Chronic illness and Older Adults

Chronic illness and Older Adults

Older Adults

  • Aging population
    • Surviving acute illness
    • Living with chronic illness
    • Becoming more educated and resourceful
    • More ethnically diverse

Demographics of Aging

  • Those reaching age 65 can expect additional years of life
    • 17.8 for men
    • 20.4 for women
      • Young-old adults are 65-74 years
      • Old-old adults are 85 and older
      • Frail old have conditions that may interfere with independent ADLs

Attitude toward aging

  • Aging is normal
    • Older adults have diverse characteristics
    • Care should not be based on age alone
    • Myths and stereotypes can lead to poor care
    • Ageism leads to discrimination and disparate care

Special Older Adult population

  • Homeless Older Adults
    • Numbers are increasing
    • Mortality rates are higher than for those with housing
    • Have a higher risk for more health problems
    • Require an inter-professional approach
  • Frail Older Adults
    • Clinical manifestations of frailty
      • Unintentional weight loss
      • Self-reported exhaustion
      • Weakness
      • Slow walking speed
      • Low level physical activity

Social support and older adults

  • Family caregivers
  • Semiformal levels of support
  • Formal systems of support
  • Elder mistreatment/abuse
    • From 2%-10% of community-dwelling older adults in the United States are abused, neglected, or exploited by trusted others
    • Mortality risk is 3 times higher
  • Mandatory reporting exists in most states
  • Self-Neglect
    • Unable to meet basic needs
    • Refuse help
    • Have multiple, untreated medical or psychiatric conditions
    • Live alone, often in squalor
    • Experience higher rates of mortality

Social services for older adults

  • Administration on Aging (AoA)
    • Part of the Department of Health and Human Services
    • Federal agency responsible for many older adult programs
  • Area Agency on Aging
    • State and local agencies funded from the AoA

Medicare and Medicaid

  • Medicare
    • Medicare is federally funded insurance for people >65
      • Also covers those < 65 with disabilities or end-stage kidney disease
    • Coverage is limited
    • Out-of-pocket expenditures continue to rise
  • Medicaid
    • Medicaid is a state-administered, needs-based program to assist eligible low-income people with medical expenses

Care alternatives for older adults

  • Adult day care and adult day health care
    • Centers provide social, recreational, and health-related services to individuals in a safe, community-based environment
  • Home health care
    • Can be a cost-effective care alternative for older adults who are homebound, have health needs that are intermittent or acute, and have supportive caregiver involvement.
  • Long-term care facilities
    • Rapid patient deterioration or function
    • Caregiver stress and burnout
    • Alteration in or loss of family support system
      • Transition may be difficult for patients and families
      • Relocation stress syndrome
  • Program for All-Inclusive Care for the Elderly (PACE)

Legal and Ethical issues

  • Many complex situations may arise for older adults
  • Decisions may be difficult
  • You can help
    • Stay informed about concerns
    • Be knowledgeable about resources
    • Advocate for patients and resolution

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