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Health Literacy, Adherence and Access To Benefits
- 1. Health Literacy, Adherence & Access to Benefits Older Adults, HIV and Online Resources webinar series QuickTime™ and a decompressor are needed to see this picture. Alanna Costelloe-Kuehn, Health Specialist Older 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 population aged 65 and older will double from 39 million to about 71 million • People living with HIV are living longer with a diverse array of aging related conditions QuickTime™ and a decompressor are needed to see this picture.
- 4. Communication • Many clinicians do not ask older patients about their sexual activity – Only 38% of older men and 22% of older women reported discussing sex life with health care providers – Silence and stigma of homosexuality in older adults may limit honest patient-doctor conversations • Lack of prevention programs geared towards older persons and physician comfort levels with geriatric patients in discussing sexuality
- 5. What is Health Literacy? “… the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” - Health Literacy: A Prescription to End Confusion The Institute of Medicine, 2004
- 6. Health literacy bridges knowledge and behavior • Health literacy includes being able to understand instructions on: – prescription bottles – appointment slips – health education brochures – doctor’s instructions – consent forms
- 7. Poor Health Literacy • Poor adherence to prescription instructions • Infrequent use of preventive medical services • 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 health literacy scores than all other age group • Only 3% of older adults surveyed had proficient health literacy skills The 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 load A Multifaceted Adaptive Testing Approach to Health Literacy in Older Adults David R. Kaufman, PhD, Columbia University Health Sciences, National Institute of Nursing Research Lower HIV Health Literacy Older adults living with HIV/AIDS with lower levels of health literacy:
- 11. Prescription Labels and Adherence • Comorbidities complicate treatment adherence and drug interactions • Adherence is higher among older adults • Up to 40% of older patients who decided to skip doses or stop taking their medicine do not tell their provider • Older adults may not adhere to drug regimens due to – Forgetfulness – Side effects – Perceived non-efficacy – Cost
- 12. Health literacy goes beyond the individual… It also depends upon the skills, preferences, and expectations of those health information providers: our doctors, nurses, administrators, home health workers, the media, and many others Access + Utilization = Health Literacy
- 13. Building Older Adults’ Health Literacy Online • Bridge digital divide • Increase confidence • Increase knowledge of health conditions and healthy lifestyles • Help people know how to talk to doctors • Increase skills in evaluating health information resources
- 14. Older Adults & the Internet Demographics of Internet Users, July 2009
- 15. What About the Boomers? • In 2 years, boomers will begin to age into the 65+ demographic • Higher Internet skills • Health seeking online is one of the only areas that boomers dominate over other generations • Younger baby boomers are most likely to have searched online for prescription drug information
- 16. Online Resources to Promote Health Literacy Among Older Adults
- 17. Ask Me 3 1.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 Guide http://www.mlanet.org/resources/consumr_index.html#senior
- 19. National Institute on Aging • Database of more than 300 national organizations that provide 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 large illustrations • Links to local services MedlinePlus.gov
- 21. Video Tutorials on MedlinePlus • MedlinePlus.gov also hosts information in the form of accessible video tutorials on a wide range of conditions including HIV/AIDS
- 22. Online Resources to Promote HIV Literacy Among Older Adults
- 27. Digital Tools for Caregivers or Patients to Enhance Adherence
- 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 online PHR health.google.com
- 29. Adherence Tools • Calendar reminders can be used to improve adherence – 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 Veterans Affairs • Ryan White CARE Act QuickTime™ and a decompressor are 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 the needs of specific vulnerable populations – Neither LGBT elders nor HIV-positive older adults are explicitly listed as vulnerable populations.
- 33. Medicare • Qualify by age or 2 years of Social Security Disability • Provides crucial medical coverage for people living with HIV and low-income elderly people • Health insurance program for people who are 65 and over • 34 million people covered through Medicare Medicare Interactive Website (www.medicareinteractive.org)
- 34. Medicaid • Health care for – disabled – low-income children and their parents – medically needy • Finances health coverage for more than 59 million people • Covers most elderly Americans, many living with HIV and AIDS • Guidelines for eligibility and benefits by state
- 36. Social Security • 65% (15 million) of adults over 65 rely on social security for half their income • 33% rely on social security for over 90% of their income • Same-sex partners not eligible • Supplemental Security Income – Provides a safety-net for people living with HIV who qualify 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/)
- 37. Department of Veterans Affairs • Largest single provider of medical care to people with HV • VA medical facilities: – Screening – Testing – Education – Clinical care
- 38. HIV-specific Healthcare & Senior Service Programs • Ryan White CARE Act – Established to meet the health care needs of people living with HIV – $2.3 billion budget • Minority AIDS Initiative (MAI) • Housing Opportunities for People with AIDS (HOPWA)
- 39. 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 service organizations in navigating NY’s health care systems
- 40. New York City Department for the Aging • Senior Services by borough or by service • Housing Finder Tool for Older Adults http://www.nyc.gov/html/dfta/html/home/home.shtml
- 43. www.sageusa.org
- 44. Upcoming Webinars Accessing and Using Social Media Thursday, March 3rd at 12pm The Aging HIV Population Thursday, March 10th at 3pm Visit www.seniorplanet.org/olderadultshiv for full webinar schedule
- 45. 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 be available to download at www.seniorplanet.org/olderadultshiv