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Providing Health Services to Aging Farmers: A Practitioner’s Perspective

Providing Health Services to Aging Farmers: A Practitioner’s Perspective. Deborah B. Reed, Ph.D. Associate Professor College of Nursing University of Kentucky dbreed01@email.uky.edu. Sources of Information. Asked for stories via AgHERE and personal e-mails

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Providing Health Services to Aging Farmers: A Practitioner’s Perspective

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  1. Providing Health Services to Aging Farmers: A Practitioner’s Perspective Deborah B. Reed, Ph.D. Associate Professor College of Nursing University of Kentucky dbreed01@email.uky.edu

  2. Sources of Information • Asked for stories via AgHERE and personal e-mails • Literature review 1990- present • Reviewed books of abstracts from NIOSH + Agricultural Health/Research conferences • Scanned the web Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  3. When Farmers Seek Health Care • When it’s urgent • When the farm work is finished • When they can afford it • When they are comfortable with it Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  4. Chronic Conditions Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  5. Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  6. Health Conditions Sustained Work Indicators of Older Farmers, NIOSH Grant # R01 OH04157-01A1 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  7. The 5 A’s of Guiding Health Care Usage • Available • Appropriate • Accessible • Acceptable • Affordable Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  8. Availability • Personal health care providers (vast majority of farmers) • Specialized services • Not as readily available in smaller towns • Perhaps none in remote areas • Occupational health services • Very limited in number & location Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  9. Occupational Health Services • Midwest – Iowa (AgriSafe) • Farm Medicine Center, Marshfield • New York Center for Agricultural Medicine & Health Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  10. Reaching Farmers through Formal Methods of Delivery • NY Center for Agricultural Medicine and Health • Farm partners (stress) • Farmer’s clinics • No-cost farm visits • National Farm Medicine Center • Nurse outreach through community hospital • AgriWellness Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  11. AgriSafe Network Clinics • Originated in 1987 • 20 clinics in Iowa; 1 in Illinois • Planned to expand to 10 other states by the end of 2006 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  12. Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  13. Appropriate • Right service, right time Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  14. Accessibility • Limited geographic scope of specialized and dedicated clinics • Hours and days of operations • Physical layout • Time and distance • Road conditions • Companion person • Parking Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  15. Acceptability • Physical facilities • Endorsement of the farm community • Social acceptance • Reputation of care • “Come as you are” Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  16. Affordability • Is “Free” good? • How much is detection worth? • Excessive price of medical care • “Surprise” charges may deter future use Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  17. Health Care Visits by Age (N = 950) Sustained Work Indicators of Older Farmers, NIOSH Grant # R01 OH04157-01A1 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  18. Frequency of Medical Visits by Age (N = 922) Sustained Work Indicators of Older Farmers, NIOSH Grant # R01 OH04157-01A1 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  19. Formal versus “Informal Care” • Rural people have long relied on informal care • Pew and aisle-side consultations • Neighbors, friends as health information sources • Evidence of reliance on periodicals, internet • Grassroots efforts Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  20. North Dakota 37 multidisciplinary cluster clinics Held in evenings Includes screenings + treatment 14% of clients age 65+ Cluster Clinics for Migrant Hispanic Farm Workers with Diabetes Heuer, Hess, Batson, 2006. Rural and Remote Health, Vol. 6 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  21. Physical arrangement of mini-clinics within a cluster clinic Heuer, Hess, Batson, 2006. Rural and Remote Health, Vol. 6 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  22. One Stop Shop • Time + distance • May need to bring family member • Challenges • May be tiring • Coordination of stops Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  23. Audiometry Respiratory function Musculoskeletal, balance Dermatology Vision Dental * Neurological Mental * Bone density * Gender specific Usual Height/weight BP Cholesterol glucose Screenings Recommended * Less frequent Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  24. Screening Events to Reduce Farmer’s Hazardous Exposures • Combined free screening and personal health education • Held in conjunction with various ag meetings 2001-2004 • 2 month post survey; 25% had improved PPE use; 13% removed noise source; 30.7% abated respiratory hazard Jenkins, Stack, Earle-Richardson, Scofield, May 2007 (in press) Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  25. Study of the Impact & Efficacy of Health Fairs for Farmers • 60% > age 55 (N = 378) • 82% lived on farms • 79% not retired • 94% had health insurance • 48% lacked preventive health services Rydholm & Kirkhorn, 2001. JASH Vol. 11, No.4 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  26. Study Findings – Health Problems Rydholm & Kirkhorn, 2001. JASH Vol. 11, No.4 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  27. Study Findings (continued) • 78% reported work safety or lifestyle changes • 47% varied work safety as a result of the fair • Improved diet • Increased exercise • Better stress management • Of the 32% recommended for follow-up, 70% sought & received care in a timely manner Rydholm & Kirkhorn, 2001. JASH Vol. 11, No.4 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  28. Canada • Evaluation of a respiratory health program • Delivered in rural communities by nurses • One on one screening, education and follow up • Labor intensive Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  29. Grassroots Movement • Health Fairs • Dairy Days & other commodity specific groups • In conjunction with other farm programs More likely to get owners/managers • Challenges • Getting the workers • Privacy areas for consulting • Follow-up services Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  30. Mobile Health Units • Very limited • ? Cost effective Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  31. Mental Health • Rosmann, 2005 JASH, Sowing Seeds of hope • Regional approach ( Midwest) 12 components: direct service through vouchers, telephone intervention, support groups Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  32. AgrAbility and Vocational Rehabilitation Programs • Federally funded health programs in place that serve farmers. Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  33. Health Promotion for Farmers at the County Market (Jones & Segrist, 1999) • Use nursing students + Ky Partnership for Farm Family Health & Safety, Inc. • Screened for hypertension only • 10 sites – 1 county • Agribusinesses, diners, country stores • 4 hour sessions • Timed to match peak turnout (some at 5:00 am) • No cost • n = 373 • Results: 1/3 BP > 140/90 Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  34. Migrant Program and Academics • Colorado Migrant Health Program and University of Colorado • Used BSN students to work in the MHP as a clinical site Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  35. Health Promotion through Family Practices • Infiltrating the existing system • Careful not to add time or financial burdens on office or patient Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  36. Practical advice • Use simple history tools • Use these to guide screenings Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  37. Conclusions/Recommendations • Parish nurses (Rydholm + Kirkhorn, 2005) • Incorporate screenings into other gathering events • One stop shop concept • Use of academics • Utilize more fully existing funded programs • Migrant health clinics • AgrAbility Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  38. Conclusions continued • Work on more formal coalitions between providers and communities • Use nurses but equip them with special training in agricultural health • Provide more education in gerontology • Need to examine methods of providing & insuring follow up for positive screening results Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  39. Need for Evidence • Do health screenings (events) lead to farmers getting treatment? • Cost effectiveness of health screenings? community based clinic based Aging Farmer Conference ~ D. Reed ~ March 6, 2007

  40. “Farming looks mighty easy when your plow is a pencil, and you’re a thousand miles from the corn field.” Farm Quotes – Dwight D. Eisenhower

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