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Working Together to Address the Challenges Faced by Aging Racial and Ethnic Minorities

Working Together to Address the Challenges Faced by Aging Racial and Ethnic Minorities. Alexis Bakos , PhD, MPH, RN Senior Advisor to the Deputy Assistant Secretary for Minority Health

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Working Together to Address the Challenges Faced by Aging Racial and Ethnic Minorities

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  1. Working Together to Address the Challenges Faced by Aging Racial and Ethnic Minorities Alexis Bakos, PhD, MPH, RN Senior Advisor to the Deputy Assistant Secretary for Minority Health Office of Minority HealthU.S. Department of Health and Human ServicesDean’s Diversity Forum, Widener University Commonwealth Law School Harrisburg, PA – February 22, 2019

  2. Agenda • Profile of Older Americans • Overview: HHS Office of Minority Health (OMH) • Other Federal Initiatives and Programs to Improve Health and Health Care Among Older Americans • Q & A

  3. Over 65 Population Expected to Nearly Double by 2060 • The age 65+ population increased 33% from 2006-2016 (37.2 million to 49.2 million) • Represented 5.2% of the population in 2016 and will rise to 21.7% by 2040 • The 85 and over population, 6.4 million in 2016, will increase 129% to 14.6 million by 2040 US Census Bureau Population Estimates

  4. Growth in Aging Racial/Ethnic Minority Population An Aging Nation: The Older Population in the United States. U.S. Census Bureau - 2014

  5. Percentage of Adults Aged ≥65 Years Who Reported Excellent or Very Good Health, by Race/Ethnicity and Poverty Status Morbidity and Mortality Weekly Report May 31, 2013 / 62(21);431

  6. OMH’S HISTORIC BEGINNINGTHE CASE FOR ELIMINATING HEALTH DISPARITIES • (1) Cancer, (2) Cardiovascular disease and stroke, (3) Chemical dependency, measured by deaths due to cirrhosis, (4) Diabetes, (5) Homicide and accidents (unintentional injuries), (6) Infant mortality Big Six • (1) Health information and education, (2) Delivering and financing health services, (3) Health professions development, (4) Cooperative efforts with the non-federal sector, (5) Data development, (6) Research agenda Improvement Areas

  7. NEW DEPUTY ASSISTANT SECRETARY FOR MINORITY HEALTH & DIRECTOR, HHS OFFICE OF MINORITY HEALTH • CAPT Felicia Collins, MD, MPH • Appointed Deputy Assistant Secretary for Minority Health and OMH Director on January 31 • Nearly 20 years at HHS, most recently as senior advisor, Bureau of Primary Health Care, Health Resources and Services Administration (HRSA) • Board-certified pediatrician and captain in the US Public Health Service Commissioned Corps

  8. The Office of Minority Health (OMH) • OMH Mission OMH Functions To improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities

  9. OMH Elevated by Congressional Statute, March 2010 • Transferred to the Office of the Secretary, administratively supported by the Office of the Assistant Secretary for Health (OASH) • Established the Deputy Assistant Secretary for Minority Health • Authorized six additional offices of minority health and the National Institute on Minority Health and Health Disparities at NIH Office of Minority Health and Health Equity Statutory Authority: Public Health Service Act §1707 (42 U.S.C. §300u-6)

  10. Examples of OMH Networks/Partners/Collaboration • Administration for Community Living • National Hispanic Council on Aging • AARP • Pennsylvania Office of Health Equity

  11. The Opioid Epidemic: An HHS Priority • OMH is administratively supported by the Office of the Assistant Secretary for Health (OASH), under ADM Brett Giroir, MD • Dr. Giroir also serves as senior advisor to the Secretary Alex Azar for the opioids epidemic • The epidemic is one of the Administration’s highest priorities • The crisis is also a public health emergency for seniors

  12. The Impact of the Opioid Epidemic on the Elderly • The crisis for seniors goes beyond their own substance use disorders • Parents of adult children who are misusing opioids become targets of financial, physical and emotional abuse • More grandparents are raising grandchildren because the parents have died, are incarcerated, using drugs, in treatment or otherwise unable to care for their children • The Administration for Children and Families reports that 92,000 children (34 percent) were removed from their homes in 2016 because of parental substance misuse • The foster system is increasingly turning to other family members for help

  13. Opioids and Elders: Medicare Part D, 2017 Data

  14. OPIOID MISUSE INCREASES AMONG OLDER ADULTS Opioid-Related Inpatient Stays and Emergency Department Visits Among Patients Aged 65 Years and Older, 2010 and 2015. HCUP September 2018

  15. Opioid Use By Race, Age 65 and Older 2015 • While the proportion of older adults who misuse opioids is relatively small compared to younger adults, opioid use nearly doubled among seniors from 2004-2014 • Among patients aged 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of non-opioid-related hospitalizations between 2010 and 2015 • In 2015–2016, whites were more likely than other races to fill an opioid prescription at least once during the year. A similar pattern was observed for frequent use of opioid prescriptions. Elderly Adults with any opioid prescriptions fills during the year Elderly Adults with 4 or more opioid prescriptions fills during the year HCUP Statistical Brief #244 September 2018

  16. HHS 5-POINT STRATEGY TO COMBAT THE OPIOIDS CRISIS https://www.hhs.gov/opioids

  17. Guideline for Prescribing Opioids for Chronic Pain • Issued by the Centers for Disease Control and Prevention for prescribing opioid pain medication for patients 18 and older in primary care setting. Three main focus areas: • Determining when to initiate or continue opioids for chronic pain • Opioid selection, dosage, duration, follow-up, and discontinuation • Assessing risk and addressing harms of opioid use

  18. Older Adults in Healthy People 2020

  19. 2018 Healthy Aging Summit and Workshop Healthy Aging Summit • Focused on healthy aging and maximizing the health of older adults through prevention strategies • Goals: (1) Explore the science on healthy aging; (2) Identify knowledge gaps; (3) Promote prevention, (4) Support people aging in place / community Healthy Aging Workshop • Support from: HHS (ODPHP, OWH, ACL, CDC), National Council on Aging, Trust for America’s Health, and Alzheimer’s Association • Key priority areas identified in participant action plans: • Chronic conditions and preventive health care, transportation, surveillance and education, health literacy, injury and falls prevention, workforce and caregiving, age-friendly communities, physical disabilities, physical activity and mobility, and healthy foods.

  20. What We Learned: Jurisdictional Priorities for Healthy Aging • Healthy Aging Topics Identified as Priorities in Action Plans • Identified by state and local health and aging officials in attendance at the Healthy Aging Summit workshop • Officials said these should be important priorities for their state action plans

  21. New HHS Investment in Adult Protective Services • $3 million investment by the Administration for Community Living to support states in building the “Adult Protective Services (APS) of tomorrow” • Continues work to develop tools and infrastructure over the next three years: • Update the National Voluntary Consensus Guidelines for Adult Protective Services Systems, create a dissemination plan for the guidelines and build a stronger evidence base of APS best practices • Establish an APS client outcomes study • Develop an inventory of screening and assessment tools https://acl.gov/news-and-events/announcements/acl-announces-3-million-investment-strengthen-adult-protective

  22. Charged with identifying and proposing solutions to challenges involving elder abuse, neglect and financial exploitation • Consists of representatives from 12 federal departments and agencies • Includes the Elder Justice Working Group, made up of senior staff from the 12 federal departments/agencies. OMH participation: • Interagency Partnership on Aging Veterans and Mental Health • Data Collection Subgroup • The Council is required by Congressional statute to issue a Report to Congress every two years. The next report will be submitted later this year. https://acl.gov/programs/elder-justice/elder-justice-coordinating-council-ejcc To Submit Public Input on Future Priorities for the Council: https://acl.gov/about-acl/public-input Public Comment Period Ends: September 30, 2019

  23. Rise in Older Incarcerated Individuals • Older incarcerated individuals have greater and unique physical and behavior health needs • Older incarcerated are 13-15 times more likely to report an ambulatory disability, 6 times more likely to report a hearing disability and 4-5 times to report a vision disability • 52 percent report living with a mental condition • There is a specific concern about prevalence of dementia among older inmates and challenges association with management Aging, Reentry and Health Coverage: Barriers to Medicare & Medicaid for Older Reentrants, March 2018 Office of the Assistant Secretary for Planning & Evaluation

  24. Examining Barriers to Medicare and Medicaid for Aging Reentrants Details operational, legal and regulatory barriers to enrollment in Medicare and Medicaid Explores promising correctional and community-based strategies for gaining coverage Identifies key gaps in current understanding and ways to help address the gaps and inform future policy • Most of the elder prison population is white, however the largest percentage of older inmates are African American • Older reentrants face greater barriers to Medicaid coverage in states that did not expand Medicaid eligibility • Distrust of the medical system causes underutilization of health care services by justice-involved African American men Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging and Long-Term Care Policy

  25. Older Veteran Behavioral Health Resource Inventory • Released by the Interagency Partnership on Aging Veterans and Mental Health • Collaboration by: • U.S. Department of Veterans Affairs (VA) • Veterans Health Administration (VHA) • Veterans Benefits Administration (VBA) • U.S. Department of Health and Human Services (HHS) • Administration for Community Living (ACL) • Center for Medicare & Medicaid Services (CMS) • Office of Minority Health • Substance Abuse and Mental Health Services Administration (SAMHSA) • National Council on Aging (NCOA) https://www.mentalhealth.va.gov/communityproviders/docs/Older_Veteran_Behavioral_Health_Resource_Inventory_050418.pdf

  26. PILOT PROJECT TO INCREASE MINORITY NURSING WORKFORCE • Diversifying the Nursing Workforce: Mentoring for Student Retention and NCLEX Success at Historically Black Colleges and Universities (HBCUs) • Pilot program to help faculty at HBCUs increase BSN graduates and passage of board certification • Train-the-trainer program developed in conjunction with the AARP’s Center to Champion Nursing in America, • The first workshop held October 9-11 in Washington, DC • Pilot includes representatives from HBCUs in Mid-Atlantic • Plans call for expansion to remaining HBCU BSN nursing programs this year

  27. Update: New NIH Rule on Clinical Research • NIH’s new Inclusion Across the Lifespan policy stipulates that people age 65 and older be included in clinical research • Clinicians don’t know how most treatments affect older people because they are not routinely included in research that informs treatment: • About 66% of clinical trials exclude elders • 67% of trials had average patient ages younger than the ages for the diseases being studied • Even when older Americans were included, the structure of the studies raises questions about the applicability of the results • The Inclusion Across the Lifespan policy became effective for all NIH grant applications with due dates on or after January 25, 2019. • The policy and effective date also apply to solicitations for R & D contracts and intramural studies

  28. Older Americans Month, May 2019(OMH Involvement?) • Organized every May by the Administration for Community Living • 2019 Theme: Connect, Create, Contribute • Connect with friends, family and services that support participation • Create by engaging in activities that promote learning, health and personal enrichment • Contribute time, talent and life experiences to benefit others • Includes web and social media recourses and event/activity ideas • https://acl.gov/oam/2019/older-americans-month-2019 • Twitter • $#OAM19 • #ConnectCreateContribute

  29. April is National Minority Health Month Theme: Active & Healthy • Builds on the new HHS Activity Guidelines • Aligns with the Office of Disease Prevention and Health Promotion’s “Move Your Way Campaign”

  30. Office of Minority Health Resource Center (OMHRC) • The nation’s largest repository of information on the health of minority populations in the U.S. and its territories • Services available include: • Literature Services • Funding Searches • Data/Statistics • Capacity Building • Consumer Materials • Technical Assistance • E-Newsletters • Social Media Phone: 301-251-1797 Toll-Free: 800-444-6472 info@minorityhealth.hhs.gov

  31. THANK YOU Potential Opportunities for HHS Funding and Engaging with OMH • Subscribe to OMH Newsletter through minorityhealth.hhs.gov • Join our listserv through minorityhealth.hhs.gov • Sign up for our grants listserv through minorityhealth.hhs.gov • orityhealth.hhs.gov • Connect with OMH on Social Media • Twitter: @MinorityHealth(English); @OMH_Espanol (Spanish) • Facebook: Office of Minority Health • Instagram: @officeofminorityhealth

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