Socioeconomic and Environmental Influences

Chapter 7

Social status, economic conditions, and environment influence our health and our response to illness.

One of the strongest and most consistent predictors of illness and death is socioeconomic status.

The environment influences safety and well-being.

Introduction

The GI Generation commonly called the “Greatest Generation”—born 1900 to 1924

The Silent Generation—born 1925 to 1945

The Baby Boomers—born 1946 to 1964

They shared certain experiences at similar stages of physical, psychological, and social development that influenced the way they perceive the world.

Age Cohorts

They are healthy and have resources to maintain their homes.

They have contributed to Social Security more than any other age group because of their higher earnings.

Older adults receive income from five sources: Social Security, assets, retirement, government pensions, and wages.

The age at which Social Security can be drawn is increasing from age 65 to 67; the retirement benefit can slightly increase for those who delay payment.

Supplemental Security Income (SSI) benefits are available for the aged, disabled, or slightly impaired and those with few assets and minimal income.

Income Sources

In peak earning years

Most married

Few have children younger than 18 still residing in the family home.

53% are still employed.

Have completely or nearly paid for homes

Average annual income is more than $49,608.

Cohort 55–64 Years

Median income before taxes is $22,887.

Expenses related to medical care increase.

Face funeral expenses.

Veterans’ benefits are important to this age group because of the increased risk of chronic disease and other acute health problems.

Cohort 65–74 Years

Women outnumber men.

Health problems increase with age as do expenses for prescriptions and assistive devices.

Quality of housing deteriorates.

Decreased strength and endurance reduce the ability to conduct household chores.

Cohort 75–84 Years

Fastest growing segment of our population

At risk for an increase in chronic disease

Decreased ability to perform activities of daily living (ADLs)

Increased expenses for assistance, assistive devices, and medication

Lowest annual income of all older Americans, and 10% live in poverty

Social Security is primary income source

Cohort 85 Years and Older

In 2015, 8.8% of those age 65 or older were classified as poor with income below the poverty level.

Affects the quality of life for older adults

Inadequate housing and diet

Delay seeking medical

Assistive aids are unaffordable luxuries.

Knowing the income level enables the nurse to direct the patient to agencies and services to help those with limited resources.

Poverty

Shown to have a strong relationship to health risk factors

Influences earning ability and lifestyle behaviors

Greater access to wellness programs and preventive health options

Education provides an opportunity to avoid stagnation and isolation and adds to the enjoyment of later life (Erikson’s seventh stage of development).

Education

Health status of older adults influences their socioeconomic status.

80% of older adults have at least one chronic condition, 50% have two.

44% consider their health to be excellent or very good.

Functional status is affected by chronic conditions.

This is an indicator of the adult’s ability to remain independent.

Health Status

Older Americans should review their insurance coverage often to determine whether the coverage they have is necessary, appropriate, and adequate.

Home, car, and life insurance

Health insurance is a necessity.

Medicare: federal health insurance program for those over 65 years old or persons of any age who are disabled or have permanent kidney failure.

Parts A, B, and D

Insurance Coverage

Cost nothing for those who contributed to Medicare taxes while working

If did not contribute to Medicare taxes while working, monthly premium can be paid.

Home health care (including durable medical equipment)

Hospice care

Hospital inpatient stay

Mental health inpatient stays

Skilled nursing facility stay

Health Insurance: Medicare Part A

For B: recipients pay a supplemental premium.

Home health services (including durable medical equipment)

Medical and other services (including inpatient doctor services and outpatient therapies)

Outpatient mental health services and partial hospitalization for mental health services

Outpatient hospital services

For D: must have Medicare

Prescription drug coverage

Health Insurance: Medicare Parts B and D

The supplemental premium deducted from monthly Social Security payment

Rules and benefits change often.

Many are confused by the paperwork, billing, and notices regarding claims.

Medicare Part C—provides comprehensive care through a variety of health care delivery models.

Supplemental insurance is secondary to Medicare, which is primary.

Facts About Medicare

Federal and state funded, state managed program for low-income individuals and their families

For eligible older adults residing in nursing facilities

Covers health-related care and other services not available in the community because of their mental or physical conditions

Each state has different coverage and requirements.

Medicaid

You are hosting an educational Health Fair for senior citizens. One booth answers questions on Medicare Health Insurance. Which of the following are true statements? (Select all that apply.)

You must be over age 65 to qualify for Medicare.

If you did not pay into Medicare, you cannot get

benefits at all.

Medicare part A covers hospitalization and hospice care.

Medicare part D is for prescription drug coverage.

Quick Quiz!

Answer to Quick Quiz

ANS: C, D

Acquaintances, friends, and family

Schools, churches or synagogues, clubs, neighborhoods, and towns

Act as buffers against the harmful effects that major life events have on the health of older adults

To cope with losses of family members, friends, and a decline in health and independence, individuals need a large social network.

Role of Support Systems

A variety of benefits and entitlements are available to older Americans.

Senior discounts

Subsidized housing

Supplemental Nutrition Assistance Program (SNAP)

Congregate meal sites/Meals on Wheels

Energy assistance

Veterans’ benefits

Benefits and Entitlements

Created in 1973―Amendment to the Older Americans Act

Purpose is to plan and implement social service programs at the local level

Nutrition services through congregate meal sites and home-delivered meals

Recreational opportunities

Chore service

Legal assistance

Transportation

Information and referral

Area Agencies on Aging

When no longer able to handle their affairs or make decisions a conservator, guardian, or durable power of attorney may be needed.

Conservator manages financial resources.

Does not necessarily indicate that older persons are incompetent

Guardian makes personal decisions not related to financial matters.

Durable power of attorney is a document that names an agent to act on behalf of a person for a specific function, like making financial or health care decisions.

Conservators, Guardians, and Power of Attorney

Environment contributes to a person’s perception of life.

Environmental factors such as adequate shelter, safety, and comfort contribute to a person’s ability to function well.

Weather extremes can contribute to isolation.

Living in an urban or rural location affects access to services, availability of support systems, and safety perceptions.

Environmental Influences and Geographic Location

An automobile is a symbol of independence.

2015—47.8 million older adults maintained their driver’s license.

Driving is a form of independence and hard to give up.

Normal physical aging changes and effects of chronic health conditions may require adaptations.

Each Administration on Aging (AAA ) is charged with ensuring that transportation is available in its area.

Transportation

Home is a reflection of the individual, and for the older person it signifies independence.

The home may be the only asset.

Safety can be a problem in any living situation.

A growing number of older adults are living a mobile life.

Many housing are options available for those who give up their house.

Housing

Independent housing

Home matching programs

Living a mobile life

Retirement communities

Assisted living facilities

Board and care homes

Nursing care facilities

A segment of the older population is homeless.

Types of Housing

Elder victimization frequently goes unreported.

Often, the perpetrator of the crime is someone known to the older adult.

Declining health and limited finances contribute to feelings of vulnerability.

Those 85 years or older are abused and neglected at 2–3 times their proportion of the older adult population.

90% of elder abuse and neglect cases with known perpetrator; a family member.

Criminal Victimization

Older adults are good advocates for their own special needs and interests.

Older adults are taking charge of their environment, their resources, their mental and physical health, and the future of all older adults.

The nurse’s advocacy for older adults is important for ensuring that the older adults continue to control their lives.

Advocacy

Socioeconomic and Environmental Influences

Why Us

Services