Health Literacy, Adherence and Access To Benefits
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  • 1. Health Literacy,Adherence & Accessto BenefitsOlder Adults, HIV and Online Resources webinar seriesQuickTime™ and adecompressorare needed to see this picture.Alanna Costelloe-Kuehn, Health SpecialistOlder Adults Technology Services (OATS)Supported by ACRIA
  • 2. Agenda• Impact of health literacy• Promoting health literacy among older adults• Benefits for older adults with HIV• Online resources
  • 3. HIV and Aging• By 2030 the proportion of the US populationaged 65 and older will double from 39 million toabout 71 million• People living with HIV are living longer with adiverse array of aging related conditionsQuickTime™ and adecompressorare needed to see this picture.
  • 4. Communication• Many clinicians do not ask older patients abouttheir sexual activity– Only 38% of older men and 22% of older womenreported discussing sex life with health care providers– Silence and stigma of homosexuality in older adultsmay limit honest patient-doctor conversations• Lack of prevention programs geared towardsolder persons and physician comfort levels withgeriatric patients in discussing sexuality
  • 5. What is Health Literacy?“… the capacity to obtain, process,and understand basic healthinformation and services needed tomake appropriate health decisions.”- Health Literacy: A Prescription to End Confusion TheInstitute of Medicine, 2004
  • 6. Health literacy bridgesknowledge and behavior• Health literacy includes being ableto understand instructions on:– prescription bottles– appointment slips– health education brochures– doctor’s instructions– consent forms
  • 7. Poor Health Literacy• Poor adherence to prescriptioninstructions• Infrequent use of preventive medicalservices• Increased hospitalizations• Increased visits to the emergency room• Overall worse control of chronic diseases
  • 8. Health Literacy For Older Adults• Adults age 63 and older have lower healthliteracy scores than all other age group• Only 3% of older adults surveyed hadproficient health literacy skillsThe 2003 National Assessment of Adult Literacy
  • 9. Complications in Older Adults• Multiple conditions• Many, many medications• Talking to doctors• Internet comfort levels
  • 10. • Had lower levels of HIV knowledge• Misconceptions of HIV transmission,HIV viral loads, CD4 cell counts• Less likely to have an undetectable HIV viral loadA Multifaceted Adaptive Testing Approach to Health Literacyin Older Adults David R. Kaufman, PhD, Columbia UniversityHealth Sciences, National Institute of Nursing ResearchLower HIV Health LiteracyOlder adults living with HIV/AIDSwith lower levels of health literacy:
  • 11. Prescription Labels and Adherence• Comorbidities complicatetreatment adherence and druginteractions• Adherence is higher among olderadults• Up to 40% of older patients whodecided to skip doses or stoptaking their medicine do not telltheir provider• Older adults may notadhere to drugregimens due to– Forgetfulness– Side effects– Perceived non-efficacy– Cost
  • 12. Health literacy goes beyondthe individual…It also depends upon the skills, preferences, andexpectations of those health information providers:our doctors, nurses, administrators, home healthworkers, the media, and many othersAccess + Utilization =Health Literacy
  • 13. Building Older Adults’ HealthLiteracy Online• Bridge digital divide• Increase confidence• Increase knowledge of health conditionsand healthy lifestyles• Help people know how to talk to doctors• Increase skills in evaluating healthinformation resources
  • 14. Older Adults & the InternetDemographics of Internet Users, July 2009
  • 15. What About the Boomers?• In 2 years, boomers will begin to age intothe 65+ demographic• Higher Internet skills• Health seeking online is one of the onlyareas that boomers dominate over othergenerations• Younger baby boomers are most likely tohave searched online for prescription druginformation
  • 16. Online Resources toPromote Health LiteracyAmong Older Adults
  • 17. Ask Me 31.What is my main problem?2.What do I need to do?3.Why is it important for me to do this?http://www.npsf.org/askme3/
  • 18. Medical Library Association• Reliable Sources of Health Information• Your Medicine: Play it Safe• Medicine Record Form• Buying Prescription Medicine Online:A Consumer Safety Guidehttp://www.mlanet.org/resources/consumr_index.html#senior
  • 19. National Institute on Aging• Database of more than 300national organizations thatprovide help to older adults• Age Page: HIV, AIDS, and Older People
  • 20. MedlinePlus.gov• Health Topics for Seniors• Introductory information about HIV/AIDS• Easy-to-read articles• Medical dictionary• Medical encyclopedia with largeillustrations• Links to local servicesMedlinePlus.gov
  • 21. Video Tutorials onMedlinePlus• MedlinePlus.gov also hostsinformation in the form ofaccessible video tutorials ona wide range of conditionsincluding HIV/AIDS
  • 22. Online Resources toPromote HIV LiteracyAmong Older Adults
  • 23. http://www.avert.org/
  • 24. http://www.kff.org/
  • 25. http://www.aidsmap.com/
  • 26. http://www.lgbtagingcenter.org/index.cfm
  • 27. Digital Tools for Caregiversor Patients to EnhanceAdherence
  • 28. Online PHR• Online Personal Health Record (PHR)• Holds information about conditions, medications(including interactions), allergies, doctors, etc.• Google Health -- free and easy-to-use onlinePHRhealth.google.com
  • 29. Adherence Tools• Calendar reminders can be used to improveadherence– Google Calendar (calendar.google.com)• Cell phone application– Pill Phone (www.pillphone.com)– Pillboxer (www.pillboxer.com)• Cell phone alarms• POZ combo cards (www.combocards.com)
  • 30. Benefits For Older Adults Living With HIV• Older Americans Act• Medicare• Medicaid• Social Security• Department of VeteransAffairs• Ryan White CARE ActQuickTime™ and adecompressorare needed to see this picture.
  • 31. The New York Academy of Medicine, 2008
  • 32. Older Americans Act• Provides state service programs– 629 area agencies on aging– Nearly 20,000 service providers• Eligibility begins at 60• The Act indicates the importance of meeting theneeds of specific vulnerable populations– Neither LGBT elders nor HIV-positive older adults areexplicitly listed as vulnerable populations.
  • 33. Medicare• Qualify by age or 2years of SocialSecurity Disability• Provides crucialmedical coverage forpeople living with HIVand low-incomeelderly people• Health insuranceprogram for peoplewho are 65 and over• 34 million peoplecovered throughMedicareMedicare Interactive Website (www.medicareinteractive.org)
  • 34. Medicaid• Health care for– disabled– low-income childrenand their parents– medically needy• Finances healthcoverage for morethan 59 millionpeople• Covers most elderlyAmericans, many livingwith HIV and AIDS• Guidelines for eligibilityand benefits by state
  • 35. Social Security• 65% (15 million) of adults over 65 rely on socialsecurity for half their income• 33% rely on social security for over 90% of theirincome• Same-sex partners not eligible• Supplemental Security Income– Provides a safety-net for people living with HIV whoqualify as disabled– Medical evidence for HIV infection(www.ssa.gov/disability/professionals/hiv-pub037.htm)• Social Security FAQ (www.ssa.gov/pubs/10019.html)• Find local Social Security office (www.ssa.gov/regions/)
  • 36. Department ofVeterans Affairs• Largest singleprovider ofmedical care topeople with HV• VA medical facilities:– Screening– Testing– Education– Clinical care
  • 37. HIV-specific Healthcare &Senior Service Programs• Ryan White CARE Act– Established to meet the health care needs ofpeople living with HIV– $2.3 billion budget• Minority AIDS Initiative (MAI)• Housing Opportunities for People withAIDS (HOPWA)
  • 38. Online Resources• HITE Site for Services– http://www.hitesite.org/– Health Information Tool for Empowerment• ACCESS NYC– https://a858-ihss.nyc.gov/ihss1/en_US/IHSS_homePage.do– Check on benefits eligibility,including city, state, and federal benefits• Community Health Advocates– www.communityhealthadvocates.org/– Assists consumers, communities, and social serviceorganizations in navigating NY’s health care systems
  • 39. New York City Departmentfor the Aging• Senior Services by boroughor by service• Housing Finder Tool forOlder Adultshttp://www.nyc.gov/html/dfta/html/home/home.shtml
  • 40. www.housingworks.org/
  • 41. http://www.gmhc.org/
  • 42. www.sageusa.org
  • 43. Upcoming WebinarsAccessing and Using Social MediaThursday, March 3rd at 12pmThe Aging HIV PopulationThursday, March 10th at 3pmVisit www.seniorplanet.org/olderadultshiv for fullwebinar schedule
  • 44. Discussion• To ask a question you can:– Ask by audio– Send you question via chat– Email your question to health@oats.org• This webinar and the rest of the series will beavailable to download atwww.seniorplanet.org/olderadultshiv