealed up to 30% of those who were not institutionalized, according to reports of significant depressive symptoms. Depression complicates the treatment of physical illnesses, makes the person more vulnerable to other illnesses and increases the use of health resources intended for the medical condition under treatment (Cummings, et al.).
Further consequences of advanced old age include functional impairment and chronic illnesses ((Cummings, et al. (2003) (Online) (Accessed 18 August 2009). As far back as 1995, studies said 37.2% of those 65 years old and older found difficulty in carrying out everyday activities because of chronic conditions and illnesses. The disability adversely affects them physically and emotionally. These activities included shopping, meal preparation, housekeeping and daily activities, such as bathing, dressing, and using the toilet. These frustrations increase the levels of their depressive symptoms. Negative emotions were found to remain in them even after their medical conditions were controlled (Cummings, et al.).
Satisfaction with Community-Based Health Care Services
Less frail elders receiving long-term care services found satisfaction when they could discuss their health problems with those rendering the services (Kolodinsky, et al. (2001). (Online) (Accessed 18 August 2009). The more frail elders, however, mostly showed satisfaction towards prompt delivery of care and the behaviors of the caregiver or agency. These were categorized into three aspects, which the care provider could control for the benefit of the patients. These were satisfaction with the punctuality of the caregiver; the quality of interaction between the patient and the caregiver; and the overall dependability of health care. Promptness or punctuality with care or service was rated most highly by both groups. Being on time affected their functioning and comfort throughout the day, specifically with dressing, bathing and daily activities. Promptness was considered the easiest and most controllable aspect for the provider. The quality of interaction made the patients feel safe, respected and valued. And satisfaction with the overall dependability of health care mostly involved the caregiver’s following through with the patient’s suggestions, especially those by the more frail patients. This last aspect was also well within the control of the health care provider (Kolodonsky, et al.).#
Champlin, L., (2004), surprising number of U.S. elders do not have health insurance coverage — not even Medicare (Online). American Academy of Family Physicians.
http://www.aafp.org/online/en/home/media/releases/2004/uninsured-elders-4-1-04 (Accessed 18 August 2009).
Cummings, S.M.; Neff, J.A.; and Husaine, B.A. (2003), functional impairment as a predictor of depressive symptomatology: the role of race, religiosity and social support (Online). Health and Social Work, National Association of Social Workers. http://findarticles.com/p/articles/mi_hb138/is_1_28/ai_n28983552 (Accessed 18 August 2009)
Kolodinsky, J.; Junghun, N.; Lee, J.K.; and Dorzewiczewski, M. (2001). Degree of frailty and elderly satisfaction with personal care services in a community setting (Online). Journal of Consumer Satisfaction, ProQuest Information and Learning Company. http://www.findarticles.com/p/articles/mi_qa5516/is_200101/ai_n21465985. Accessed 18 August 2009).
Marshall T.A. (2001). Inadequate nutrient intakes in elderly — nutrient & body composition in the elderly (Online), Frost & Sullivan. http://findarticles.com/p/articles/mi_m0887/is_11_20/ai_81102742. (Accessed 18 August 2009).
Rodgers, C.C. (2002). America’s older population (Online), Food Review, U.S. Department of Agriculture. http://findarticles.com/p/articles/mi_m3765/is_2_25/ai_9291403. (Accessed 18 August 2009).
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