San Joaquin Valley center of emerging health crisis among elderly

UCLA Health article
Senior citizens in California's Central Valley region have the worst health in the state and may provide a snapshot of the challenges California faces over the next two decades — a time in which the elderly population is projected to double.
Diabetes, obesity and falls, as well as low mammography rates and sedentary lifestyles, are all more acute among older adults in the San Joaquin Valley than elsewhere in the state, according to a new report, "Trends in the Health of Older Californians," by the UCLA Center for Health Policy Research.
Throughout the state, older adults are increasingly likely to report cancer, obesity, diabetes, high blood pressure, high cholesterol and the need for help with emotional problems. The use of medical care services has also risen, with increases in the percentage of older adults who went to the emergency room and those who made monthly or more frequent doctor visits.
"This is a bad way to start the new century," said Steven P. Wallace, the report's author and associate director of the Center for Health Policy Research. "Unless there is an increased focus on the prevention and management of chronic diseases, the promise of a healthy and happy retirement will be unattainable for millions of Californians."
The report did note some positive trends, including improved screening rates for several types of cancer and a drop in the number of older women taking hormone-replacement therapy drugs, which have been linked to an increased risk of cardiovascular disease and breast cancer.
This last change is linked to significant new information provided to doctors and their older patients about the dangers of hormone replacement therapy.
"It's an example of a concerted prevention effort that will have a long-term payoff in terms of better health and fewer health care costs," Wallace said.
In the heavily Latino San Joaquin Valley, such doctor-patient prevention efforts may be harder due to problems in the health care system, language and cultural barriers, and limited community resources. In addition, a fear of using government health services because of immigration concerns, even among documented residents and U.S. citizens, remains a significant barrier to preventative health care, Wallace said.
The proportion of older adults reporting diabetes in the San Joaquin Valley region increased from one in six in 2001 — just above the state average — to the highest in the state, with one in four reporting having diabetes in 2005. The San Joaquin Valley is also the only region of the state where mammography rates worsened between 2001 and 2005. In every other region, the proportion of older women who had undergone a recent mammogram increased.
The San Joaquin Valley also has particularly high rates of sedentary lifestyle, obesity and falls.
California's elderly population is expected to become majority non-Caucasian by 2030, with Latinos among the largest ethnic groups.
The report looked at data gathered by the California Health Interview Survey (CHIS) over three different time periods: 2001, 2003 and 2005.
Among the findings:
  • The San Joaquin Valley region's elderly population has the highest rates of diabetes (25.7 percent) and reported high blood pressure (63.9 percent) in the state.
  • In 2005, 41.8 percent of older women in the San Joaquin Valley region reported having had no mammogram over the previous 12 months. The rate was nearly 10 points higher than all other regions and a 19-percent change for the worse since 2001.
  • After Imperial County, Kern and Stanislaus counties had California's highest rates of diabetes among the elderly: 30.6 percent in Kern and 31.3 percent in Stanislaus.
  • 23 percent of the San Joaquin Valley's elderly population is obese — more than three points higher than all other regions.
  • 15.3 percent of the elderly population in the San Joaquin Valley reported having experienced a fall in the previous 12 months — more than three points higher than all other regions.
  • Almost one-quarter (23.9 percent) of low-income older adults in the San Joaquin Valley are food insecure, meaning they have trouble during the month obtaining sufficient nutritionally adequate food. This is particularly troubling given the fact that the region is among the most productive agricultural areas in the country.
The California Health Interview Survey, conducted every two years by the UCLA Center for Health Policy Research, is the nation's largest state health survey and one of the largest health surveys in the United States.
The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.
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Gwen Driscoll

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