Older adults

  Population considerations:

  • Lack of access to health care. Many rural older adults experience limited access to healthcare (Goins, 2005).  Limited access may prevent older adults from seeking care for prevention or maintenance for heart disease or stroke. 
  • Not being recognized/treated. A conservative perspective suggests that more than half of all older adults have some form of significant heart disease and that a large proportion of this disease may not be recognized or treated (Fair, 2003). 
  • Transportation: Some seniors may lack transportation or the transportation that is available does not adequately take into account their physical limitations (AHRQ). 
  • Lack of support. Lack of social support (e.g., from family, friends, health care providers) is associated with physical inactivity among older adults (Schutzer, 2004; Rhodes, 1999).  Support is important for making lifestyle changes, such as being active, eating healthy and quitting tobacco.
  • Lack of prescription drug coverage. Overall, low-income rural older adults have greater prescription medication needs, yet are more likely to lack prescription drug coverage (Coburn, 2000; Soumerai, 1999). Medicare prescription drug coverage (Part D) is insurance that covers both brand-name and generic prescription drugs at participating pharmacies.  Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.  There is extra assistance for people with limited income and resources.  For Medicare beneficiaries that qualify for extra assistance, Medicare will pay for almost all of their prescription drug costs.  www.socialsecurity.gov
  • Poor treatment adherence.  Older adults may have difficulty adhering o treatment plans due to transportation problems, a lack of confidence in their doctor’s ability to help them, a lack of satisfaction with the concern shown them by their physicians and a lack of satisfaction with how welcome and comfortable they are made to feel by office staff (Worth, 2006). Older adults may also face challenges paying for medications and other treatments, which could contribute to poor adherence.
  • Poor health literacy.  This is related to the aforementioned, (poor treatment adherence).  Older Americans, particularly low-income, geographically isolated Americans have poor health information knowledge.

  Strategies to address considerations:

  • Utilize Community Resources. The place to start with strategies is to identify the Area Agency on Aging serving your county.  Use the directory in the enclosed link to find an AAA. http://moaging.com/Public/Directory.aspx.  Ascertain if a needed strategy has already been implemented to address the issue.
  • Increase transportation options. The convenience of having activities and resources nearby is important to increasing healthy behaviors among those who are no longer able to drive themselves or have challenges with using public transit. Some have found it helpful to have a van to pick up seniors, or to work with the public transportation systems (e.g. OATS) to ensure that they are equipped with lifts or other assistance.   The mission of OATS, Inc. is to provide reliable transportation for transportation disadvantaged Missourians so they can live independently in their own communities.  http://www.oatstransit.org/bus.php Where appropriate, it may be possible to hold classes and programs where seniors gather or places they can access easily (e.g., senior centers, places of worship, salons, pharmacies, malls, schools).
  • Provide low-cost treatment and programs. It might be useful to work with health care facilities, recreational centers and grocery stores to provide appropriate classes and programs and to address what may be financial constraints for some seniors by providing sliding scale fees.  Likewise, efforts to reduce the cost of medications and other treatments, or to ensure older adults have adequate health insurance may be needed.  Prescription drug companies often have special programs for low-income populations.  Contact specific pharmaceutical companies for their special programs. 
  • Build social support. Providing opportunities for older adults to learn together may increase their likelihood of adopting healthy lifestyle behaviors.
  • Doctor recommendations. Older adults are more likely to consider healthy lifestyle behaviors when they are advised to do so by their health care providers.  Intervention strategies that incorporate encouragement and specific suggestions by healthcare providers may help to increase healthy behaviors.

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