We asked public health professionals from around the globe to offer up their most pressing public health issues. Many responded with incredible depth and insight on a variety of issues. This segment addresses elder care as a public health issue.
Glenda Hynes, RN, a post-acute care consultant, says that her work with elders who have chronic diseases, diabetes, CHF, and COPD demonstrates the need for strong ongoing healthcare education initiatives starting at an early age. “If the patients I see had formed early habits around healthy nutrition, exercise, tobacco, alcohol and drug use, 2013 Medicare and Medicaid expenditures might be less challenging,” she says. “The contrast I observe between a 90-year old non-smoking, moderate drinking individual who walks or jogs daily is particularly significant when the next individual is a 68-year old obese smoker with diabetes. Although public health professionals and physicians counsel their patients related to these factors, a large gap remains.”
Hynes concedes that physicians lack time in a busy practice to design disease management programs for patients with chronic diseases and often do not have the time or resources to provide meaningful education related to prevention for younger patients. “Preventative health education through electronic media and at every point of care, in schools and through organizations, requires consistency and expansion. For those already ill, disease management training and medication reconciliation from one point of care to another is lacking and can result in medication errors, complications, and non-compliance which often becomes traumatic and costly readmissions for older adults.”
Bob O’Toole, president of Informed Eldercare Decisions, says his most pressing public health issue is care for frail elders and family caregivers. “While the needs of frail elders and family caregivers continues to grow, the availability of funds to pay for that care and support continues to shrink,” he says. “More than two years ago the National Academy of Science, National Academy of Engineering, Institute of Medicine, and The National Research Council issued a detailed report that outlined the extent of cuts and the need for a larger healthcare workforce to handle aging baby boomers.”
O’Toole offers a summary of those findings:
- Cuts enacted in at least 46 states plus the District of Columbia since 2008 are in all major areas of state services, including health care (31 states), services to the elderly and disabled (29 states and the District of Columbia), K-12 education, higher education and other areas.
- Need for these services rose as the number of families facing economic difficulties increased.
- Legislatures and governors enacted budgets for fiscal year 2011 that go further than those enacted in 2008.
- Cuts to state services harm vulnerable residents, worsen the recession, and dampen the recovery.
- At least 44 states and the District of Columbia have reduced the workforce, required unpaid leave, and enacted new hiring freezes.
The public health problem that expert Nancy Bruning is working on is overly sedentary, indoor lifestyle. “Humans were not designed to spend so much time sitting indoors. The benefits of exercise are well known, but the benefits of being outdoors are only beginning to be appreciated: stress reduction, mental clarity and improved thinking and learning, physical and mental refreshment, and rejuvenation in people of all ages, not to mention the benefits of vitamin D production from sunlight,” says Bruning. “While information about the pluses of outdoor exercise are getting out via the media, too much attention is given to costly technological solutions such as adult playgrounds that are nothing more than indoor gyms moved outdoors. We need creative solutions using the existing things in our outdoor environments. That’s why I am promoting outdoor exercise of all kinds, including the notion of using existing features such as park benches, as exercise equipment.”
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