Tag Archives: Chronic Disease

The Power of Health Literacy in Later Life

What is Health Literacy?

Health literacy refers to the ability to access, understand, communicate, and act on information related to health and disease. People who are health literate can find and understand health information, discuss concerns with medical professionals, and act on decisions to improve health and manage conditions. As a social determinant of health, health literacy is related to social factors, such as culture, education, or socioeconomic status.

It is an important factor in public health as health literacy rates affect health systems and the health services they provide. People with high levels of health literacy show healthier lifestyles, have fewer chronic illnesses, are more adherent to treatment, report better health, and live longer lives. In contrast, people with lower levels of health literacy have less use of preventive health services, are at higher risk for misdiagnosis, experience difficulties managing chronic conditions, medications, and treatment adherence, and have poorer health outcomes.

Health literacy affects everyone—even people with good literacy skills can have low health literacy. Most people will have difficulty understanding health terms or information at some point in their lives. Sometimes, people first hear specific medical terms or health information when they or a loved one has a serious health problem.

Health literacy has been shown to affect rates of illness and death, use of health services, and health outcomes. Low health literacy may account for up to five percent of overall healthcare costs. To address this, the European Union (EU) financed the European Health Literacy Survey, which revealed that nearly 50 percent of the population have a poor understanding of healthcare, disease prevention, and health promotion.

Why Does It Matter to Older Adults?

Health literacy is population-focused rather than individual-focused. Like many regions in the world, Europe is experiencing an increase in chronic conditions. It is the leading cause of mortality representing 77 percent of all deaths. When people manage multiple health conditions, they need to understand complex health information and navigate healthcare systems. Research finds that people who have the most difficulty with limited health literacy are older adults, recent immigrants who may not understand the regional language, those with lower levels of education, and ethnic minorities. For some older adults, using the internet to find health information or services is a struggle, and for others using basic math to schedule medications is challenging.

With populations growing older, more people will live with chronic conditions and may not have the skills to access, understand and act on health information. Although Europe has a relatively high socioeconomic status, up to half of its citizens have a poor understanding of their health, which means that health literacy is a crucial factor to active and healthy aging. Improving health literacy supports people in taking responsibility for their own lives, to make better decisions about their personal health, and to have the capacity to live longer lives in better health.

Increasing health literacy means addressing the knowledge and skills of people with low health literacy, their families, and communities. It also requires teaching health professionals how to provide health information that is understandable for individuals and how to help their patients understand what that information means for their own health. Improved health literacy empowers individuals to further engage in their healthcare and take a more active role in their personal health. In turn, this will have positive impacts on health promotion, disease prevention, and better treatment outcomes.

Carrie Peterson is a gerontologist and consultant in eHealth and Innovation.

 

Advertisements

Migrant Health: What About the Elders?

By now, most have heard about the migrant crisis, where around 1 million people migrated to Europe due to war, persecution, and other unfortunate circumstances. Many efforts to provide aid and support have focused on children, which is typical of most disaster and emergency responses. This is appropriate for the situation in Europe as children and unaccompanied minors comprise around 25 percent of migrants.

But what about the older migrants? Are they also receiving quality, targeted, and culturally sensitive care?

In disaster and emergency response, older adults have distinct needs that many relief organizations are ill-equipped to address. In fact, there is clear evidence that older people are often overlooked, neglected, or even abandoned. The main issues that such migrants face are health effects, housing issues, and pension challenges, which are significantly worse when compared to native groups of the same age. In addition to the psychological issues of being displaced, separated from family and community, and in violent situations, there are basic physical issues which make migration difficult for older adults. Temporary housing is often inadequate and cognitive conditions such as depression, dementia, and delirium all play a part. For some, reduced mobility impedes evacuation, while others may suffer from fatigue or frailty that affect balance when standing in lines for food, water, and medical care.

Both medical professionals and individual migrants face challenges in health consultations since cultural and linguistic backgrounds are very different. This can lead to older adults being less likely to seek out medical advice and care and the health sector having trouble in accurately diagnosing and treating those who do seek help due to the language and culture barriers. There is also the consideration that care services will not meet the (often different) needs of elderly migrants who receive health and social care or accommodate the cultural tradition of parent-child relationships.

Quality, targeted, and culturally sensitive services are required to meet the needs of older migrants. Likewise, training services are needed for health and social care professionals to develop these competencies. The age-specific information on migrants is growing, but more information is needed.

In Denmark, The Migration School is the largest training programme for the care of minority groups in Scandinavia and the first research project in Europe focused on diagnostic methods associated with dementia. In the Netherlands, Pharos has two programmes called Health for the Elderly and Asylum Seekers and Refugees. Both programmes focus on physical activity to prevent falls, supporting (migrant) carers for people with dementia, improving preventive care for asylum seekers and refugees, and the responsible use of medicine.

The global proportion of older adults is increasing. Older people will outnumber children under age nine by 2030 and people under age 25 before 2050. The majority of older people live in low‐ and middle‐income countries, where some are prone to disasters and emergencies. Not only will there be more older adults to be affected by disasters, but more older adults will also provide aid in the aftermath. It is thus important to address ageism and the ethical responsibilities of non‐discrimination in disaster and emergency management – older adults’ lives matter and should not be disregarded when distributing aid and planning services.

Carrie Peterson is a Gerontologist and Consultant in eHealth and Innovation.

Can the Arts Promote Health-Related Quality of Life in Australia?

As the global population ages, it is important to start designing strategies to address quality of life among older adults. The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Designing programs and policies to encourage quality of life across the age spectrum should not focus solely on addressing health issues as they arise, but rather promoting positive ways of living that can impact health in all realms – physical, mental, and social – throughout one’s life.

Strategies for healthy aging should include promoting activities that foster both individual growth and community participation. One such option is participation in the arts, which has shown to have a positive impact on both the individual and society.

Studies have shown that participating in visual arts, music, dance, drama, storytelling, etc. can improve mental and physical well-being, provide increased opportunities for friendship and meaningful social contact, foster a sense of social cohesion between different age groups, and break down stigmas associated with aging.

In Australia, several initiatives have been put in place to encourage “creative ageing,” which is defined as “the utilisation of the arts to excite imagination and support older people to age well.” For example, creative ageing was included in the Eastern Australian state of New South Wales’ Ageing Strategy, where community-based organizations such as the Creative Ageing Centre and Institute for Creative Health were established to encourage older adults to engage in the arts.

Results from the 2014 report titled Arts in Daily Life: Australian Participation in the Arts showed that participation in the arts increased from 41 percent to 48 percent since community arts centers became part of health policy. Among adults aged 55-64, participation increased from 36 percent to 44 percent.

The number of Australians aged 65 and over is expected to increase to 6.2 million by 2042, up from an estimated 3.4 million in 2014. Australia’s population is ageing. Now, more than ever, is the time to think creatively about aging and how these innovative strategies can have positive effects beyond for both the individual as well as society as a whole.

Diana Kingsbury is a doctoral student and graduate assistant in prevention science at Kent State University College of Public Health.

Does Participation in Organized Sports Help Australia’s Older People?

With the conclusion of the Summer Olympics last month, there is an opportunity to reflect on the accomplishments and physical prowess of the athletes who competed. Sports and wellness are important for the human body especially given the decreasing participation rates in physical activity and increasing rates of chronic disease worldwide.

While the benefits of regular participation in physical activity on both physical and mental health have been widely established, participation rates remain low among older adults. It has been shown that participation in organized sports typically peaks in early adulthood and steadily decreases as a person ages. In addition, when viewed in light of gender, men typically report higher levels of participation in sport compared to women, regardless of age.

In Australia, the participation rate in organized sports among older adults is estimated at around 6.8 percent for males aged 55 to 64 and 8.9 percent among females 55-64. Among men 65 and older, participation in sport is estimated around 9.1 percent for men and 8.9 percent for women. Though rates are low, the benefits of regular participation in sports for older adults have been identified. In a 2012 cohort study, it was shown that older adults who participated in popular organized sports experienced a 20-40 percent reduction in all-cause mortality compared with older adults who did not participate in sports. Social benefits of participation in organized sports also include decreased feelings of isolation and reports of stronger support systems, two important contributors to quality of life in older adults.

The benefits of participation in organized sports are many, however, it is important to address potential barriers that might prevent an older adult from getting involved. While one third of older adults who report they are physically active are participating in organized sports in some form, older adults who are not commonly report lack of time, lack of opportunity, and physical limitations as reasons why they do not. It has been acknowledged within Australia that creating more opportunities for older adults to participate in organized sports through targeted programming should be a priority.

There is an opportunity to engage older adults both physically and socially through organized sports. Perceived barriers should be addressed to make physical activity through organized sports accessible to older adults.

Diana Kingsbury is a doctoral student and Graduate Assistant in Prevention Science at Kent State University College of Public Health.

Health Profile of Older Adults in Tasmania

Photo Credit: Stefano Lubiana
Photo Credit: Stefano Lubiana

Tasmania (Pop. 517,000) is an isolated island located off Australia’s Southern Coast. It is the smallest of six states in Australia, with an area of about 26,410 square miles. When considering the demographic makeup of Tasmania compared to Australia as a whole, Tasmania has the second oldest population (after South Australia), where 18.4 percent of the population is aged 60 years and over. However, when compared to other Australian states and territories, the Tasmania’s population is aging more rapidly than any other state.

Recent estimates projected the majority of population growth in Tasmania to occur in older age groups over the next 10 years. By 2019, it is expected that Tasmania will have the oldest population in Australia, where roughly 25 percent of the population will be 60 years and older. Such estimates help society to understand and respond to the needs of older adults living in Tasmania, ensuring that elders maintain good health and positive aging experiences.

In the Health Indicators Tasmania 2013 report, people aged 60 and over reported high levels of social support. 75.7 percent of seniors reported that they were in good, very good or excellent health and few (9.0 percent) reported that they currently experienced very high or high levels of psychological distress.

Of the health issues of concern, arthritis ranked highest, with 52.8% of Tasmanians aged 60 and older self-reporting they had been diagnosed with arthritis, followed by cataracts at 28.6%, depression/anxiety at 19.1%, heart disease at 18%, and cancer at 17.2%. In terms of behaviors that can improve personal health, 96.1% of older adults reported they had received a blood pressure screening in the past 2 years, 82.3% reported they had received a cholesterol check, and 76.5% reported they had received a diabetes test. Of the screenings that were reported, only 38.7% reported they had received a bowel cancer screening, which could be a target for future public health action. When reporting fruit and vegetable consumption, smoking status, and alcohol consumption, older adults were more likely to report they consumed fruits and vegetables, were less likely to smoke, and less likely to consume alcohol when compared to other segments of the adult population.

It is important to consider, however, how these indicators may vary by region within Tasmania, and also, how the health of younger segments of the adult population may impact their future health as older adults.

Diana Kingsbury covers Australia for Global Health Aging. She is a doctoral student and Graduate Assistant in Prevention Science at Kent State University College of Public Health.

Menopausal Experiences Among Major Ethnic Groups in the U.S.

The world’s population is rapidly aging and women make up the majority of seniors in every country due to their higher life expectancy. There will be over 60 million peri- and post-menopausal women in the United States by 2030 and about 1.2 billion throughout the world.

Menopause Experiences in the United States

In the U.S., menopause often begins at the age of 51 with most women experiencing hot flashes and other symptoms like vaginal dryness and joint pain, according to the National Institute on Aging. While most studies have not focused on ethnic populations in the United States, a recent study by the Western Journal of Nursing Research found that certain ethnicities in the U.S. are more prone to menopausal symptoms. The study documented specific ethnic differences in the number and severity of symptoms among four major ethnic groups (Non-Hispanic Whites, Hispanic, African Americans, and Asians) and focused on women ages 40-60 since most women experience menopause around the age of 50.

According to the study, Hispanic women reported night sweats and hot flashes more frequently than non-Hispanic white women, although other symptoms were less common. Hispanic women also reported significantly larger numbers of total symptoms, physical symptoms, and psychosomatic symptoms than Asian women. African American women reported a significantly larger number of psychosomatic symptoms than Asian women, and non-Hispanic white women reported significantly larger numbers of total symptoms, physical symptoms, psychological symptoms, and psychosomatic symptoms than Asian women.

Osteoporosis and Menopause

Osteoporosis is a progressive form of bone loss common among postmenopausal women. About 70 percent of women in the United States have osteoporosis by the age of 80 and about 15 percent of non-Hispanic white women in the country eventually experience an osteoporosis-related hip fracture, according to the John Hopkins Arthritis Center. The development of osteoporosis is associated with lack of estrogen after menopause but hormone replacement therapy has been found to reduce the risk of the disease among women.

Interestingly, research has found that estrogen levels may be one factor that influences the development of osteoporosis in women, although ethnicity and lifestyle might be more important. For instance, 10 percent of Hispanic women over 50 have osteoporosis, according to the California Hispanic Osteoporosis Foundation. There are probably several explanations for the lower osteoporosis rates, aside from genetics. Ultimately, a more labor-intensive lifestyle and diet rich in phytoestrogens help guard against bone loss.

Photo Credit: Pain Pix
                                                               Photo Credit: Pain Pix

Conclusion

Specific differences exist for particular ethnic groups of menopausal women in the U.S. These differences are useful for targeting efforts to promote strategies to reduce menopausal symptoms and make best use of health promotion efforts such as adopting healthy-eating habits and leading an active lifestyle.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.

Richard Gaines, MD is the President and Chief Medical Officer of HealthGains, a leading hormone optimization center founded in 2005. Dr. Gaines has more than three decades of experience as a healthcare executive and physician with a focus on hormone therapy and platelet rich plasma therapy.

Integrating Alternative Medicine with Geriatric Care in Australia

In the last 20 years, aromatherapy in geriatric care has grown extensively especially in the Oceania region. This treatment uses plant-derived, aromatic essential oils to promote physical and psychological well-being. Age-related conditions such as dementia and arthritis as well as respiratory diseases, blood pressure and skin changes can benefit greatly from aromatherapy.

Photo Credit: Pixabay
Photo Credit: Pixabay

A survey from the Australian Longitudinal Study on Women’s Health (ALSWH) identified significant use of self-prescribed complementary and alternative medicine (CAM) for back pain regardless of education, income or urban/rural residency. CAM was among a range of care options but the study found that a large number of women aged 60-65 self-prescribed one or more CAM for back pain in the previous 12 months. The most common self-prescribed CAM was supplements, vitamins/minerals, yoga/meditation, herbal medicines and aromatherapy oils.

It was further noted that women who visited health professionals three or more times in the previous 12 months were more likely to self-prescribe CAM for back pain than those who did not. This study was useful in exploring the prevalence and characteristics of women who self-prescribe CAM for back pain. Medical professionals can integrate alternative medicine with geriatric care to treat ailments and improve quality of life for older adults.

While aromatherapy helps with a number of diseases, studies have mixed results when it comes to treating agitated behaviour in people with dementia. One study found that lavender oil had no discernible effect on affect and behaviour in Australian nursing home residents while another study reported that despite a downward trend in behaviours displayed, no intervention significantly reduced disruptive behaviour. These findings are important because older adults respond differently to alternative medicine. Individual needs must be considered and health professionals can assess the effectiveness of CAM.

Aromatherapy is a great way to manage symptoms of a chronic illness or relieve age-related discomfort. For instance, complementary therapy in palliative care such as Massage/aromatherapy, Reiki, and Therapeutic Touch™ enhances regular symptom management, increases comfort, and more. This can help support the immune system as people get older. Aromatherapy is becoming increasingly popular especially since it improves quality of life during the aging process.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.

Is Gogo the New Mama? How HIV/AIDS and globalization are increasing the role of older caregivers

Precious, a woman who looks well beyond her sixty-six years of age, sits in her yard in rural Zimbabwe watching over her three grandchildren, ages four, six and seven. “Gogo, gogo!” the youngest one beckons his grandmother, as he chases after his older siblings who are in search of guava fruits. Precious’ son, Michael, left for South Africa for work shortly after he married Mary, a girl from the same village. Michael contracted HIV in South Africa and transmitted it to Mary during one of his visits back home. While Michael was able to access antiretroviral drugs and continues to generate a small livelihood – a portion of which he sends from South Africa to Zimbabwe every few months – Mary died from AIDS shortly after the birth of her third child. Michael and Mary’s three children are now under the full-time care of Precious. [1]

Photo Credit: Blue Skyz Studios
Photo Credit: Blue Skyz Studios

Precious’ story is similar to those of many other grandmothers in Sub-Saharan Africa. The fact that Zimbabwe, Malawi, Kenya and other parts of the region are suffering from an Orphan Crisis is a topic of much debate internationally. The new systems of care that transnational economic structures are creating, and the pressing problem of HIV/ AIDS, continues to garner growing attention. For example, 2007 saw the first United Nations-led Global Summit on Grandparents and Kinship Caregivers. Sub-Saharan Africa currently has 17.9 million orphans, a large number of whom are being brought up by elderly grandparents.

A study conducted among the Luo ethnic group in Kenya demonstrates that older caregivers face severe strain while taking on parental roles in the lives of their grandchildren. For instance, grandmothers have noted going hungry on a regular basis to help feed the 1-9 orphans they care for. Many cannot sleep through the night as they have to nurse young infants. There is also the perpetually looming stress of being unable to provide financially for the children. This is especially hard when the children are HIV positive and require medical attention.

Another study in rural Uganda shows that caring for young children creates both physical and mental stressors, negatively impacting older caregivers’ health. The inability to participate in a livelihood livelihood generating activity causes grandparents to borrow from other households, which stigmatizes them in the societies they live in. In addition, children in the care of elderly are more likely to be victims of abuse as the elderly are often unable to protect them from these negative influences. All these factors culminate in weight loss, poor health and depression among the aging.

The preferred method of care for orphans in Sub-Saharan Africa is community-based as opposed to institutional. Keeping the child in a familial environment, and the village or tribe they come from, is key. While this method is certainly ideal, given the strain it places on the bulk of caregivers – grandmothers – there needs to be stronger social nets, such as feeding programs and free education, in place to help both caregivers and orphans live relatively successful lives. While certain NGOs provide stipends for food and education to such families, they do not have nearly enough capacity to address the issue of caregiver strain at the pace at which it is growing. It is important, thus, to consider the larger picture and understand how globalization and national policy can mitigate rather than exacerbate the issues that older caregivers face.

[1] This particular story is fictional. It is based on the lives of many women living in the rural Zimbabwe.

Sachi Shah is a recent graduate with a degree in International Development and Economics from Sarah Lawrence College, New York. She currently works as a grassroots campaign organizer, and is actively seeking opportunities in the international public health sector.

Elderly Refugees: The Experiences of Cambodian populations under the Khmer Rouge

Photo Credit: Extraordinary Chambers in the Courts of Cambodia
Photo Credit: Extraordinary Chambers in the Courts of Cambodia

War, natural disaster and fear of persecution often result in the tragic displacement of people far away from their homes. These people, refugees, live in uncertainty and under significant psychological and physical stress. Among these refugees are the elderly who are a particularly vulnerable group. Aging is not limited to disease and disability, but also the sudden change and a loss of belonging. The experiences of Cambodian elderly refugee populations is a clear example.

The Khmer Rouge took over Cambodia in the 1970s, prompting several years of genocide and a mass exodus of Cambodians into Thailand, US and other countries. By 1979, there were 160,000 Cambodians in refugee camps in Thailand.

A 10 year study sought to capture the experiences of Cambodian Americans in Northern California. Most Cambodian Americans lived in run down neighborhoods with a high prevalence of criminal activity. Elderly immigrants were at high risk of occupying poor housing conditions. Despite this fact, some refugees chose to move back into inner city neighborhoods as they aged to be a part of the community they once were as recent immigrants. In the case of this refugee population, many elderly people did not want to return to Cambodia given the turmoil which influenced their flight. Of those who did, they were constantly reminded of the differences in living conditions between the two countries.

Many Cambodian refugees in the US had poor education. With low income and little to non-existent English skills, elderly refugees constantly needed support from other immigrant populations, their children, and resources from the government. One woman says, “At my age, I’ve nothing to do, but pray for my children. I know that now I am their pillar, but later when they all grow up and leave, I will be alone with only myself to rely on.”

The past experiences with the hardships of the Khmer Rouge are constantly woven into their current narratives. For instance, many elderly complain of diseases such as high blood pressure or sleeplessness, and attribute such ailments to the harsh lives under the the Khmer regime. Post-traumatic stress disorder and depression are also common among Cambodian refugees. According to one study, family-related anger is prevalent among refugee families because of the cultural gap between refugees and the general population, as well as between refugees and their children who are much better adjusted to American lifestyle.

There are many organizations working towards improving the lives of elderly immigrants. The International Rescue Committee (IRC), one of the world’s leading organizations for refugees, has an Elderly Refugee Program. This program provides English as a Second Language classes, and assists in part-time employment and obtaining citizenship.

Yet the question remains – What can be done about the sense of loss of loved ones, one’s home, country and citizenship?

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Sexual Health and Intimacy in Later Life

The concept that older adults cannot have intimacy or a satisfying sex life is misleading. One basic need involves emotionally based relationships which play a vital role in the overall human experience. People have a universal need to belong and to love and having intimate relationships provides social networks and emotional support to older adults.

Photo Credit: Alex Proimos
Photo Credit: Alex Proimos

As people grow older, they want and need to be close to others. This includes the desire to continue an active and satisfying sex life despite changes in sexual behavior. Older adults may be impaired by infirmity but relationship needs such as closeness and sexual desire still remain. Many seniors can have sexual relationships, and probably a few others find ways to maintain or rekindle intimacy and a satisfying sex life as they age.

Health plays a key role in the level of older adults’ sexual activity. Many chronic health conditions such as pain as well decreased sexual desires due to emotional or health problems can affect sexual health. Health professionals have known that sexual dysfunction is not only a major problem for relationships and mental health, but can be an indicator of serious physical health issues such as heart disease. Older adults need preventive health screenings to reduce sexual problems. In addition, older women can improve the quality of their sexual experiences by aggressively managing their health conditions.

Age does not protect seniors from sexually transmitted diseases. In fact, older adults who are sexually active may be at risk for diseases such as syphilis, gonorrhea, genital herpes, among other sexually transmitted diseases (STDs). It has been reported that the number of older adults with HIV/AIDS is growing. While casual sex offers only a moment of emotional intimacy. It does not provide the love and commitment of a serious relationship.

In conclusion, older adults need to feel a sense of belonging and acceptance, whether it comes from a social group or connections. This desire to belong can bring about companionship and intimacy among seniors. Sex and older adults is still a taboo in some societies and often ignored. It is paramount that sexual health becomes a vital component of the quality of life for seniors.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.