Objective: This study's central purpose was to assess risks for and effective management of common chronic illnesses in an older adult, mostly minority, medically underserved population.
Design: A descriptive, cross-sectional design was used.
Population, sample, setting, years: This study was begun in 1998 and completed in 2000 with the study population being persons age 50 and older residing in an inner-city, medically underserved area. The final sample included 342 persons between ages 50 and 99, with 89% being ethnic minorities.
Study Variables: Predictor variables included demographic data (age, gender, race, marital status, religious preference), health behaviors, health care utilization (frequency of health care visits, type of provider, insurance coverage), health risk factors (use of alcohol, smoking behaviors, body weight), experience pain, and depression (CES-D). Outcome varibles included systolic and diastolic blood pressure, blood glucose, and functional ability (IADL/ADL scale from the larger AHEAD instrument).
Methods: Following random selection of blocks in the target area and purposive sampling from two residential settings, data were collected using a door-to-door survey method, including on-site measurement of blood pressure and blood glucose.
Findings: Health risks included high rates of smoking behaviors (33%), identified pain (46%), and high rates of > ideal body weight. Depression was identified in 16.7% of the total sample, with 50% of the 50-64 age group screening positive for depression. One or more functional deficits was found in 61.5% of the sample with at least three lower body limitations in 19.5% of the total sample. Higher than normal systolic blood pressure was found in 71% of persons diagnosed and treated for hypertension and blood glucose levels > 120 were found in 20% of persons diagnosed and treated for diabetes. Overall, the 50-64 and >84 age groups were identified as presenting with the greatest health risk factors and unmet health care needs. Predictors of hypertension and diabetes management were identified for the 50-64 and 75-84 age groups, with functional limitations being predicted by pain, >ideal body weight, depression, low self-rated health, and low health care utilization across age groups.
Conclusions: High rates of functional limitations and ineffective management for common chronic illnesses were found in the target population, with the 50-64 and >84 age groups presenting with the highest levels of health risk factors and ineffective management for hypertension and diabetes. Predictors (pain, >ideal body weight, depression)of ineffective management of chronic illnesses and functional limitations were identified and are amendable to intervention.
Implications: Findings point to the need for effective and accessible health care services for at-risk, older minority populations. Targeted interventions directed at predictors of ineffective management and functional limitations are suggested by the findings, increasing the potential effectiveness of care. Findings also point to the need for preventive services for the 50-64 age group, where the highest rates of health risk behaviors were identified.
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