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