abuse. Elder abuse is linked to psychological distress, displacement, and at its extreme, threats to physical safety and death. The COVID-19 crisis has increased the risk of elder abuse in social isolation and loneliness (World Health Organization, 2021). Research from Alignment Healthcare USA (2022) revealed three major social determinants of health factors as barriers to care for America’s seniors. They identify these barriers as economic instability, loneliness, and food insecurity. Economic instability—challenges in paying medical bills— was a widespread issue for respondents. One out of six seniors shouldered medical debt, and one out of five reported that finances were their most significant barrier to care. For many seniors, financial barriers to care were tied to competing priorities. Over a third of individuals said financial responsibilities precede health within the upcoming year. Additionally, nearly a quarter of individuals said that challenges in covering medical bills, prescriptions, and medical supplies were a significant financial barrier to care in the next year. Other barriers included unresponsive providers, lack of in-home support, transportation access issues, lack of nutritious foods, and technology troubles. Sixteen percent of seniors said they had outstanding medical debt, of which more than half reported having medical debt amounting to one month of living expenses or more (Alignment Healthcare USA, 2022). These financial difficulties contribute to uncertainty around seniors’ ability to cover medical expenses in the next year. Loneliness, previously discussed here, is another predominant social Disability Physical, intellectual, mental health, and other long-term disabilities constitute another facet of diversity within the U.S. The number of Americans reporting a disability has increased in recent years due to chronic health conditions and population aging. In 2019, 27% of Americans reported a disability (Preidt, 2021), and 12% stated that they have more than one disability. The CDC (2020) points out that two in five adults aged 65 and older have a disability. One in four women has a disability, and two in five non-Hispanic Native American Indians/Alaska Natives have a disability.
determinant of health factor that can become a barrier to care for seniors (Alignment Healthcare USA, 2022). A fifth of seniors reported increased loneliness in the past year. While nearly 7 out of 10 seniors see a family member, friend, or another companion often throughout the week, 16% only see a companion every two to three weeks (Alignment Healthcare USA, 2022). Food insecurity is the third social determinant of health that often impedes seniors’ access to care and ability to adhere to treatment. The survey found that 15% of seniors expected to experience barriers to food access in the next year (Alignment Healthcare USA, 2022). An even more significant number of seniors reported that grocery assistance was their top need for support. Seven of 10 seniors said they would use a monthly grocery allowance. More seniors ranked monthly grocery allowances as their most prized benefit than 24/7 telehealth or virtual care access. (Alignment Healthcare USA, 2022). Seniors have reported transportation as one of the barriers to seeking care. More than 20% of respondents note the lack of reliable transportation as a problem when seeking medical care. One in 7 say they will not have consistent transportation to medical care in the next year (Alignment Healthcare USA, 2022). Moreover, technology has also been cited as impacting health care for older adults. One in 10 (10%) seniors say their lack of access to reliable technology or difficulties using it will be an obstacle to health and medical care in the next year (Alignment Healthcare USA, 2022). Evidence-Based Practice : Research shows that adults with disabilities are more likely to smoke, suffer from obesity, and have heart disease and diabetes (CDC, 2020). Healthcare professionals must be alert to the diseases linked to disability. These diseases can compound the challenges that people with disabilities face. This means that mental health professionals need to become comfortable and competent in working with disabled individuals. People with disabilities tend to be in poorer health and to use healthcare at a significantly higher rate than people who do not have disabilities (The Current State of Health Care for People with Disabilities, 2022). Table 2 summarizes the percentage of adults with specific categories of disability in the U.S.
Table 2: Percentage of Adults with Functional Disability Types in the U.S. Functional Disability Description
Percentage
Mobility
Serious difficulty walking or climbing stairs
13.7% 10.8%
Cognition
Serious difficulty concentrating, remembering, or making decisions
Independent Living
Difficulty doing errands alone
6.8% 5.9% 4.6% 3.7%
Hearing
Deafness or severe difficulty hearing Blindness or severe difficulty seeing
Vision
Self-Care
Difficulty bathing or dressing
Note : From Centers for Disease Control and Prevention (CDC). (2020). Those with disability have experienced a history of discriminatory practices that have often resulted in exclusion from mainstream society. Historically, individuals with a disability have been physically segregated from others due to policies encouraging the institutionalization of people with physical, developmental, and mental health
disabilities. Institutionalization prevented many individuals with a disability from meaningful education and work and limited opportunities to socialize with the broader community. At its worst, institutionalization resulted in the neglect, mistreatment, and abuse of those with disability. Deinstitutionalization was ushered in by the public exposure
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Book Code: PYTX1226
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