Health Literacy and Older Adults Reshaping the Landscape: Proceedings of a Workshop (2018) / Chapter Skim
Currently Skimming:
5 Reflecting on the Day's Presentations
5 Reflecting on the Day's Presentations
Pages 47-66
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 47... ...
Goodman, author of the Acting Our Age: Women's Lives at 85+ blog; Yolanda Taylor Brignoni, strategic communications director at AARP; and Mary Ann Zimmerman, founding director of Silver Spring Village, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
|
From page 48... ...
With that as her introduction to the session, Rudd asked the four panelists to comment on how they have gained insights into the experience of older adults. Edwards replied that she has gained insights from varied settings, including her 7 years as a practicing physician, as the caregiver for an elderly aunt who lived to be 100 years old and for her parents, and in her current position, where she focuses on the associates and their dependents
|
From page 49... ...
Taylor Brignoni said her job as strategic communications director for AARP is to make sure the organization is communicating in one voice about health across the 35 to 50 communication vehicles that AARP uses to deliver information that its 38 million members can use to make solid health decisions. Prior to her current job, she was a health reporter for many years.
|
From page 50... ...
"Every time we try to take people out of the picture, it does not work out well and everybody seems surprised." She also noted that focusing on health literacy and health disparities for a sub-segment of the population typically results in improvements for everyone, because so often the underlying root causes reflect systemic issues. One striking observation she has made regarding an example of ageism was the tendency of clinicians to speak to her when she accompanied her aunt to an appointment even though her aunt had no cognitive issues at all and was fully aware of what the clinician was saying.
|
From page 51... ...
"She was a lot more than swollen hands and feet," said Goodman. Goodman also noted that when she worked in subsidized senior housing in Boston, there was an exciting program at Tufts University School of Medicine that would send medical students into these housing developments one afternoon per week for an entire semester.
|
From page 52... ...
In her opinion, many health literacy barriers people face would be lowered if they felt they could trust their providers to ask questions and if the providers went into these communities to form the type of connections that doctors used to have with their patients and communities. Taylor Brignoni noted that while technology is great, there will always be human error, and so trust once again becomes an important issue.
|
From page 53... ...
She noted that she has had the opportunity because of her blog. Taylor Brignoni said she would like to see more attention paid to how the health system and communities can support the family caregiver because of the great deal of stress they are under and the critical role they play in providing care for older adults.
|
From page 54... ...
"The mixture of normative behavior and limited literacy skills through limited vocabulary perhaps can really exacerbate the problem of expressing your needs and expressing your feelings," said Rudd. Edwards added that limited health literacy plays an outsized role just at a time when life is getting increasingly complicated, and Rudd wondered what a health literacy focus can do to help mitigate these issues and increase access to care.
|
From page 55... ...
Fitzpatrick suggested that Zimmerman got lucky and that her doctors are outliers. Edwards remarked that there is a huge opportunity to work with the American Association of Medical Colleges to embed better practices and community involvement into medical education from the very beginning so that they become part and parcel of what a medical student or other health care professional learns and is expected to do.
|
From page 56... ...
Zimmerman said that helping with advance directives and estate planning were among the first services that Silver Spring Village offered, and it still provides them every couple of months. She added that these programs are open to the broader community, not just village members.
|
From page 57... ...
Bernard Rosof from Quality HealthCare Advisory Group asked Smith how Northwell, with its innovative educational programs with no real classes, addresses the issue he raised. "We teach communication skills using a very high proportion of standardized patients with videotape review," said Smith, "and asking people for advance directives is one of the standard exercises that every student does." His program also gets physicians, when they have those conversations with their patients, to ask permission for the students to be in the room and hear how a physician with a good relationship with a patient has that conversation.
|
From page 58... ...
"I think Mary Ann [Zimmerman] did a nice job reminding us that people know what they want and what they need and that they want to be partners in care, and they have the capacity to do so when we all show up together and recognize humanity in all kinds of spaces." The key idea that Earnestine Willis from the Medical College of Wisconsin gleaned from the workshop was that the aging process is heterogeneous.
|
From page 59... ...
Vanessa Simonds from Montana State University noted that the issues discussed at the workshop will affect her directly as her young-old parents start having health issues and start interacting with the health care system whose complexity will increase the demands on them. She added that she appreciated the attention to racism and rural issues, both of which affect her family and make the context of care more complex, and the attention to building trusted relationships by finding places where people feel safe and comfortable, which can help mitigate complexity.
|
From page 60... ...
Even in the cases when attempts are made to give them appropriate care, the training most health care professionals receive in geriatric medicine is poor, and clinicians struggle with providing appropriate care for many of the illnesses and conditions that affect older adults. "We have a context in which the quality of care is poor and then you layer on top of that low health literacy, and it is really a distressing and concerning situation," said Dillaha.
|
From page 61... ...
One concern that the day brought up for her was that technology has the potential to exacerbate health disparities, though it can also help reduce social isolation. She recounted how her father recently asked for a smartphone to replace his old flip phone because he felt disconnected from the rest of the family since he could not be part of group chats or receive pictures from the family.
|
From page 62... ...
Cindy Brach from the Agency for Healthcare Research and Quality said she heard some themes that the roundtable has focused on over the years, including the universality of limited health literacy and the multiple and exacerbated navigation challenges that people face when they get multiple chronic conditions, a common occurrence among the elderly. One thing the workshop did not address was some of the more acute problems this population faces, particularly regarding social determinants of health, such as housing.
|
From page 63... ...
It is important, he said, to have places where everyone knows everyone's name, for those are the locations where people can communicate with one another and have conversations about health and social connections in a health literate manner. Suzanne Bakken from Columbia University said from her perspective as a health informatician who works with populations in which health disparities are common, much of what was discussed at the workshop is intersectional in nature in that it occurs at the intersection of social determinants of health, health literacy, and age.
|
From page 64... ...
Assaf corrected him, and once the doctor started talking directly to her mother, her mother seemed to take ownership of her recovery and her recovery proceeded more rapidly. Assaf said it struck her that many of the health literacy problems older adults experience are similar to those experiences by people of all ages and perhaps similar to those of racial and ethnic groups, but the problems are magnified because older adults are
|
From page 65... ...
The boy, Deamonte Driver, died of a brain infection after a lack of accessible dental care allowed bacteria from a dental abscess to move into his brain.3 Robinson noted her appreciation for the work Thomas is doing at the community level because it offers the best opportunity to reduce health disparities, though she wishes that a dentist or hygienist was included in the groups that visit barbershops and beauty salons, given the importance of dental health to chronic disease management. 3 To read the workshop summary section of Congressman Cummings's keynote address, see www.nap.edu/read/13484/chapter/3 (accessed April 23, 2018)
|
From page 66... ...
"It is really the team, and the team includes the patient, the family, and the community. I think if we begin to think about that a little bit more seriously, we will recognize that we can improve health care by team function rather than perhaps what we think about as a single caregiver."
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.