Introduction
Over the next few decades the US will witness unprecedented growth in the population age 65 and over. Currently, the population age 65+ numbers 34 million individuals or 14% of the total population. By 2050 when the Baby Boom population will comprise the vast majority of older adults there will be 80 million adults over the age of 65, representing 20% of the US population (U.S Bureau of the Census, 2014). Furthermore, the US population is living longer. Advances in public health and medicine, in particular prevention, over the past several decades have led to decreases in mortality and increases in life expectancy across race, ethnicity and gender. However, while the population is living longer, for some it means living longer in poor health. For example, while Latino life expectancy is equivalent and in the case of women, better than that of Non-Latino whites, middle aged and older Latinos have higher rates of obesity, diabetes, and functional difficulties (Villa et al, 2012). So too the burden of disease is often higher for racial/ ethnic populations compared to whites. African Americans with high blood pressure are more likely than other populations to also have cardiovascular disease and renal failure (Clark and Gibson, 1997; Saab et al., 2014). Therefore, when examining markers for health status, it is important to disaggregate the population by race/ethnicity in order to garner a more precise picture of the level of health of the population. Meeting the needs of older adults with health issues, as well as enabling those with good health to maintain their health requires that the population have access to programs and services that support health.
Conclusion
Despite overall gains in life expectancy, there are populations that continue to experience health disparities as they age. Improving health and maintaining health for a population that is living longer requires improved access to health and social services that promote and protect health. The above data find that Los Angeles City and County employees age 60 and over are “not sure” if a number of health and social services exist. Access to services can be vastly improved by better outreach and information about the services and programs that exist in the community.
Recommendation
Scale-up proven, community-based and evidence-informed health promotion and disease prevention initiatives.
Approximately three-fourths of healthcare costs result from chronic conditions and about 80 percent of older adults have at least one chronic condition. We spend about $30 billion each year on treatment for older adults who have fallen and sustained injuries, while about one-fourth of older adults experience some sort of mental disorder. Health promotion programs are essential to preventing and managing a variety of chronic conditions.
However, only a small fraction of older adults in Los Angeles have access to these programs. Research demonstrates the use of evidence-based promotion and preventive practices among diverse communities falls, below the levels recommended by Healthy People 2020, while rates of chronic disease and the medical cost of treating them, continues to escalate.
Through scaling up evidence-based interventions, such as Chronic Disease Self-Management Program (developed by Stanford University) and A Matter of Balance, by ensuring equitable access and culturally responsive programming, we can help reduce the onset/worsening of chronic conditions, and assist older adults in effectively managing these conditions.
Identifying risk factors and strengthening protective factors such as addressing mental and physical health problems and increasing social connectedness are key for this population. The Health Agency will craft a protocol, in collaboration with LADOA and WDACS, to address health and mental health risks associated with loneliness and social isolation.
Suicide prevention can also be better addressed through community-based health initiatives. Many older adults receive their physical and behavioral health care in the community-based setting which is an ideal location for suicide awareness and prevention to occur. Suicide rates are particularly high among older men, with men ages 85 and older having the highest rate of any group in the country. Factors such as careful planning, use of lethal methods, social isolation (which leads to less likeliness of being discovered), and physical frailty (which means they are less likely to recover from an attempt), all lead to higher rates of death among this population.
Expand and enhance oral health services for low-income, older adults.
An ongoing source of dental care is necessary to ensure optimal health for older adults. The challenges in improving oral health are twofold: ensuring access to low-cost dental care and utilization of available dental benefits. Since Medicare does not cover oral health services, it is vital that older adults are connected to an accessible, ongoing dental health provider. As of 2018, the State of California had fully restored adult dental benefits (e.g., lab-processed crowns, posterior root canal therapy, periodontal services, and partial dentures) under a program called DentiCal for Medi-Cal beneficiaries. Given that many low income older adults in Los Angeles qualify as dual eligible (receiving both Medicare and Medi-Cal), and public awareness of these services has been limited, many older adults are unaware of their newly reinstated dental health benefits.
The Health Agency will launch a community oriented Denti-Cal awareness campaign and strengthen their internal capacities to provide referrals to sustainable dental homes (ongoing source of oral health care). In L.A. County, key areas are identified as “dental deserts,” which are highly populated, low-income communities with limited access to affordable and accessible dental care. To the extent funding and capacity allows, the Health Agency will integrate oral health case management/ referrals and/or awareness at their medical sites situated at or nearby dental desert communities. This inter-disciplinary approach will increase the awareness of the importance of oral health as a crucial step for overall health.
Support dementia-focused community engagement, programs and policies.
The number of older adults in California living with Alzheimer’s Disease will roughly double from 2010 to 2030. Through PALA, the County and City launched the Dementia Friends Program, which empowers residents in the Los Angeles Region to learn more about these conditions and the small steps they can take to promote Dementia Friendly Communities. WDACS and LADOA will build on Dementia Friends through new initiatives, programs and policies that address the needs of intergenerational populations with Dementia, Alzheimer’s and Autism. A key component of these efforts is implementation of the Bringing Our Loved Ones Home Initiative (BOLOH), which will enhance preventative measures in the Los Angeles Region to reduce wandering among individuals with Alzheimer’s/Dementia/Autism, while ensuring a comprehensive and coordinated response to wandering incidents when they occur.