Health Literacy and Older Adults Reshaping the Landscape: Proceedings of a Workshop (2018) / Chapter Skim
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3 The Family and Community Landscape
3 The Family and Community Landscape
Pages 17-32
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From page 17... ...
Stephen Thomas, professor of health services administration and director of the Maryland Center for Health Equity at the University of Maryland, College Park, then spoke about how health literacy can be a tool for easing disparities among vulnerable older adults. In the session's final presentation, Nora Super, director of the Aging and Disability Business Institute of the National Association of Area Agencies on Aging, discussed community living and independence for older adults.
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From page 18... ...
SOURCES: As presented by Jennifer Wolff at the workshop on Health Literacy and Older Adults on March 13, 2018; UN DESA, 2005.
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From page 19... ...
These many decisions include routine daily activities, such as when and how to access appropriate and timely medical care, knowing and understanding treatments and adhering to them, and accessing publicly available benefits and community service. Low health literacy can make it difficult for older adults to hire and fire direct care workers who can help them manage functional impairments and to prepare for future long-term care and medical needs in the event of incapacity by purchasing private long-term care insurance plans or engaging in advanced care planning.
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From page 20... ...
One of the major conclusions of Families Caring for an Aging America was that there are numerous challenges to providing structural support for family caregivers and care delivery, said Wolff. For example, the traditional entrenched systems that govern financing and delivery of services are not well aligned to support family caregivers.
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From page 21... ...
legal regulatory frameworks that prioritize patient privacy and the protection of personal health information often impede access for family members despite the fact that it may be appropriate and beneficial when they are involved in coordination of care or managing medications or prescribed treatments for older adults in the community, she added. Moreover, when providers are formulating care plans that will require assistance in bridging deficits in physical or cognitive function, family members typically are not involved in those discussions.
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From page 22... ...
Many EHR vendors even offer the capacity to allow patients to enroll family care partners and to provide them with their own identity credentials. In studies conducted in partnership with the Geisinger Health System, Wolff and her colleagues surveyed Geisinger patients who had registered for the patient portal and had shared access with a family member or friend.
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From page 23... ...
SOURCES: Adapted from a presentation by Jennifer Wolff at the workshop on Health Literacy and Older Adults on March 13, 2018; Wolff et al., 2016a. Patient Care Partner 89.0% 88.0% 55.0% 54.8% 53.6% 30.3% 22.0% 9.0% SUSPECTED OF LOW HEALTH HIGH SCHOOL EDUCATION DAILY USE OF INTERNET USE OF MYGEISINGER LITERACY OR LESS FIGURE 3-4 Comparing patients and their care partners.
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From page 24... ...
According to Healthy People 2020, a health disparity is a "particular type of health difference that is closely linked with social, economic, and/ or environmental disadvantage."3 This difference, said Thomas, is often caused by something such as systemic discrimination. The flip side of health disparity is health equity, which again, according to Healthy People 2 This section is based on the presentation by Stephen Thomas, professor of health services administration and director of the Maryland Center for Health Equity at the University of Maryland School of Public Health, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 25... ...
Washington was the first to recognize that African Americans had to take charge of their own health, and from 1915 to 1951, he launched the National Negro Health Movement, which in the 1930s became the federal Office of Negro Health Works. In 1951, in the name of integration, the office was decommissioned, but in 1985, the Secretary of Health and Human Services created the Office of Minority Health with what Thomas said was "almost amnesia to the success of the Negro Health Movement." He noted that many African Americans, not long out of slavery and still hampered by Jim Crow laws, could not read, but this movement worked because of the creative methods used to engage the population.
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From page 26... ...
Thomas and his team have taken this one step further and created Health Advocates In-Reach and Research (HAIR) , a network of 10 barber shops and beauty salons in African American neighborhoods in the Washington, DC, metropolitan area that hosts health professionals with the goal of reducing health disparities through community building and health education (Linnan et al., 2012)
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From page 27... ...
Super noted that of the people who call the Eldercare Locator looking for help with transportation, the majority are seeking help for current needs for transportation to medical appointments, and yet many health care plans complain about no-show rates among older adults. As an example of how one community dealt with this problem, a Medicare Advantage plan partnered with a Boston area agency on aging program to arrange for transportation services to bring older adults to their medical appointments.
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From page 28... ...
To address some of the issues that older Americans with dementia face, the White House Conference on Aging launched Dementia Friendly America, 1 of 75 initiatives to come from the conference.9 This program, modeled after Minnesota's ACT on Alzheimer's program10 and run by n4a, has the goal of catalyzing a movement to more effectively support those living with dementia and their care partners. Dementia Friendly America began with 8 pilot states that hoped to have 15 participating communities within the year, but the program exceeded its goal and now has more than 200 Dementia Friendly America communities in 37 states.
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From page 29... ...
In many cases, the medical residents learn that the Meals on Wheels delivery is the only meal some older adults receive all day and yet they share that meal with their pets. "It brings a new understanding of what health means to physicians and health professionals," said Super, "so prescribing a drug in the hospital might not be the best thing if these people are not even getting basic nutrition at their homes." DISCUSSION Parnell started the discussion by commenting on Wolff's remark about the lack of a defined role for family caregivers.
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From page 30... ...
"Recognizing what both parties can bring to the table, allowing them to practice at their highest level, and working in the community are some of the successes that we'll have in addressing the aging population," said Super. Winston Wong from Kaiser Permanente asked the panelists for their perspectives on introducing telehealth technologies into interactions with older adults, and if there are any warnings they would give health care systems with regard to how to leverage that technology in a way that adversely affects communication among the patient, caregiver, and clinician.
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From page 31... ...
Super agreed with McKee and said that the aging and disability communities do not really understand each other. She noted that when the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities were combined in 2012 to form the Administration for Community Living, disability organizations and aging organizations were brought together in an arranged marriage that can be uncomfortable at times, particularly given the history of mistreatment of the disabled community by the health care system.
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From page 32... ...
He did note that a recent publication highlighted the success of using African American barbershops to address hypertension in African American men (Victor et al., 2018)
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