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How Public Health Programs Can Become Age-Friendly

A report says innovative solutions are needed to better serve older adults


Years ago, when Terry Fulmer was a nurse working in a hospital, she often had the same thought as she discharged an elderly patient: “I wished I could call a public health representative and say ‘I’m sending this person home – they will not do well. Can you help me?’”

Fulmer, who is now president of the John A. Hartford Foundation (JAHF), which funds programs that improve the lives of older adults (and is a Next Avenue funder), told this story during her recent talk at the Columbia University Mailman School of Public Health in New York. She was there to discuss a Hartford-funded report titled “Creating an Age-Friendly Public Health System.” The report addresses the needs of people 65 and older.

“We’ve doubled our lifespan, but we don’t take care of these people,” Fulmer said.

Medicine can bring back people from cardiac arrest and offer chemotherapy for cancer, but after that, patients are often sent home to overwhelmed caregivers. “Forty million caregivers are stunned by what they have to do when a patient is discharged — and they have to take care of tubes, drips and drains,” Fulmer said.

What Public Health Departments Do

Public health departments cover a wide range of issues you might expect, such as educational campaigns about infectious or chronic disease, or cradle-to-grave programs and policies like maternal and child health, workplace safety and healthy aging. So we wouldn’t think it surprising for public health departments to alert people to the dangers of eating contaminated romaine lettuce. But most of us don’t realize that public health departments also could help with things like providing affordable housing and transportation, and preventing social isolation of older adults, said Megan Wolfe, policy development manager for Trust for America’s Health. The organization partnered with JAHF to produce the age-friendly public health report.

In the meantime, the number of older adults continues to grow, and the amount of public health and social service funding from federal, state and local governments continues to shrink. This makes funding from both public and private sectors necessary, according to the JAHF report.

Time to Expand Their Roles?

The report says public health programs needs an overhaul. The United States, it notes, lacks an overall system of long-term care, “offering, instead, an uncoordinated and often confusing patchwork of community-based programs with varying eligibility criteria, costs and availability.”

Of the people eligible for both Medicare and Medicaid, 58 percent have unmet needs for assistance in performing the ordinary activities of daily living. Public health programs can fill gaps by providing critical education and training, such as teaching caregivers how to safely bathe or transfer a person from a bed to a chair at home.

Family members and other informal caregivers provide the lion’s share of support for older adults in this country, but greater numbers of working women and geographic distances among families have reduced the ability of younger family members to help older ones with daily activities.

In 2013, there were more than 14 adults of prime caregiving age (45-64) for every person over 85. By 2050, this ratio will drop to less than 4 to 1. “We don’t have a pipeline of people to take care of older adults,” Fulmer said. In addition to not having enough younger people to provide family care, there aren’t enough health care professionals specializing in geriatrics.

Making Public Health Programs Age-Friendly

The report identifies some key ways in which public health programs could better serve aging people.

One is smartly coordinating government agencies. For example, if people can’t get regular physical activity — important for maintaining health and mobility — because of concerns about neighborhood safety or the lack of walkable neighborhoods, the public health system could remove these barriers by working with law enforcement, parks and recreation and city planning departments to create solutions.

Another area where public health departments could help relates to reducing the number of unnecessary medical emergency calls. Because of a lack of preventive care, older adults often wind up in emergency rooms and hospitals when their condition finally becomes dire.

“One trillion dollars is spent in acute care,” Fulmer said. “We need to move to a preventive agenda.”

In addition, calling 911 is often the default when older adults simply need someone to provide answers that don’t require a visit to the emergency room.

Public health departments also could coordinate support services to avoid duplication, and identify gaps in services. For example, many older people do not receive immunizations, yet 90 percent of flu-related deaths occur in people 65 and over. One clever solution is working with Vote & Vax, which provides flu vaccines in polling places.

Emergency preparedness is another area in which public health programs can be useful. The U.S. Department of Health and Human Services developed an initiative providing federal data and mapping tools to local and state public health departments to assist them in identifying populations who rely on electricity-dependent medical and assistive devices or dialysis machines, oxygen tanks and home health services. This information enhances assistance for at-risk populations who could be affected by severe weather, fire, earthquakes and other disasters.

One local example of an emergency preparedness program focused on older adults is in Florida’s Oskaloosa County. The health department there has an initiative called “Lean On Me,” in which volunteers visit the homes of older adult residents to make sure they are prepared for hurricanes and other disasters.

Creating a Model to Follow

People working to make public health programs age-friendly plan to create a new template of best practices in communities where public health is successfully accommodating aging.

“Hopefully, at the end of this project , we will have a model or framework that will support something replicable across communities across the country,” Wolfe said. “Every community is unique. We’re not saying the same thing will work for every community. There is no silver bullet, but we really have to start someplace.”

By Deborah Quilter
Deborah Quilter is an ergonomics expert, a certified Feldenkrais practitioner, a yoga therapist and the founder of the Balance Project at the Martha Stewart Center for Living at Mount Sinai Hospital in New York. She is also the author of Repetitive Strain Injury: A Computer User's Guide and The Repetitive Strain Injury Recovery Book.

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