NURS 4433 case study 4
NURS 4433 case study 4
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What is at the root of health care disparities for older adults?
To what extent might health risk behaviors contribute to this inequality?
A study in 2013 set out to examine the possible socioeconomic inequalities and found them, even among the most generous Medicare states. Certainly, socioeconomic inequalities have been demonstrated, especially among older adults, but this study conducted jointly from the School of Public Health at the University of Albany and the Aging Research Center at Stockholm University, explored the degree to which four behavioral risk factors were actually associated with socioeconomic position. These were:
- Smoking
- Obesity
- Physical inactivity
- Heavy drinking
Their goal was to determine “whether these behaviors mediate socioeconomic differences in mortality [as well as] the onset of disability.”
The study started with a baseline of individuals who were disability free and examined their statistics over a 10-year period. Using data from the Health and Retirement Study (n = 19,245), their results suggested the following:
- The combination of smoking and inactivity was more likely at lower levels of wealth.
- Obesity was also more likely at lower wealth levels, primarily in women.
- Heavy drinking, on the other hand, was less prevalent at lower wealth levels.
The report also indicated some differences depending on age and gender. For example, the team reports that “. . . health behaviors account for between 23 and 45% of the mortality disparities among men and middle-aged women, but only about 5% of the disparities found among women over 65 years.” At the same time, though, these health behaviors accounted for about 33% in women and 9% to 14% among men.
The study concluded that behavioral risks in older adults contribute moderately overall to the socioeconomic inequalities in older adults’ health. Recommendations are made for promoting healthier lifestyles, particularly among older adults who are socioeconomically disadvantaged. Education may help prevent future later-life inequalities in health.
Source
Shaw BA, McGeever K, Grubert E, et al. Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame? Social Science & Medicine 2014;101:52-60. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933820/. Accessed February 17, 2015.
Questions:
- Mrs. Elliott and her daughter arrive at a clinic under duress. Both are very angry. The daughter says, “Part of my mother’s bills are paid for by me, so I don’t appreciate the fact that she smokes and has a glass of gin and orange juice before bed. It’s bad for her, and I want you to make her stop.” The mother says, “I’m 87. It’s about time I got to do what I please with my own body!” Does the daughter have a right to force her mother to stop these behaviors?
- Mrs. Elliott and her daughter neglect to show up for the mother’s next blood pressure check, so a public health nurse stops by the mother’s home. She looks disheveled and unclean, her hair in a tangle. “I’m sorry I missed the appointment,” she says. “My daughter won’t drive me or pick up my prescriptions until I stop smoking.“ She starts to cry, putting a shaky hand to her forehead.“ “I’m trying, but it’s hard. I gave her the money for them, but she says I can’t have my meds till I quit for good.” If the daughter is considered the caretaker, is she within her rights to instill this set of consequences?
- With the help of a public health nurse, Mrs. Elliott makes the decision to enter an assisted living program. “I love my daughter,” she says, “and I know this has been hard for her and frustrating. But I don’t want her to be the one to make my medical decisions for me. Right now I can make my own decisions, but what can I do to protect my own preferences if I have a stroke or something and can’t speak or write?” Which documents should the public health nurse discuss with Mrs. Elliott?
- Identify a interprofessional collaborative practice core competency that pertains to this issue with a rationale. (support with cited reference).
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