Barriers to Healthcare in the Elderly Population

Barriers to Healthcare
Statistics
Older population: classified as those 65+ years old.
Every 1 in 7 American's is 65+.
In the U.S., the population of older Americans has grown 21% over the past 10 years.
In 2012, New York State totalled 2,757,572 older Americans.
Costs
In 2012, older adults averaged health care expenditures of $5,118. This is an increase of 43% since 2002, and these costs were out-of pocket.

The total population spent an average of $3,556 out-of-pocket, significantly less than older adults.

Health costs incurred on average by older consumers in 2012 consisted of $3,186 (62%)for insurance, $935 (18%) for medical services, $798 (16%) for drugs, and $200 (4.0%) for medical supplies.
Nurse Advocacy Motions
Promote community outreach programs to make the elderly more involved with their own health and improve access to resources.

Educate elderly on available options, familiarize with modes of transportation to appointments.

Advocate for shared appointments between elderly groups with similar health concerns.

Geriatric Emergency Rooms to reduce hospital stay.
Reported Barriers to Healthcare Access
In a study of 4,889 older Americans, the following barriers were identified. The mean age of participants was 76.
1.Doctors not responsive to concerns
2.Medical bills
3.Transportation difficulty
4.Fear for safety on streets
5.Fear of discovery of serious illness
6.Fear of unneeded tests
7.Not having a regular doctor
8.Taking care of others
9. Work responsibilities
Community Outreach Programs
PACE: Program of All-inclusive Care for the Elderly.
Medicare/Medicaid program involving health care professionals who help coordinate care without moving to a long term care facility.

Large decrease in emergency room visits was seen when PACE began. PACE helps patients utilize ambulatory care services instead of acute services. 93% of PACE enrollees saw a physician, therapist or other medical professional within the first 6 months. 74% of PACE decliners utilized medical professionals in the same time frame.

PACE enrollees spent an average of 1.9 nights in a hospital after 6 months in the program compared with those who declined PACE and spent an average of 6.1 nights inpatient.

Allows patients to attend adult day programs, but stay in their homes.
Educate
Brochures, videos, informational education sessions that take time to thoroughly explain details to the elderly.
discuss programs such as PACE
transportation options and ways to set up transportation
advertise use of primary care providers consistently instead of ER visits.
teach about existence of geriatric ERs.
utilize clinical affiliates and physicians specializing in geriatrics to reduce the barrier of doctors being insensitive to concerns.
in the Elderly Population
Carly Detor, RN, BSN
(Administration on Aging, 2013)
(Administration on Aging, 2013)
(Fitzpatrick, Powe, Cooper, Ives, & Robbins, 2004)
Shared Medical Appointments
Elderly often have complicated, time consuming medical problems, however, these problems are shared among many elderly individuals. View the YouTube video from the Cleveland Clinic to learn more!


Resources in Onondaga County
PACE CNY: http://www.pacecny.org/

Onondaga County Department of Aging and Youth, New Senior Resources: http://www.ongov.net/aging/documents/NewSeniorResource.pdf

GEM Care, Senior Emergency Care: http://www.upstate.edu/community/services/gem.php

Catholic Charities, Diocese of Syracuse Transportation: http://www.ccoc.us/services/older-adults-services/transportation-services-for-seniors

Centro Senior Call-a-Ride: http://centro.org/OSCAR.aspx
(Cherniak, 2014)
References
Administration on Aging (2013). A profile of older americans: 2013. U.S. Department of Health and Human Services. Retrieved from http://www.aoa.gov/Aging_Statistics
Profile/2013/docs/2013_Profile.pdf

Chatterji, P., Burstein, N.R., Kidder, D., White, A. (1998). Evaluation of the program of all inclusive care for the elderly (PACE): The impact of PACE on participant outcomes.
Centers for Medicaid and Medicare Services. Retrieved from https://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/PACE_Outcomes.pdf

Cherniack, E., P. (2014). The use of shared medical appointments in the care of the elderly.
Journal of Ambulatory Care Management, 37
(1), 32-37. doi:10.1097/
JAC.0000000000000003

Cleveland Clinic. (2011, April 18).
Shared medical appointments a recipe for success
[Video file]. Retrieved from

Fitzpatrick, A. L., Powe, N. R., Cooper, L.S., Ives, D.G., & Robbins, J.A. (2004). Barriers to health care access among the elderly and who perceives them.
American Journal of
Public Health, 94
(10), 1788-1794.

Webb, M., & Campbell, K. (2014). Innovating care in the community.
British Journal of Healthcare Management,
20(7), 330-332.

(Chatterji, Burstein, Kidder & White, 1998)