KNPE 335 Final Flashcards
Health Inequity
unjust or unfair differences between persons, often rooted in social, economic, environmental or systemic conditions that disadvantage certain groups
*preventable
examples of inequity
more infant mortality in lower income places, access to healthcare, race, gender etc
Health Inequaltiy
observable or measurable health differences in health status or outcomes among different population groups
*differences quantifiable
*natural result of diverse pop
examples of inequality
varying life expectancy, mortality rates, older adults are more susceptible to chronic illness
Diversity with aging
as people age, experiences of health, support andn well being vary based on social det. of health which can lead to inequalities naturally
Health inequality in aging
measurable differences in health outcomes among older adults
-often result from many factors
Health inequity in aging
often stem from lifelong disadvantages such as poverty, racism, limited access to healthcare, affecting adults late life
*preventable, reflects social injustice
ex. rich ppl get better healthcare
links with health outcomes
-physical and mental inequities
-socio-economic factors
-poverty and disadvantage
inequities and inequalities relates to survival from various health conditions are closely linked to
age, sex, ethnicity
risk factors for senior risk of isolation, health inequality & inequity
-age and gender
-ethnicity
-social relationships
-poverty/lack of resources
-sexual & gender identity
-geography
-life transitions
-health&disability
-knowledge & awareness
opposite of a risk factor
in some cases the opposite of a risk factor is a protective factor
Indigenous peoples in canada
-were in good health prior to colonization
-included nutritious diets, rich and diverse healing systems and active lifestyles
how did contact with european settlers greatly affect health outcomes and continues to affect their health
-poorer health outcomes
-suffer from more chronic illnesses and disabilities (heart disease and diabetes)
direct causes of poor health outcomes for indigenous people living in canada
embedded racism & loss of support system
*type 2 diabetes continues to be 5 times more common against indigenous due to historical trauma and land dispossession
example of systemic discrimination
residential school system; loss of cultural identity is a loss of health
which entho-racial groups have higher risks of developing dementia
Black, hispanic/Latino, Native Hawaiian/Pacific Islander
*differences persist despite similar rates of cognitive decline
risk and expression of dementia are influenced by
social determinants, discrimination and access to healthcare
disparities in dementia care
access, diagnosis and outcomes
influential factors of disparities of dementia:
socioeconomic status, cultural diversity and geographical location
how are 12 risk factors of dementia influenced by inequities
lower income ad minorities face more barriers to managing risk
Prescription drug access
-insurance generally does not cover this
-people w private insurance plans have better access
-many older adults, indigenous and immigrants struggle to afford meds leading to poor adherance and health outcomes
Oral health inequities
-affect older adult
-often based on income and private benefits not provincial plans
why do many older adults avoid dental care
high costs
how does poor oral health impact overall health for older adults
-lost/broken teeth affect nutritional status = additional health complications
-stigma around poor oral appearance can affect mental health leading to social isolation
older adults who are caregivers
-face additional inequalities
-increase burden, depression, stress, financial problems, poor health, loneliness & social isolation
spousal caregivers
-at greater risk of experincing loneliness and decreased social support
proportion of seniors who are also caregivers
almost 1/4 aged 65 and older
female caregiver inequity rates
female caregivers tend to feel more inequities than male counterparts
Caregiver interventions that are proven to reduce inequalities and inequities
-physical and financial support through informal assiatance
-respite services
-home care or related services
-income and tax relief programs
-education and skills training
-psychological support
-interavtive online activities and groups
population of older adults that are immigrants
3.3%
Older adult immigrants in canada
-immigrant older adults are significantly lonelier
-lower prevalence of successful aging
Healthy immigrant effect
immigrants are generally healthier than domestic-born Canadians when they first arrive
Hypothesis explaining healthy immigrant effect
only people who are healthy migrate
Inclusive healthy aging interventions for immigrant older adults in canada
-additonal data collection research on immigrant older adults
-culturally and linguistically appropriate programs and services
Older adults in rural/remote areas
-increased risk of social isolation, smaller support networks, greater loneliness and lower utilization rates of health and social services
-increased risk of morbidity, obesity, diabetes, heart disease, cancer, COVID and excess mortality
what percent of seniors live in rural areas
23%
what are rural populations considered
a health disparity group in part because these populations have higher rates of mental illness, chronic disease & worse general health
strageties for improving healthy aging in rural areas
-Reducing
-joining
-developing
-improving
-stimulating
Strageties for improving HA in rural areas: Reducing
reduce health inequalities by providing older people with better access to healthcare services (more centers/programs)
Strageties for improving HA in rural areas: Joining
joining transport, housing, healthcare services to improve cost-effective service provision and access to services (all services in one area)
Strageties for improving HA in rural areas: developing
-cost effective transportation solutions to afford accessability and better social integration
-developing volunteer/community based initiatives to improve social integration
Strageties for improving HA in rural areas: Stimulating
bottom up socal enterprises and collaborative ventures to improve economic diversity of rural areas to encourage FURTHER DEVELOPMENT
Low income older adults
-one of most financially vulnerable canadian populations (esp people who live alone)
-increased risk of loneliness, social isolation, poor health outcomes, lower QoL and premature mortality
rate of older canadians living in low income has increased from
12.1% to 14.1% in 2016
Higher income older adults
experience more years of good health and better QoL
Programs and Services to help low-income older adults
- Income assistance
- Provincal and teritorial programs
- Residental rehabilitation assistance program (RRAP)
- Avance life deferred annuities (ALDAs)
- Variable life payment annuities (VPLAs)
Healthcare professionals - increasing cultural competence in HA
Awareness, Knowledge and skills (learn about their own personal biases and prejudices)
4 characteristics of aiming for culturally sensitive healthcare
- Under-served needs
- Cultural targeting (not one size fits all)
- Patient care/ health literacy (patients have a voice)
- Cultural Competence
cultural competence in healthcare
culturally sensitive care is essential to address diverse needs and promote healthy aging among all older adults
Low income impact
financial vulnerability among older adults leads to worse health outcomes and lower QoL
most tolerated form of social discriminationin canada
ageism
what percent of canadians would treat someone differently because of their age
35
unfamilliar negative expectations of old age
-twilight years
-golden years
-autonomy
-smelly
age related stereotype
cognitive structures embedding beliefs and expectations that people hold about different age stages
stereotypes of aging are
assumptions and generalizations about how people at or over a certain age should behave
2 types of stereotypes
- Explicit attitudes
- Implicit Priming
Explicit attitudes
-previously learned info’
- What people consciously endorse or believe
-direct and deliberate
-can be adknowledged
Implicit Priming
-associations that are outside of the conscious awareness
-unconscious and effortless
-indirect and automatic
-involuntarily active
stereotype content model
-2002
-all group stereotypes and interpersonal impressions form along two dimensions: warmth and competence
warmth dimension SCM
based on notion that people are evolutionarily predisposed to first assess a strangers intent to either harm or help them
competence dimension (SCM)
judge capacity to act on percieved intention
Low Competence, High Warmth
Paternalistic Prejudice
low status, not competitive pity, sympathy
ex. elderly, disabled, housewives
High Competence, High Warmth
Admiration
high status, not competitive pride, admiration
ex. in group close allies
Low Competence, Low Warmth
Contemptous prejudice
low status, competitive contempt, disgust, anger, resentment
High Competence Low warmth
Envious prejudice
high status, competitive envy, jealous
eg, asians, jews, rich ppl, feminists
Stone & Baker 2017
-self-efficacy and biomechanics related to stair navigation in older adults
-primed older adults can navigate stairs with more confidence and efficency
Barber et al., 2020
-stereotype threat can impair older adults physical performance
-dependent on tasks objective difficulty an participants subjective evaluations of their own resources
what categories did older adults claim to be thriving more compared to younger persons
-social
-financial
-community
-physical
What is ageism
how we think (stereotypes, feel (prejudice) and act (discrimination) towards others or ourselves based on age
Everyday ageism
occurs in day-to-day lives through interpersonal interactions and exposure to ageist beliefs, assumptions and stereotypes
percentages of everyday ageism
82% experience one or more forms everyday
65% exposure to ageist messages
45% ageism in interpersonal interactions
36% internalized ageism
3 types of ageism
cognitive (stereotypes)
Emotional (prejudice)
Behavioural (discrimination)
Cogntive ageism
how we think about agining and older adults
emotional ageism
how we feel about getting old
behavioural ageism
how we act towards getting older
Ageism in the workplace
can affect financial security and mental health
rate of workplace ageism
78% of older workers experienced/witnessed age discrimination at work
ageism in healthcare
prevalent through communication, diagnosis and treatment decisions
ageism in the media
negative portrayls, underrepresentation, and framing aging as the program
ageism in the legal system
ageism language, age restrictions and accessability
how does ageism shorten older adults lives
-poor physical health
-delay in injury or illness recovery
-decreased mental health
-increased social isolation and loneliness
-lower QoL
ageist effects on society
-shortens lives
-costs society billions of dollars
-causes conflict between generations
-causes loss of productivity in the workplace
-causes elder abuse (directly and indirectly)
rates of portrayl of older adults in the media
-96% positive portrayl under 50
-72% positive portrayl adults over 50
-15% of images are of 50+
disney roles of older characters
-39% of older adults had a major role
-80% were male
-many portrayed as neagtive or villanous
aging in the beauty industry
normative aging is associated with a loss of beauty. there is a direct link between body concerns and ageism
Categories of everday ageism (3)
- Exposure to ageist messages
- Ageism in interpersonal interactions
- Internalized ageism
most popular form of everyday ageism
“I see, hear and read jokes about old people, aging etc”
age stereotypes affects individuals well being how?
via physical and mental health, autonomy & how they see themselves
what does cognitive health have to do with ageism
those who experience cognitive issues ar emore likely to experience ageism
Combatting ageism via policy and law
can address discrimination and inequality based on age and protect the human rights of everyone, everywhere
how can education combat ageism
educational activities can transmit knowledge and skills and enhance empathy of aging process & older adults
**educate on how to include and take care of older adults
how can intergeneration combat ageism
contribute to mutual understanding of cooperation of different generations
how to combat ageism with research
-having an undertanding of its impacts tells us how to address it
- investing resources into formaitive, monitoring and evaluation research
-campaigns to foster learning environ.
-findings must me responses to in timely manner
how to incorporate campaigns that foster learning environments
- include research
- know when, what and how best to measure
3 ways to combat ageism with community work
- Engage
- Involve
- Include
How to ENGAGE ageism with community work
-engage, respond to and incorporate voices of the community
-parcipitory action research
how to INVOLVE ageism with community work
-involve a range of government structures
-middle-out approach
-work alongside various partners to enable effective use of resources
How to INCLUDE ageism in community work
-include representatives from affected communities in workshops, marketing and feedback
-create co-researchers
intergenerational programming
combat ageism, depression, social isolation, and overall improve HA
Highest percieved barrier to healthy aging
multi-morbidity; therefore aging itself is one of the highest barriers to HA because multi-morbidity increases with age
Lowest ranked percieved barriers to healthy aging
end of life planning
social comparisson theory
internal barrier to HA. 2 types of comparisson, upward & downward
Upward Comparison
comparing yourself to someone “better than you”
leads to self improvement via motivation
Downward Comparison
comparing yourself to someone who is “worse” than you
leads to increased self esteem and avoiding failure (by avoiding situations where you may fail)
comparing social status
upward comparisson is more likely; strongest results in improvements in overall health
types of barriers to healthy aging
- Physical
- Social
- Emotional
- Spiritual
- Environmental
Physcial barriers to healthy aging
-exercise
-nutrition
-sleep
-illness/activity
a barrier not considered to HA but should be
knowledge
who is more likely to engage in HA programs and gain more knowledge regarding HA
males
Physical barriers demographics to HA
-age
-advanced age
-gender
-comorbidities
-addiction
-medical events
Social Barriers to HA
-personal relationships/family
-meaningful activity
-engaging with community
-loneiness/social isolation
-not having children
-illness and disability
-physical/cognitive limitations
-responsibility
-
Aging and Driving
-changes to vision, reflexes and hearing as you get older impairs ability to drive
-loss of ability to drive decreases autonomy and social connection, increasing isolation
-older people feel like a burden on the road
-
Emotional and Spiritual Barriers to HA
-self-esteem
-self-knowledge
-coping skills
-nature and meaning of ones life
-religion
-balancing what can and cannot be changed
Environmental Barriers
-housing
-transportation
-income
-services
safety
-education
-programs available
Primary facilitators of healthy aging
-healthy diet
-physical activity
-mental well-being
-social support
-preventative health and safety
-acceptance of aging
-multimodal interventions
-economic autonomy
Facilitators to healthy aging
supportive environments, social support networks, and mental health resources are essential, promotion of positive health behaviours and adaptations can mitigate barriers
Health Promotion
the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being =. Health promoting is an action for health using knowledge, communication & understanding (WHO)
How does health promotion help healthy aging
complementing existing health promotion programs to ensure they are adequately meeting the needs of older adults, esp vulnerable populations
Healthy aging framework around national prevention strategy
-promoting health, preventing injuey & managing chronic conditions
-optimizing cognitive health
-optimizing physical health
-optimizing mental health
-facilitating social engagement
Healthy aging framework around national prevention strategy: IDENTIFY
what matters most for patient in all aspects of healthy aging and focus
Healthy aging framework around national prevention strategy: ENGAGE
patient in developing action plan for HA
Healthy aging framework around national prevention strategy: Provide
patient education, support and resources
Healthy aging framework around national prevention strategy: Coach Revise
advance directives/care planning
Age friendly communities
one that responds to both the opporitunities and challenges of an aging population by creating physical and social environments that support independent active living and enable older people to continue contributing to all aspects of community life
Safety of Aging in Place
-objective is to increase living environments support safe and injury free aging
Aging in place smart materials and devices
-environemtnal safety monitoring
-printable electronics
-next gen medication adherance
-chronic wound monitoring
Aging in place AI assisted decision making
-wearable and embedded sensing
-gait assessment and mobility monitoring
-integrated decision support
Aging in place standards
-objective is to increase Canadian Age Tech adoption through evidencce-based-age-friendly standards and policies
AgeTech Adoption
-evaluation and adaptation of agetech
-technical inoperability
Core strageties for promoting healthy aging
-focus on prevention and wellness
-equity and accessibility
-Person-centered approach
Focus on prevention and wellness
-proactive health screenings
-health education
-vaccine and immunization programs
Equity and Accessibility
-address rural and low income for older adults
-culturally sensitive care
Person-centered approach
-personalized health plans
-self-management support
-advance care planning
Six Evidence-Based Strageties for Healthy Aging
-Physical Activity
-Social/Leisure Activities
-Intellectual Engagement
-Nutrition
-Stress Management
-Sleep
Examples of Nondrug prevention and treatment strageties currently under study
-blood pressure and control
-diet
-sleep
-hearing
-cognitive training
-social engagement
-PA
Highest levels of PA reduce risk of cognitive decline and dementia by what percent
20%
intersectionality of PA & healthy aging
-PA programs + cognitive stimulation = significant improvements in cogntive health and mental well-being
-PA has most positive results on healthy aging i combination with interventions
-reduces anxiety & depression
-Improves sleep
Sleep & HA
-good nights sleep supports brain health at any age
-not enough sleep can leada to trouble with memory, concentration and other cognitions
lack of sleep
- makes brains emotional center overreact, while reducing control over emotions, increasing the risk of depression, aggression and attention problems
- difficulty interpreting emotional signals ad may respond more strongly to negative cues
- when sleep deprived people perceive neural things as negative, leading to threat bias in perception
intersectionality of social/leisure activities and HA
social relationships = maintain and improve cogntitive and mental wellbeing.
recent research shows there is a relationship between:
- Social activity with global cognition, overall executive functioning, working memory, visuospatial abilities and processing speed
- Social networks with global cognition
- Social support with global cognition and episodic memory
Nutrition and HA
-reduces risk of cronic disease and improves cognitive and metal health
-some studies show medetteranian diet result in lower dementia
-isolated vitamin deficiencies associated w cognitive disorders
-adequate intake of protein, fiber, vitamin D and omega 3-FA
caloric restriction
-caloric restriction controversially shown to benefit cognitive aging but NOT reccomendd for older adults
Managing Stress
-chronic stress and high allostatic load speed up aging and raise the risk of age-related diseases
-managing stress, encouraging healthy behaviours and reducing psychological responses can help lower allostatic load promoting HA
Stressor affects
percieved stress affects behavioural response and individual differences to both affect physiological response which affects allostatic load
what is geronotechnology?
-interdisciplinary field linking existing and developing technologies to the aspirations and needs of aging and aged adults
-supports successful aging and is a response to the combination of the aging of society and rapidly emerging new tchnologies
3 categories in Gerintechnology
- Successful aging
2.. Improved communitcation & Mobility - Aging in place
Successful aging in Gerontechnology
-any device or intervention that contributes to the persons perception of or ability to, successfully age
-ensures individuals actively engage with life
Improved communication & Mobility in Gerontechnology
includes wearables, mobility aids, implants & cognitive aids
gerontechnology wearables
-apple watches
-life alert
gerontechnology implants & replacements
-cardiac impairments (pacemaker)
-cochlear implants
gerontechnology mobility aids
-powerchairs
-walkers
gerontechnology cognitive aids
-Brain Communicative Interfaces
Aging in place
-remain living in community with independence rather than residential care
aging in place gerontechnology
- Traditional technologies
- Non-traditional technologies
traditional technologies for agining in place
-technologies that facilitate human contact, can be used personally connect or travel
nontraditional technologies for aging in place
robots and voide first technology can eb used to connect with loved ones, assist in daily living…
smart home devices for aging in place
ex. amazon alexa
-voice-activated, linked to wifi, to create smart home system
-can take the place of a care giver for tasks
-ensures ind. can live at home for longer
ambient assisted living (AAL) Systems
comprised of various sensors that use AI to analyze behaviour and compare it to established patterns, identify changes and call caregivers as needed
RF Pose
provides accutate human pose estimation through walls and obstructions. showing every body position
primary use of RF pose
security and aging in place
helpful considerations for AAL systems
-constant vigilance & security
-known location if fall/unconscious
-quick response time
harmful considerations for AAL systems
-personal life becomes known
-personal privacy, explaining long bathroom times, bedroom etc
-24/7 surveillence and security risk
Considerations for Gerontechnology
-line between wanting to help vs. relinquishing autonomy
-is intervention sustainable?
-does intervention require more attention to detail?
gerontechnology shoes
Nike Go Flyease
Nike Go Flyease Pros
-reduced bending an eliminates need for hand dexterity
Nike Go Flyease cons
-require balance to remove; questionable support
goal of Nike Go Flyease
improve independence so people can put shoes on themselves
why werent seniors buying Nike Go Flyease
-costly and not covered
-designed for younger people
OrCam Myeye pros
improves QoL of people who are visually or hearing impaired
OrCam Myeye cons
requrires dexterity, needs baseline level of hearing, does not eliminate need for glasses, pricy not covered
Care Predict
identifies patterns in daily lives of seniors that can predict declines in their health and enable early intervention
Care Predict: Senior living
–resident call button
-fall detection
-visitor management
-wander management
-predictive insights
-touchpoint
-keyless door entry
-location tracking
Care Predict: Homecare
-predictive insights
-smart location awareness
-customizable data collection
Care Predict: At home
-proactive alerts
-location insights
-attention on demand
-care circle
-carevoice
Does carepredict work?
so far yes
-lower hospitalization, fall rate and greater length of stay
main takeaways regarding carepredict
-more research needed
-important that user and staff are educated on how to use devices before implementing
Aims of gerotechnology
-improve patient-centred care
-lower treatment risk
-improve QoL
-alleviate symptoms
circle of gerotechnology
- Identify
- Assess
- Optimize
- Support
- Reassess
repeat
important things to consider with gerotechnology
-population in question
-accessability and sustainability
-cost to benefit
Age friendly communities
recognize profound impact of alrge populations of older people on communities and community infrastructures.
WHO initiative for age friendly communities
Global Age-Friendly Cities Project in 2007 to promote policies, services, settings and structures that enable older aduls to actively age in place
3 domains of Global age friendly cities
- Physical Environment
- Social Environment
- Personal Well-being
Global age friendly cities; physical environemnt
-outdoor spaces & public buildings
-housing
-transportation
Global age friendly cities: social environment
-respect & social inclusion
-social participation
-civic participation & employment
Global age friendly cities: personal wellbeing
-communication & information
-community support & health services
outdoor spaces & public buildings
safe and accessible neighbourhoods encourage outdoor activities and engagement with community
-stop gap ramps
-entending cross walk times
-age friendly checklist and benches
transportation
condition and design of transportation affecting personal mobility. access to public transport is important
-cycling safety workshop
-training for older adults on using public transit
-driving safety clinics
Hosuing
availability of appropritae, affordable and supportive hosuing options that incorporate flexibility
-homesharing
-housing directories
-home safety programs
Social participation
level of interaction that older adults have with other members of community
-PA programs
-arts-based programs
-tea & talk educational & social sessions
Respect & social inclusion
community attitudes
-senior of year award
-intergenerational progrmas
-age friendly business programs
CIvic participation & employment
older adults desire to be involved, remain employed, or find new employment
-support for voting
-volunteer fairs
-age-friendly employment programs
Communication & information
provide info about community events and services in accessible formats
-newsletter
-resource guides
-fairs/expos
Community support & health services
access to and awareness of services and mental and physical health programs contribute to QoL and age-friendly ness
-fall prevention classes
-cooking programs
-community paramedicine
individual benefits to age-friendly communities
-increased healthy behaviours
-supports aging in place
-increased opporitunity for social interaction
-improved awareness of community and health services
Community benefits of age-friendly communities
-economic retention & tourism
-volunteerism
-fosters intergenerational connections
-increased housing options
-improved accessability
what percent of municipans in ontario have age friendly initiatives
18%
ontario AFC planning guide
4 interconnected steps:
1. Define local principles
2. Assess need (survey)
3. Develop action plan
4. implement
how many municipals in ontario are involved in AFC planning guide
81
what happens throughout AFC planning guide
evaluation & sustainability
ontario AFC outreach program
provinical knowledge translation and exchnage program designed to support AFC development in ontario
3 types of core facilitation strageties
- People based
- Web-based
- Monitoring Evaluation
People based core facilitation strageties
-collaborative networks
-knowledge broker
Web based core facilitation strageties
-monthly e newsletter
-webinars
-website
-interactive maps
-community profiles
Monitoring and evaluation core facilitation straeties
-annual survey
-keeping view of what movement looks like
what does a knowledge broker do?
role is NOT to have the answers but to know weere to find them
jobs of knowledge broker
-identify, engage and connect stakeholders
-facilitate collaboration
-build capacity
-create tailored products and exchange strageties
-support communication & info sharing
-facilitate and evaluate change
support sustainability
-network development
-identify & appraise info
definition of knowledge broekering
act of linking people to people or people to info in order to share learning, better understand goals, forge partnerships …
where woud you find knowledge brokers
-organizations
-connected to projects
-independent
10 steps to being a knowedge broker
- Be the helper
- INtegrate the evidence
- Build and maintain relationships
- Lead, listen and facilitate
- Avoid one size fits all strageties
- Be open to collaboration
- Draw on big ideas
- MACRO-MICRO mindset
- todays effort is tomorrows advantage
- think like a knowledge broker
step 1 to being a knowledge broker
be the helper
-enable other people to do great things
step 2 to being a knowledge broker
Integrate the evidence
-research-based
-practice-based
-lived experience
-integrate and look at providing solutions
step 3 to being a knowledge broker
build and maintain relationships
-be curious
-follow up and stay connected
-authentic relationships lead to people you can draw on
step 4 to being a knowledge broker
Lead, Listen & Facilitate
-set purpose
-keep people anchored
-facilitate others to draw out ideas and move group forward
step 5 to being a knowledge broker
Avoid one size fits all
-consider evidence, audience and contect
-chose passive and active strageties
step 6 to being a knowledge broker
Be open to collaboration
-look to your team and your network
-embrance different ways of thinking
step 7 to being a knowledge broker
draw on big ideas
7 P’s of knowledge exchange
7 ps of knowledge exchange
- People
- Perceptions
- Policy
- Products
- problems
- Practice
- Policy
step 8 to being a knowledge broker
MACRO-MICRO mindset
Macro mind
-draw on big ideas
-what else is happening politically?
Micro mind
-take ideas and narrow the scope of mind to details
step 9 to being a knowledge broker
Todays effort is tomorrows advantage
-capture info in a way you can refer back to it
step 10 to being a knowledge broker
think like a knowledge broker
