New Healthcare Challenges for a Divers and Growing Elderly Population Term Paper

Pages: 10 (3430 words)  ·  Bibliography Sources: 8  ·  File: .docx  ·  Level: College Senior  ·  Topic: Healthcare

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There were an estimated 3.3 million African-Americans over 65 in 2010, according to the Administration on Aging (AoA). By 2050, it is expected that the elderly population of African-Americans will account for about 11% of the 65-and-older population in the United States (AoA).

And although African-Americans are living longer, the majority of those over 65 years of age have had "at least one chronic health condition and many have multiple conditions" (AoA). The AoA provides a breakdown into the most frequent chronic conditions that afflicted older black people between the years 2005 and 2007.

Topping the list is hypertension, with 84% of elderly African-Americans reporting this medical problem. The following medical ailments are listed with percentages of black elderly people in parentheses: a) diagnosed arthritis (53%); b) "all types of heart disease" (27%); c) sinusitis (15%); d) diabetes (29%); and e) cancer (13%) (AoA).

Statistics provided by the Administration on Aging reflect that at age 65, a black male can expect to live to 80.3 years of age and a black woman at 65 may live to age 83.7. In 2009, surveys of elderly African-Americans showed that 47% had both Medicare and supplemental private health insurance, which is close to the average of "all elderly people" (54% had Medicare and a supplemental policy) (AoA).

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Since such a high percentage of African-Americans have been diagnosed with hypertension, it seems worthy to note a qualitative descriptive study of elderly black people's ability to "self-care" with reference to their struggles with hypertension. After all, learning to not just cope with but to actually help provide treatment for their maladies is the theme of any "self-care" program. The authors of the study report that they worked with ten African-Americans in a Midwest city -- all of whom had hypertension and also had "…some difficulties in cognitive functions" (Klymko, et al., 2011).

Term Paper on New Healthcare Challenges for a Divers and Growing Elderly Population Assignment

The results of the research -- during which healthcare professionals taught these individuals practices in better diet, physical activity, and the importance of self-care -- showed that even cognitively challenged elders can improve their lives with help and encouragement.

Innovative Health Policies in Response to an Increasingly Diverse Older Population

There are strong currents of thought in the professional healthcare community that a change is necessary -- and may be in the wind -- when it comes to providing services for a racially and ethnically diverse aging population. Ann Bookman explains that there are new models that provide "meaningful connections" between elderly people from diverse backgrounds, and these models eschew the traditional institutional settings (such as nursing homes). This models go farther than the original "aging in place" format, which often results in an elderly American sitting in the living room watching television and eventually suffering from "isolation" (Bookman, 2008, 423). That isolation can (and does) lead to depression and other mental health problems, but there are innovative healthcare programs that, while embracing the "aging in place" theory, nonetheless allow elderly and sometimes frail people to be with others in order avoid the pitfalls of isolation and depression (Bookman, 423).

This concept is called "naturally occurring retirement communities" (NORC); and as of the publishing of this article, there were 41 states, including New York State, that have adopted the model. Briefly, the model presented by Bookman, a professor at Massachusetts Institute of Technology, provides: a) a "geographical location" where many older people live in "close proximity" but had no previous cultural or social connection; b) the neighborhood is "multi-generational" so the young interact with, and help support, the elderly; c) services and activities are planned for by the older people in the NORC and supported by private or government funds, hence NORC-SSP; d) the NORC contracts with health care providers, transportation agencies, and social service professionals; and e) volunteers from the community of elderly people participate in services and "tasks…to others in their community, or each other" (Bookman, 424).

One can quickly discern the positives that would come from multicultural opportunities for aging people of diverse backgrounds; by living cooperatively in a NORC, whether in a suburban or urban setting, Latinos, African-Americans, Asians and others could find joy not only in the company of others but in service to others.

Four years after Bookman's scholarly piece, the peer-reviewed journal Aging International published an article that also embraces the NORC concept. In the introduction the authors point to statistics that show how serious the crisis vis-a-vis elderly Americans has become for healthcare providers. To wit, by 2030, there will be 72 million over-65 citizens requiring meaningful healthcare and one in five Americans will be 65 or older; and by 2050 an estimated 21% of Americans will be 65 or older (Guo, et al., 2012). Given these staggering statistics, Guo uses research by the American Association of Retired Persons (AARP) that some 85% of older people wish to live in "familiar and comfortable surroundings" -- and that means they wish to stay home and out of nursing homes (Guo, 215).

Guo points to health benefits that many older adults of diverse racial and ethnic backgrounds are enjoying through NORCs. Among those are reduced risks of heart disease, falls, Alzheimer's disease, and "post-hospitalization re-admission" (Guo, 220). Moreover, the NORC experience allows older people to become more knowledgeable about community resources that are available to them and it involves them in volunteerism -- which is always a positive experience because helping others, giving to others, strengthens person-to-person relationships (Guo, 220). Added to those benefits for the elderly living in a NORC environment there emerges a "positive perception of health" and "positive expectations about community living" and physical activities that are part of the NORC experience (Guo, 220).

Shortage of Key Healthcare Professionals - Geriatricians

It is a joyous thought to imagine a diversity of elderly people living in a non-planned, non-institutional but strategically ideal neighborhood, as the NORC environment offers. Still, these older people need healthcare wherever they reside, and that portends problems because of the acute shortage of geriatricians. Doctors apparently are avoiding the specialization of gerontology; and according to an article by the Associated Press, nationwide, by 2030, there will be just one geriatrician for every 3,800 older Americans. This is very unfortunate because many general practitioners "…aren't train to care for seniors, whose biology is different from younger adults" (Sedensky, 2012). The salaries of geriatricians are generally lower than other medical specialists, Sedensky reports. On fact, the geriatrician's median salary of about $183,523 is puny compared to other specialists' earnings, which are "…two or three times more" (Sedensky, p. 2).

Clearly the dearth of geriatricians is not a new issue, and it's somewhat surprising that this shortage of skilled physicians who understand the health needs of the elderly has been ongoing for nearly twenty years. In a 1996 peer-reviewed article (Lancet) the author reports that the number of practicing (and teaching) geriatricians in the U.S. "…remains woefully inadequate" (Firshein, 1996).

Moreover, in 1996 there were "less than a quarter of the number of academic physicians that were needed…" in order to train future doctors in the field of geriatrics; this fact, expressed 18 years ago, may well explain the dire shortage of geriatricians in 2014 (Firshein, p. 1). Echoing the report by the Associated Press in previous paragraphs, Firshein points to poor compensation offered to geriatricians as a possible reason more doctors decide not to specialize in geriatrics. Since most patients of geriatricians are over 65 and "often frail or chronically ill," the geriatrician is often dependent upon Medicare for reimbursement, which is "…limited and does not cover the added cost of resources" that frail older people require which the geriatrician "must coordinate while overseeing their care" (Firshein, p. 1).

Ethical Concerns Regarding Innovative Technologies in Healthcare

In addition to the shortage of geriatricians in the healthcare field, there are other serious concerns when the subject of diversity within the aging population in the United States. One of those involves ethics, and it comes into focus because of the emerging emphasis on home care for elderly people. The NORC style of living for older Americans -- reviewed in great detail earlier in this paper -- may not be appropriate in many instances for home healthcare services, but when home care involves monitoring devices, including sensors, data recorders, and communication networks, serious concerns may arise.

Those technologies also include portable wearable devices that are attached to the person so a healthcare giver in another place can monitor the patient's activities (Kang, 2010). These monitoring devices can offer "…continuous physiological data" and may be worn like "pendants" that monitor heart rate, sleep patterns, and more. However, as Kang explains on page 1583, these devices "…may intrude on a person's free choice, decision-making, privacy and autonomy." Those elderly persons surveyed reported serious objections to being monitored, especially by video technologies; hence, while these technologies may be appropriate in some situations, the ethical concerns must be addressed and resolved.

Conclusion

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