UCLA study examines health of California seniors

About 44.7 percent of the state's older Latinos and 46.2 percent of seniors with limited English abilities report poor or fair health (versus good, very good or excellent). Both groups also report higher rates of diabetes and emotional difficulties, lower rates of screening procedures and preventive services, and less generous health insurance.

In contrast, just 30 percent of California's total population of 3.6 million residents age 65 and older report poor or fair health, and 26 percent nationwide. About 40 percent of older adults in San Francisco, Kern and Tulare/Kings counties report fair or poor health, compared with just over 20 percent in Marin/Sonoma, Napa and the mountain counties of Alpine, Amador, Calaveras, Inyo, Mariposa, Mono and Tuolumne.

Using data culled from the California Health Interview Survey (CHIS) 2001, the 137 page report provides detailed profiles of health behavior, health status and preventive care among California's oldest residents. Data are available by region, county, gender, ethnicity, income level and English proficiency. The report -- titled "Health of Older Californians: County Data Book" -- was funded by the Archstone Foundation and The California Endowment, a statewide health foundation.

"Most older persons are working to maintain their health by following recommended schedules for cancer screenings, obtaining flu shots, not smoking and taking medicines for chronic conditions. Yet some groups, such as Latinos, have more health problems than average and obtain fewer preventive services," said lead author Steven P. Wallace, associate director of the center and professor of health sciences at the UCLA School of Public Health.

"The health and prevention profile of some counties, such as Tulare and Kings, is worse than average, suggesting that those areas may need extra help in providing services to their older population. Other counties, such as Imperial, have older populations that are likely to be difficult to reach. In Imperial County, 40 percent of the older population has limited-English abilities and almost half have limited incomes," Wallace said.

"Every county has room for improvement in one or more of the health indicators," he added. "This report can help counties prioritize their outreach to the groups of elders who lag behind in preventive care."

The report examines specific health behaviors such as smoking and drinking habits; health status in relation to heart disease, diabetes, asthma, hypertension, arthritis, skin cancer, difficulty in climbing stairs and emotional problems; preventive care such as cancer screening, bone density testing, hormone replacement therapy and influenza immunization; and use of medical, dental and prescription medication services.

"The findings from this report reveal that low-income seniors, primarily immigrants and people of color, are in the poorest health because of lack of access to health-care services and often face language and cultural barriers within the health system," said Diane Yamashiro-Omi, senior program office of The Endowment, who oversees a program that is focused on prevention strategies, and works to build the leadership and advocacy skills of this population.

Among the report's specific findings:

• Smoking and drinking are relatively uncommon among older Californians. Fewer than one in 10 currently smoke and fewer than one in 20 report having three or more drinks in a single sitting during the past month -- both lower rates than the national average. Heavy drinking is rare among older women and especially rare among older Asian Americans. Older African Americans are more likely to report smoking than other races and ethnicities.
• Flu shots: A simple preventive measure like a flu shot is not received by 45 percent of older Latinos statewide, compared with 33 percent of all elders in the state and almost three-fifths of Latino elders in Tulare/Kings and San Bernardino counties.
• Prescription drug insurance: While 15 percent of older people statewide lack insurance coverage for prescription drugs, more than one-third go without in rural Northern and Sierra counties.
• Supplemental health insurance: While 78 percent of non-Latino whites report having private supplemental health insurance, only 37 percent of limited-English speakers report having such insurance, the largest difference of any indicator in the report.
• Mental health: Emotional problems like depression or anxiety impair the daily activities of 11.5 percent of California's elders. One-quarter report that they do not feel calm and peaceful most of the time. Those most likely to report mental health problems include elders of color, those with limited-English abilities and Medi-Cal recipients.
• Heart disease is reported by about 24 percent of older Californians, slightly above the national average of 21 percent. Heart disease is most commonly reported in Tulare/Kings and Madera counties (more than 30 percent) and least commonly reported in San Francisco and San Luis Obispo counties (less than 18 percent).
• Arthritis is reported by half of older Californians and 55 percent of older people nationally. Women in California have among the highest rates of arthritis, and account for about two-thirds of the one million older Californians whose daily activities are limited by the condition.
• Colon cancer screening: About two in five older people in California report never having had a colonoscopy (37 percent), better than the national average of 48 percent. The worst rates in California for lacking this screening are found among older limited-English speakers (50 percent), Latinos (49 percent), Asian Americans and Medi-Cal recipients (48 percent). Of the 1.3 million older Californians who have never had a colonoscopy, two-thirds are women.
• Dental care: One in three older Californians did not have a dental visit in the past year. Among those least likely to obtain dental care are older Medi-Cal recipients (47 percent), and older African Americans, those with a low income and limited-English speakers (45 percent each).

The UCLA Center for Health Policy Research, established in 1994, is one of the nation's leading health-policy research centers and the premier source of key health-policy information for California. Directed by E. Richard Brown, the center is based in the UCLA School of Public Health and is also affiliated with the UCLA School of Public Policy and Social Research. In addition to Wallace, other Center for Health Policy Research investigators involved in the project included Nadereh Pourat, Alek Sripipatana and Vilma Enriquez-Haass.

CHIS is a collaboration of the UCLA Center for Health Policy Research, the California Department of Health Services, and the Public Health Institute. The California Department of Health Services, the California Endowment, the National Cancer Institute, the California Children and Families Commission, the Centers for Disease Control and Prevention (CDC), and Indian Health Services funded the survey.

Online resources:

• California Health Interview Survey: www.chis.ucla.edu/
• UCLA Center for Health Policy Research: www.healthpolicy.ucla.edu/
• UCLA School of Public Health: www.ph.ucla.edu/
• Archstone Foundation: www.archstone.org/
• The California Endowment: www.calendow.org/