Introduction
Over the next few decades, the US will witness unprecedented growth in the population aged 65 and over. Currently, the population aged 65+ numbers 34 million individuals, or 14% of the total population. By 2050, when the Baby Boom population will comprise the vast majority of older adults, 80 million adults will be over 65, representing 20% of the US population (U.S. Bureau of the Census, 2014). Furthermore, the US population is living longer. Advances in public health and medicine, particularly prevention, over the past several decades have reduced mortality and increased life expectancy across race, ethnicity, and gender.
However, while the population is living longer, for some it means living longer in poor health. For example, while Latino life expectancy is equivalent to and, in the case of women, better than that of non-Latino whites, middle-aged and older Latinos have higher rates of obesity, diabetes, and functional difficulties (Villa et al., 2012). So the burden of disease is often higher for racial/ethnic populations compared to whites. African Americans with high blood pressure are more likely than other populations to also have cardiovascular disease and renal failure (Clark and Gibson, 1997; Saab et al., 2014). Therefore, when examining markers of health status, it is important to disaggregate the population by race/ethnicity to gain a more precise picture of the population's health. Meeting the needs of older adults with health issues and helping those with good health maintain it requires access to programs and services that support health.
Conclusion
Despite overall gains in life expectancy, some populations continue to experience health disparities as they age. Improving health and maintaining health for a population that is living longer requires improved access to health and social services that promote and protect health. The data above show that Los Angeles City and County employees age 60 and over are “not sure” whether a number of health and social services exist. Better outreach and information about the services and programs available in the community can greatly improve access.
Recommendation
Scale Up Proven Community-Based and Evidence-Informed Health Promotion and Disease Prevention Initiatives
Approximately three-fourths of healthcare costs result from chronic conditions, and about 80 percent of older adults have at least one chronic condition. We spend about $30 billion each year on treatment for older adults who have fallen and sustained injuries, while about one-fourth of older adults experience some sort of mental disorder. Health promotion programs are essential to preventing and managing a variety of chronic conditions. However, only a small fraction of older adults in Los Angeles have access to these programs. Research shows that evidence-based promotion and preventive practices among diverse communities fall below the levels recommended by Healthy People 2020, while rates of chronic disease and the medical cost of treatment continue to escalate.
By scaling up evidence-based interventions, such as the Chronic Disease Self-Management Program (developed by Stanford University) and A Matter of Balance, and ensuring equitable access and culturally responsive programming, we can help reduce the onset or worsening of chronic conditions and assist older adults in effectively managing these conditions. Identifying risk factors and strengthening protective factors, such as addressing mental and physical health problems and increasing social connectedness, are key for this population. The Health Agency will craft a protocol, in collaboration with LADOA and WDACS, to address health and mental health risks associated with loneliness and social isolation.
Suicide prevention can also be better addressed through community-based health initiatives. Many older adults receive their physical and behavioral health care in the community-based setting, which is an ideal location for suicide awareness and prevention to occur. Suicide rates are particularly high among older men, with men ages 85 and older having the highest rate of any group in the country. Factors such as careful planning, use of lethal methods, social isolation (which leads to less likeliness of being discovered), and physical frailty (which means they are less likely to recover from an attempt), all lead to higher rates of death among this population.
Expand and Enhance Oral Health Services for Low-Income Older Adults
Ongoing dental care is necessary to ensure optimal health for older adults. The challenges in improving oral health are twofold: ensuring access to low-cost dental care and ensuring older adults use available dental benefits. Because Medicare does not cover oral health services, it is vital that older adults be connected to an accessible, ongoing dental health provider. As of 2018, California fully restored adult dental benefits (e.g., lab-processed crowns, posterior root canal therapy, periodontal services, and partial dentures) under a program now called Smile California for Medi-Cal beneficiaries. Because many low-income older adults in Los Angeles are dual eligible (receiving both Medicare and Medi-Cal), and public awareness of these services has been limited, many older adults are unaware of their newly reinstated dental health benefits.
The Health Agency will launch a community-oriented Smile California awareness campaign and strengthen its internal capacity to refer patients to sustainable dental hubs (ongoing sources of oral health care). In LA County, key areas are identified as “dental deserts,” which are highly populated, low-income communities with limited access to affordable, accessible dental care. To the extent funding and capacity allow, the Health Agency will integrate oral health case management, referrals, and awareness at its medical sites situated at or near dental desert communities. This interdisciplinary approach will increase awareness of oral health as a crucial part of overall health.
Support Dementia Focused Community Engagement, Programs, and Policies
The number of older adults in California living with Alzheimer’s Disease will roughly double from 2010 to 2030. Through PALA, the County and City launched the Dementia Friends Program, which empowers residents in the Los Angeles Region to learn more about these conditions and the small steps they can take to promote Dementia Friendly Communities. WDACS and LADOA will build on Dementia Friends through new initiatives, programs, and policies that address the needs of intergenerational populations with Dementia, Alzheimer’s, and Autism. A key component of these efforts is the implementation of the Bringing Our Loved Ones Home Initiative (BOLOH), which will enhance preventative measures in the Los Angeles Region to reduce wandering among individuals with Alzheimer’s/Dementia/Autism, while ensuring a comprehensive and coordinated response to wandering incidents when they occur.
Read and download the Purposeful Aging LA Age-Friendly Action Plan to learn more about recommendations to enhance age-friendliness for all older adults and multigenerational residents of the Los Angeles region.