Transcript Slide 1
MIDLIFE WOMEN’S HEALTH
DHHS OFFICE ON WOMEN’S HEALTH
WOMEN’S POLICY, INC.
CONGRESSIONAL CAUCUS FOR WOMEN’S ISSUES
WOMEN’S HEALTH TASK FORCE
Women’s Health and Healthy Aging:
Living Longer, Living Better
Darlene Yee-Melichar, EdD, CHES
Professor and Coordinator,
Gerontology Program
San Francisco State University
[email protected]
Overview
Demographic Imperatives
Aging in America
Feminization of America
Diversity in Aging America
Health Indicators
Life Expectancy
Leading Causes of Death
Multiple Chronic Conditions
Activity Limitations and Disabilities
Health Care Challenges
Healthcare Access for Midlife Women
Multi-Level Approach to Healthy Aging
Consumer Health and Health Literacy
Comprehensive Geriatric Assessment
Midlife Women and Caregiving
3
Aging in America
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf
4
Feminization of America
http://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf
5
Diversity in Aging
6
Diversity in America
7
Life Expectancy
8
Leading Causes of Death for
White American Women
http://www.4woman.gov/owh/pub/minority/table1.htm
White American Females
Cause of Death
All Causes
1
Diseases of the Heart
2
Malignant Neoplasms (cancers)
9
Number of
Deaths
1,064,096
320,168
232,608
3
Cerebrovascular Diseases (including stroke)
89,642
4
5
6
7
8
9
10
Chronic Lower Respiratory Diseases
Alzheimer’s Disease
Influenza and Pneumonia
Diabetes Mellitus
Unintentiaional Injuries
Nephritis, Nephrotic Syndrome and, Nephrosis
Septicemia
58,024
32,936
32,912
29,552
29,262
15,213
14,088
Leading Causes of Death for
African American/Black Women
http://www.4woman.gov/owh/pub/minority/table1.htm
African American/Black Females
Cause of Death
All Causes
1
Diseases of the Heart
2
Malignant Neoplasms (Cancers)
10
Number of
Deaths
140,642
40,783
29,128
3
Cerebrovascular Diseases (including stroke)
11,195
4
5
6
7
8
9
10
Diabetes Mellitus
Nephritis, Nephrotic Syndrome, and Nephrosis
Unintentional Injuries
Chronic Lower Respiratory Diseases
Septicemia
Influenza and Pneumonia
Human Immunodeficiency Virus (HIV)
7,250
3,837
3,746
3,369
3,341
3,075
2,448
Leading Causes of Death for
Hispanic Women
http://www.4woman.gov/owh/pub/minority/table1.htm
Hispanic Females
Cause of Death
All Causes
1
Diseases of the Heart
2
Malignant Neoplasms (Cancers)
11
Number of
Deaths
47,082
12,253
10,022
3
Cerebrovascular Diseases (including stroke)
3,322
4
5
6
7
8
9
10
Diabetes Mellitus
Unintentional Injuries
Influenza and Pneumonia
Chronic Lower Respiratory Diseases
Certain Conditions Originating in the Perinatal Blood
Chronic Liver Disease and Cirrhosis
Nephritis, Nephrotic Syndrome, and Nephrosis
2,821
2,134
1,322
1,238
951
875
841
Leading Causes of Death for
Asian/Pacific Islander Women
http://www.4woman.gov/owh/pub/minority/table1.htm
Asian/Pacific Islander Females
Cause of Death
All Causes
1
Malignant Neoplasms (Cancers)
2
Diseases of the Heart
3
Cerebrovascular Diseases (including stroke)
4
5
6
7
8
Unintentional Injuries
Diabetes Mellitus
Influenza and Pneumonia
Chronic Lower Respiratory Diseases
Nephritis, Nephrotic Syndrome, and Nephrosis
Essential (primary) Hypertension and Hypertensive Renal
Disease
Septicemia
9
10
12
Number of
Deaths
15,857
4,356
3,926
1,733
621
556
528
411
273
179
170
Multiple Chronic Conditions Among Adults Aged 45 and Over:
Trends Over the Past 10 Years
1999–2000
2009–2010
Percent
SE
Percent
SE
Total
16.1
0.3
21.0
0.4
Men
15.2
0.5
20.6
0.6
Women
16.9
0.4
21.3
0.5
Total
37.2
0.5
45.3
0.6
Men
39.2
0.8
49.0
0.9
Women
35.8
0.6
42.5
0.8
Age in years
45–64
65 and over
NOTE: SE is standard error.
SOURCE: CDC/NCHS, National Health Interview Survey.
13
Activity Limitations and Disabilities
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf
14
Healthcare Access for Midlife Women
Access to health care for midlife women is a
challenge:
• Cost: may not have health insurance and often can’t
afford it
• Transportation: have no way to get to a doctor or
other health care providers
• Sandwich generation: have major caregiving duties
for younger and/or older family members
• Low health literacy: don’t understand the language
and/or the health information
15
Multi-Level Approach to Healthy Aging
and Continuum of Health Care
Primary Prevention
(health promotion and disease
prevention)
Secondary Screening
(monitoring and tracking the disease)
Tertiary Treatment
(rehabilitation and treatment)
16
Consumer Health and Health Literacy
The degree to which individuals have the capacity to
obtain, process and understand basic health information
and services needed to make appropriate health
decisions (U.S. DHHS, 2000).
Low health literacy is a widespread problem, affecting
more than 90 million adults in the U.S.
Results in patients ’ inadequate engagement in, and
benefit from, health care advances as well as medical
errors.
Is likely to be a major contributor of adverse health
outcomes.
17
Comprehensive Geriatric Assessment and
Geriatric Care Coordination
History and Physical Examination
Functional Assessment
Mental Assessment
Psychological Assessment
Social Assessment
Values Assessment
Health Promotion and Disability Prevention
18
Midlife Women and Caregiving
• Estimates of the percentage of family or informal caregivers who are
women range from 59% to 75%.
• The average caregiver is age 46, female, married and working
outside the home earning an annual income of $35,000.
• Although men also provide assistance, female caregivers may spend
as much as 50% more time providing care than male caregivers.
• One study concluded that the caregiving time burden falls most
heavily on lower-income women: 52% of women caregivers with
incomes at or below the national median of $35,000 spend 20+ hours
each week providing care.
Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480
19
Midlife Women and Eldercare
One national study on women and caregiving highlighted the
conflicting demands of work and eldercare. The study found
that:
• 33% of working women decreased work hours
• 29% passed up a job promotion, training or assignment
• 22% took a leave of absence
• 20% switched from full-time to part-time employment
• 16% quit their jobs
• 13% retired early
Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480
20
Negative Health Effects of Caregiving
on Midlife Women
• As many as two out of three older women do not take advantage of
preventive health services due to lack of information and high out-ofpocket costs.
• 25% of women caregivers have health problems as a result of their
caregiving activities.
• Coronary heart disease (CHD) is one physical risk factor of
caregiving. Women who spend nine or more hours a week caring for
an ill or disabled spouse increase their CHD risk twofold.
• Other health effects include elevated blood pressure and increased
risk of developing hypertension; lower perceived health status;
poorer immune function; slower wound healing; and an increased
risk of mortality.
Source: http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480
21
A Call for Action
• Call attention to the importance of midlife women’s health and
its contribution to overall (family) health, the need for
increased access to health care for midlife women, and the
need for more research and training funds targeting women’s
health and healthy aging.
• Increase funding for women’s health research, especially for
subpopulations of women, including midlife women, older
women, and women of color.
• Expand women’s health services and the education and
training of geriatric physicians, gerontologists and other
women’s health professionals.
• Reinforce the important need for the Consumer Bill of Rights
in relation to improving consumer health and health literacy
which are essential to midlife women’s health and healthy
aging.
22
Resources
AoA website
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf
CDC website
http://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf
DHHS-OWH websites
http://www.womenshealth.gov/
http://www.4woman.gov/owh/pub/minority/index.htm
http://www.4woman.gov/owh/pub/minority/table1.htm
Family Caregiver Alliance
http://www.caregiver.org/jsp/content_node.jsp?nodeid=892&expandnodeid=480
HRSA website
http://mchb.hrsa.gov/whusa08/index.html
NIH-ORWH websites
http://www4.od.nih.gov/orwh
http://www4.od.nih.gov/orwh/decade-2.pdf
Women of Color Health Data Book
http://orwh.od.nih.gov/pubs/WomenofColor2006.pdf
23
Resources (continued)
Agenda for Research on Women's Health for the 21st Century, Volume 7
(This is a brief summary of an 8 volume set. Volume 8 is available in Spanish)
http://www4.od.nih.gov/orwh/agenda-vol7.pdf
NIH Publications on Women's Health Issues
(Contains women's health publications and contact information for each NIH Institute or
Center)
http://www4.od.nih.gov/orwh/NIHPubs.pdf
Science Meets Reality: Recruitment and Retention of Women in Clinical Studies, and
the Critical Role of Relevance
(Proceedings from a national meeting looking at lessons learned, continuing challenges
and ethical and policy issues in recruiting and retaining clinical research participants).
http://www4.od.nih.gov/orwh/SMR_Final.pdf
24
Resources (continued)
Yee-Melichar, D., Flores, C.M., and Cabigao, E.P. Long-Term Care
Administration and Management: Options, Issues and Trends in Effective
Elder Care. New York, Springer Publishing Company. (pending)
Yee-Melichar, D. (2010). Resilience in Aging: Cultural and Ethnic Perspectives.
In Resilience in Aging. Edited by Barbara Resnick, Lisa Gwyther and Karen
A. Roberts. New York, NY: Springer-Verlag New York, Inc.
Yee-Melichar, D., Renwanz-Boyle, A. and Flores, C. (2010). Assisted Living
Administration and Management: Effective Practices and Model Programs in
Elder Care. New York, Springer Publishing Company.
Yee-Melichar, D. (2010). Key Moment in History—1987: GSA Launches
Minority Issues Task Force. Gerontology News, 6(1), 7.
Yee-Melichar, D. (2010). Housing: Experts Corner—Assisted Living. In The
Aging Network: A Guide to Programs and Services for Older Americans by K.
Niles-Yokum and D.L. Wagner. New York, Springer Publishing Company.
25
Resources (continued)
Yee, D. (2004) “Aging Asian Americans and Health Disparities.” In Closing
the Gap: Improving the Health of Minority Elders in the New Millennium.
Gerontological Society of America, Washington, DC.
Markson, E. and Yee, D. (2004). The Older Woman. In AGHE brief
bibliography: A selective annotated bibliography for gerontology instruction
[CD-ROM].
Washington, DC: Association for Gerontology in Higher
Education.
Yee, D. “Overview of Asian American Women As Research Subjects.” In
Proceedings of the First National Clinical Trials and Asian American Women
Summit. Washington, DC: National Institutes of Health, 3(3):1-12, 1998.
Yee, D. "Issues and Trends Affecting Asian Americans, Women and Aging." In
Women and Aging: A Research Guide. Edited by Jean M. Coyle. Westport,
CT: Greenwood Publishing Group, Inc., 1997.
26
Comments? Questions? Thank You.
Dr. Darlene Yee-Melichar
Professor and Coordinator
Gerontology Program
College of Health and Social Sciences
San Francisco State University
1600 Holloway Avenue
San Francisco, CA 94132
(415) 338-3558
[email protected]
27