Geriatrics (Final): Week 2

social determinants of health

the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life

- Education

- Health and Health Care

- Neighborhood and Built Environment

- Social and Community Context

- Economic Stability

Healthy People 2030 organizes the determinants into five key domains:

•oral health does not happen in isolation or in a vacuum.

•it exists along a continuum influenced by the values and attributes of both the individual and community they live in

•oral health reflects a complex mix of biological, cultural, social, economic, and psychological factors

•oral health is influenced by the individual's changing experiences, perceptions, expectations, and ability to adapt to circumstances

The World Dental Federation's (FDI's) definition of oral health, emphasizes:

75

social and environmental factors have a far greater impact on health outcomes along with health behaviors they are responsible for ___% of a person's health status.

1.Social Determinants

2.Familial Determinants

3.Individual Determinants

What 3 factors affect an individual's access to care:

1.Change the way we think about aging, aware of your implicit biases (ageism).

2.Age friendly environments

3.Align dental care to meet the needs of our older patients (part of a system and assess their dental needs in the context of their daily environment, pay close attention to function and quality of life)

4.Develop a system for long term care

What can we do to promote healthy aging:

worse

Those with lower SocioEconomic Status face ______ health outcomes.

socioeconomic status

refers to one's economic and social position in society. It is based on income, education and occupation:

position on the class pyramid

The strongest predictor of health is a person's :

2,000

The Department of Health and Human Services recommends a provider-to-patient ratio one dentist to every

________ patients.

29

____% of older adults fall below the most basic health literacy levels.

3

__% of older adults are proficient in the most basic health literacy

15

social isolation is as bad for health as smoking ____ cigarettes per day

•Being 80+

•Major life events

•Living alone

•Chronic health problems (physical and cognitive)

•Pain

•Poor oral health

•Disabilities and sensory impairments

•Changes in social structures losing contact with family and friends

•Living on a low income

Factors that increase the risk of isolation:

1.Changes in health and physical ability - deteriorating chronic health problems, cognitive decline mental health issues, depression, decreased vision, hearing, mobility, increased difficulties with ADLs and IADLs.

2.Loneliness, isolation, losing a spouse, friends or their pet.

3.Loss of independence, inability to drive safely, lack of transportation

4.Not having a sense of purpose or a place in their community.

5.INVOLUNTARY or FORCED RETIREMENT can be very stressful because work is attached to a sense of purpose.

Sources of long-term stress:

true

t/f: Voluntary retirement does not cause a decline in either physical or mental health. It may improve functional health, happiness and life satisfaction.

•Increased levels of cortisol

•Elevated blood pressure

•Decrease in metabolism

•Increased blood sugar

•Increased inflammation

•Clenching and grinding

Effects of stress on the body:

the attainment of the highest level of health for all people

Healthy People 2020 defines health equity as:

to a disparity (difference in disease prevalence or disease burden) + the injust or maldistribution of resources

Inequity =

- Mexican American

- non-Hispanic black

- low income

- had less than a high school education

- current smokers

Summary some older adults were more than twice as likely to have untreated decay:

3

__ in 5 older adults have periodontal disease

•Men

•Non-Hispanic Blacks

•Mexican Americans

•Low income

There is a higher prevalence of periodontal disease in older adults in those who were:

•Geographic isolation (rural areas in health provider shortage areas)

•High unemployment and poverty

•Low health literacy;

•Lack of social and economic infrastructure

•Lack of transportation

•Political, and cultural disenfranchisement.

•Fragmented data.

Native American elders face some of the greatest challenges in accessing dental care and, as a result, have very high levels of dental disease due to:

affordability

- indirect cost: transportation

- direct cost: cost of treatment

What is the #1 barrier for low income elder adults accessing dental care?

not having teeth - no perceived need for regular visits

For high income seniors the number one reason for not accessing dental care was :

dental

______ care has the highest level of cost barriers of all types of health care

- Rx drugs

- dental

- medical

- eye

- mental health

65

____% of elder people have no dental insurance so all their dental treatment expenses are paid out of pocket

9

__% have Medicaid which is the public dental benefit program for the poor

65-74

The percentage with dental insurance was highest among those aged _____ compared with older age groups since not everyone retires at 65 -they still have access to dental insurance through their employer

9

Approximately ___% of seniors have incomes 100% below the Federal poverty threshold ($11,756,per year for a single person in 2021)

1 in 3

Roughly ______ seniors are economically insecure—living at or below 200% of the federal poverty

increases

poverty _______ w/ age

women aged 80 +

What population has high highest poverty rate?

Medicare

ID if medicare OR medicaid:

- federal

Medicare

ID if medicare OR medicaid:

- same program nationwide

Medicare

ID if medicare OR medicaid:

- insurance type of program

Medicare

ID if medicare OR medicaid:

- eligibility: 65 and older regardless of income

Medicare

ID if medicare OR medicaid:

- does not provide dental care

Medicaid

ID if medicare OR medicaid:

- Jointly-funded Federal-State health assistance program for low-income people.

Medicaid

ID if medicare OR medicaid:

- eligibility: low-income based regardless of age

Medicaid

ID if medicare OR medicaid:

- dental not required, but some states offer limited coverage

1.Eliminate barriers that contribute to oral health disparities

- Adopt a comprehensive oral health policy agenda centered on equity

- Integrate Dental Coverage In Medicare Part B

- Include Comprehensive, Affordable Oral Health Coverage For Everyone

2.Prioritize oral disease prevention and health promotion

3.Provide oral health services in a variety of settings: private practices, community health centers, FQHCs, LTCF, or using mobile dentistry..

4.Include collaborative and multidisciplinary teams working across the health care system

5.Develop and rely on a diverse and expanded workforce such as(dental therapist, PH hygienists , Community Health Dental Coordinators

6.Foster improvement and innovation

What can we do to help underserved and vulnerable older adults?