These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals.
PHYSICAL INACTIVITY AND AMERICA’S AGING POPULATION
(Fontana, 2009). Many of the age-associated changes leading to decreased mobility and increased disease are directly or indirectly linked to a lack of physical activity and exercise (Booth, Laye, & Roberts, 2011). A lack of physical activity over a lifetime can actually accelerate aging and physiological changes in the body by up to 30 years, which results in premature health and mobility problems (Booth et al., 2011). Physical inactivity increases with aging. Current guidelines suggest older adults should participate in a minimum of 150 minutes of moderate activity per week with an additional 2 days of resistance training. It is estimated that more than 90% of adults over the age of 75 do not meet these guidelines (Centers for Disease Control and Prevention, 2016a). This epidemic of inactivity is costly in both economic and personal terms. Worldwide inactivity causes 6% to 10% of major noncommunicable diseases such as heart disease, type 2 diabetes, and some forms of cancer (Andersen, Mota, & Di Pietro, 2016). This puts inactivity on a par with tobacco use as a major risk factor for noncommunicable disease (Hallal et al., 2012b). Despite the magnitude and consequence of physical inactivity, more than 71% of adults have never been prescribed physical activity during a medical consultation (Lee et al., 2012). This is despite the large amount of evidence that suggests a physical activity prescription should be equal to drug prescriptions in the treatment of many illnesses (Lee et al., 2012). Research now clearly demonstrates that even adults who have been sedentary for most of their lives may benefit from the implementation of physical activity (Chou et al., 2012; Concannon, Grierson, & Harrast, 2012; de Vries et al., 2012; Hamer, Lavoie, & Bacon, 2014). It is becoming increasingly clear that physical inactivity has major detrimental consequences, and physical therapists (PTs), as the profession that promotes the movement system, should be involved in reversing the current sedentary trends seen in older adults.
The demographics of the American population are undergoing a major change. Every day more than 10,000 people in the United States turn 65. By the year 2030, all baby boomers will be over the age of 65, and by the year 2050, more than one fifth of the U.S. population will be over the age of 65 (Federal Interagency Forum on Aging-Related Statistics, 2016). It is expected by the year 2060, over 20 million adults will be over the age of 85 years in the United States alone (Federal Interagency Forum on Aging- Related Statistics, 2016). The past 100 years have seen not only an increase in the number of older adults but also an increase in general life expectancy. At the turn of the last century, life expectancy was approximately 46 years. Today, improvements in housing and hygiene, along with medical advances, have raised the average life expectancy of men and women to more than 75 years (US Department of Health and Human Services Administration on Aging, 2012), and those who survive to age 65 are expected to live an average of 19 more years (Federal Interagency Forum on Aging-Related Statistics, 2016). The increase in life expectancy seen in the past century has brought a new urgency to develop programs dedicated to assisting older adults in staying fit and active for as long as possible. Aging is a complex interaction of biomedical and psychosocial factors leading to a progressive deterioration in the physical structure and biological functions of the body. It is universally characterized by a decrease in the body’s ability to maintain homeostasis within its various systems, leading to a progressive decline in body function, an increased risk of disease, and eventually death (Barzilai, Huffman, Muzumdar, & Bartke, 2012). Many of these body system changes accelerate after the age of 70 (Fontana, 2009), leading to a progressive decline in mobility and physical function in older adults. In addition to decreases in physical function, aging has also been associated with the development of a number of serious systemic diseases such as cancer, heart disease, and type 2 diabetes. However, aging does not have to result in decreased mobility or increased disease
BODY SYSTEM CHANGES WITH AGING
As a result of physical inactivity and increased systemic disease, many older adults experience an increased vulnerability to any challenges the body systems may face from illness and injury. These changes may diminish an older adult’s ability to survive a serious illness, a fall, or other event – including life- saving surgery – that stresses the body systems. Struthers and colleagues (2008) found that major surgery stressed the body and resulted in increased oxygen consumption in the immediate time period after the procedure. In older patients with poor physical fitness and a low cardiorespiratory reserve, the increased demand for oxygen may lead to unnecessary increases in complications, and in extreme circumstances, even death after surgery (Struthers et al., 2008). Before attempting to prescribe an exercise intervention for older adults, it is critical to understand the changes that typically occur in the body with aging, as many of these changes will affect not only the ability of older adults to participate in exercise but also their response to exercise. A firm understanding of the anatomical and physiological changes that take place with aging is necessary to both prescribe and monitor an exercise intervention in older adults.
Older adults face a multitude of changes within all major body systems. Even in the absence of major disease, aging leads to deteriorations in almost all physiological systems of the body (Chodzko-Zajko et al., 2009). Decreases in cellular regeneration lead to a progressive deterioration in cellular and organ health. This leads to a decrease in function of most body systems, including a reduction in the function of all the special senses, resulting in hearing loss and decreased vision, taste, and smell. A slowing in the cellular turnover of the dermal and epidermal cells in the skin leads to a thinning of the skin, decreased wound healing, and an increased risk of infection (Humbert et al., 2016). Elastic tissue throughout the body also decreases with age, and this loss in combination with an increase in cross-links in collagen deposits leads to a general loss of elasticity in connective tissue (Ahmed, Matsumura, & Cristian, 2005). The general loss of elasticity results in an increased stiffness in the cardiovascular, respiratory, and musculoskeletal systems with resulting decreased cardiovascular, respiratory, and mobility function (Chester & Rudolph, 2011). Although some changes may be inevitable with aging, physical inactivity can actually hasten the aging process, resulting in more rapid declines in most major body systems.
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