Health status and health care services among older persons in India

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

The Role of Non-Governmental Organizations for the Welfare of the Elderly

Summary

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the nongovernmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived.     

Happy Living in Darkness! Indoor Lighting in Relation to Activities of Daily Living,Visual and General Health in 75-Year-Olds Living at Home

ABSTRACT

Lighting has been identified as a significant environmental attribute for promoting vision and general health among older people, enabling successful aging at home, but it has received little attention in the literature. Indoor lighting levels, self-reported vision and general health, and activities of daily life were measured in 114 healthy 75-year-old Norwegians. Despite very low levels of indoor lighting, the subjects were happy and healthy. There is a large discrepancy between self-assessed health and recommended lighting levels, and low awareness of the effect of lighting on age-related vision loss or daily living in the future. Knowledge of how to utilize indoor lighting to ensure healthy and safe aging in the home is needed.     

Oral diagnostics: an integral component to geriatric health care

Abstract

Aging is inevitable, every day we live we age. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. Oral health reflects overall well being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in age. Diagnosis and proper treatment is essential for healthy aging. Timely diagnosis, appropriate treatment and regular follow-up of both oral and systemic diseases are a prerequisite for active aging. Oral diagnostics is a revolutionary development with high potential to replace other investigative modalities. Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. This paper is aimed to shed light on the growing elderly population and their ailments. It also aims to create awareness among health care providers about oral diagnostics and their application in geriatrics.     

The Built Environment,Health, and Longevity

Abstract

This paper reviews and integrates interdisciplinary literature that investigates the influence of the built environment on the subjective and objective health status of older persons that may improve their quality and quantity of remaining years of life. The development, expansion and synthesis of person-environment and ecological models provides the theoretical foundation. Central to this discussion is the identification and elaboration of salutogenic and pathogenic pathways (Antonovsky, 1979) through which the built environment may influence health, functioning and longevity. Research and knowledge drawn from literature on relocation, housing characteristics and well-being, the meaning of home, delay of institutionalization, technological devices, falls and other injuries, and healthy communities is used to demonstrate environmental pathways to health and longevity.     

Policymaking for Diversity Among the Aged in India

Abstract

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.     

Neglect and Abuse Associated with Undernutrition in Long-Term Care in North America: Causes and Solutions

ABSTRACT

Protein-calorie undernutrition in institutional long-term care is a significant cause of morbidity, mortality, increased health care costs, and poor quality of life. Failure to provide adequate nutrition constitutes neglect, and certain practices associated with feeding the dependent elder or adult with developmental disabilities can be abusive. The causes are multifactorial. They are related to conditions common to these persons; multiple medication use, difficulty in swallowing, gastrointestinal dysfunction, poor oral health and oral care, sensory changes with aging, and lack of education and training in the proper protocols required to provide adequate food and liquid to persons with cognitive and physical impairments. Solutions which are simple, cost-effective, easy to apply and cross national, ethnic, and cultural boundaries are described.     

Understanding Older Americans' Attitudes,Knowledge, and Fears About Vision Loss and Aging

ABSTRACT

The purpose of the present study was to identify factors associated with attitudes, knowledge, and fear of age-related vision impairment in a representative sample of US adults age 55 and older. Data were obtained from a national telephone survey. Attitudes toward vision impairment and aging were positive, but fears were extensive and knowledge was lacking. Higher socioeconomic status and experience with nonrelated persons who were visually impaired predicted better attitudes and greater knowledge. Being a women and having experience with persons who were visually impaired predicted lower fear. Findings emphasize the importance of accurate knowledge and training about visual impairment for practitioners working with this population.     

American College Health Association-National College Health Assessment Spring 2008 Reference Group Data Report (Abridged): The American College Health Association

Objective: Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey that ACHA developed in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, and impediments to academic performance. Participants: The spring 2008 reference group includes ACHA-NCHA data from 80,121 students at 106 institutions of higher education. Methods: Officials at participating institutions administered the ACHA-NCHA to all students, randomly selected students, or students in randomly selected classrooms. ACHA collected data between January and May 2008. Results: Results from the spring 2008 reference group (N = 80,121) are presented. Conclusions: These data expand the understanding of the health needs and capacities of college students.     

American College Health Association-National College Health Assessment Spring 2007 Reference Group Data Report (Abridged)

Objective: Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey that ACHA developed in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, and impediments to academic performance. Participants: The spring 2007 reference group includes ACHA-NCHA data from 71, 860 students at 107 institutions of higher education. Methods: Officials at participating institutions administered the ACHA-NCHA to all students, to randomly selected students, or to students in randomly selected classrooms. ACHA collected data between January and May 2007. Results: Results from the spring 2007 reference group (N= 71, 860) are presented. Conclusions: These data expand the understanding of the health needs and capacities of college students.     

Marital Quality,Socioeconomic Status,and Physical Health

Recent efforts to promote marriage among the socioeconomically disadvantaged are based on the assumption that marriage is equally beneficial for persons with varying levels of socioeconomic status. Using 3 waves of data from a sample of married adults (the National Survey of Families and Households; N = 1,849), the authors evaluated whether the health benefits of marital happiness and the health costs of marital conflict might vary by education and income levels. They found that increases in marital happiness were associated with increases in self‐rated health for individuals with more education. In addition, increases in marital conflict were linked to greater increases in functional impairment for persons with lower income. Although the results were not consistent and effect sizes were modest, the evidence nonetheless tentatively suggests that higher levels of marital happiness may be less beneficial for health and that higher levels of marital conflict may be more detrimental to health among persons with lower socioeconomic status.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Longitudinal Evaluation of Peer Health Education on a College Campus: Impact on Health Behaviors

Objective: The authors investigated the longitudinal impact of peer health education on the health behaviors of undergraduate students pertaining to alcohol and drug use, eating and nutrition, and sexual health. Participants: From fall 2003 to spring 2006, the authors annually administered a Web-based survey to a cohort of 2,000 randomly selected undergraduate students. Results: Students who had contact with peer health educators were significantly more likely over time than other students to report less alcohol consumption and fewer related negative consequences. Results also show that students who had contact with peer health educators initially endorsed engaging in unhealthy weight management and fat talk behaviors during their first year but decreased these unhealthy behaviors by their third year. No significant differences in sexual health behaviors were found. Conclusions: Results indicate that peer health educators play an important role in promoting healthy behaviors in the areas of alcohol and drug use and in eating and nutrition.     

Socioeconomic Status,Psychosocial Factors and Health in Urban Guyana

Abstract

This study seeks to understand the relationship between socioeconomic status (SES) and self-reported indicators of physical and mental health in an urban Third World context. The data come from a probability sample of 654 adult residents of Georgetown, Guyana. There is a significant inverse association between formal education and morbidity for four of the six measures of health status. In this research the extent to which self-concept, health behaviors, stress and social ties are linked to health status and SES, and can explain SES differences in health status is explored. Psychosocial factors, especially the self-concept measures (self-esteem and mastery) play a moderate role in accounting for educational differences in health status.     

A Profile of Adolescent Health

SUMMARY

As the adolescent population living in this country undergoes dramatic demographic changes in the 21st Century, increasing both in numbers and ethnic/racial diversity, practitioners and policy makers need to understand the prevalence of and trends in adolescent risk-taking behaviors, morbidity and mortality. Significant disparities in health status exist by ethnicity/race and gender in areas including: unintentional injury, violence, mental health, substance use, sexual behavior, and disease prevention. The epidemiological profile can help mobilize communities to address adolescent health issues. Developing effective interventions will require an ecological approach that builds on adolescents' assets and takes into account the contexts in which they live.     

Health Care Rationing Affecting Older Persons

Abstract

Health care resources are finite and, therefore, need to be rationed among potential users. Over the past decade and a half in the United States, a variety of explicit, official rationing schemes have been proposed, including some in which chronological age would play a significant role. For ethical and political reasons, it is very unlikely that any age-based rationing schemes will be adopted explicitly and officially. However, various de facto forms of health care rationing are occurring at present. This article outlines the implications of payer behavior, physician practice patterns, the development of evidence-based clinical practice parameters or guidelines, and reliance on consumer choice of health plans as unofficial and generally unacknowledged mechanisms of health care rationing that may exert an important impact on the accessibility of health services for older persons.     

Socioeconomic Status and Health Disparity in the United States

Abstract

Low socioeconomic status (SES) has been associated with high rates of many chronic diseases. This study was a cluster analysis of data from 9,830 adults in the 1994-96 Continuing Survey of Food Intakes by the Individuals (1994-96 CSFII) in order to characterize more fully the biologic and social factors that might be associated with chronic diseases. The study employed cluster analysis to define three SES groups (low, middle, and high) based on income, education, age, gender, and race. A significant increase was found in self-reported diabetes, hypertension, heart disease, obesity, and stroke across these groups, being highest in the lowest SES group. Results revealed that health disparity in the U.S. may be substantial, with some population groups bearing a disproportionate burden of chronic diseases.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Impediments to Health Care for the Foreign Student

Abstract

Today's college students occupy a “window” between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.     

Adult Day Centers and Mental Health Care

ABSTRACT

This research focused on the mental health issues at adult day centers and used a cluster analysis to profile older persons who received these services. The sample included 280 participants who attended adult day care. The data were collected from intake files using a biopsychosocial framework to guide the selection of variables from January 1, 1999 to December 31, 2000. A cluster analysis revealed two distinct profiles of participants. The first profile was characterized by women, who were single, African-American, had low incomes, relied more on public funding, and had no psychiatric diagnoses. The second profile was differentiated with more men, who were married, relied more on private funding, and had higher incomes and psychiatric diagnoses. Participants clustered in the second profile, including those diagnosed with psychiatric disorders, disenrolled at a faster rate than those in the first profile, including older adults without psychiatric disorders. Both profiles were similar in age, education, caregiving, religious affiliation, household size, and service intensity. They also resembled each other with respect to functional limitations, nutrition risk, and prior nursing home placement. Slight differences were found in frequency of previous hospitalizations and years of education. Recommendations for strengthening the mental health training of social workers employed at adult day centers were made.