Life Course Approach on Health Disparities in Older Adults

Abstract Vaccination represents a cost-effective public health intervention that saves millions of lives globally each year as well as increasing health and wellbeing of the population. Approximately 20 vaccines are currently in use in routine schedules, with several new or improved in the research pipeline. While immunisation programmes have traditionally targeted children, in recent strategic thinking around vaccination has shifted from an infancy focus to a life course approach that considers the benefits of vaccination at all ages. There are many benefits to targeting different age groups for vaccination, such as targeting individuals at an age that maximises protection (HPV among teenagers, shingles among older adults); boosting waning immunity (Td/IPV among teenagers); protecting at-risk individuals when they are most vulnerable (influenza in pregnancy, pneumococcal vaccine in older adults at clinical risk); protecting newborns in utero before they have the chance to be vaccinated (pertussis in pregnancy); or targeting an older age group to indirectly protect younger infants (MenACWY vaccination of teenagers). Even though the public health benefits of the life-course approach are evident, delivering vaccination programmes spanning such disparate groups represent constant challenges. These challenges can be grouped into: a) limited access to services b) communication challenges influencing attitudes and knowledge of vaccination and c) logistical challenges associated with the use of a wide range of settings for vaccination. This session will explore, at country and regional levels, experiences and reflections on delivering vaccination across the life course, and evidence-based policy and operational actions taken to deliver an optimal programme at all ages. Key messages Life course vaccination presents opportunities to better protect the population but also brings unique challenges, both from the patient side and from the health systems side. Evidence-based tools and strategies to improve vaccine programmes across the life-course are increasingly available. Country and European level action is needed to achieve optimal results.

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A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study

Community Dentistry And Oral Epidemiology ◽

10.1111/cdoe.12463 ◽

2019 ◽

Vol 47 (4) ◽

pp. 333-339 ◽

Cited By ~ 2

Author(s):

Haena Lee

Keyword(s):

Life Course ◽

Social Mobility ◽

Tooth Loss ◽

Sensitive Period ◽

Health And Retirement Study ◽

Mobility Models ◽

Life Course Approach ◽

Retirement Study

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Life Course Predictors of Allostatic Load Among LGBTQ Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2615 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 735-735

Author(s):

Charles Hoy-Ellis ◽

Hyun Kim ◽

Karen Fredriksen Goldsen

Keyword(s):

Older Adults ◽

Life Course ◽

Interpersonal Violence ◽

Allostatic Load ◽

Identity Management ◽

The Body ◽

Linear Regression Models ◽

Psychophysiological Stress ◽

Increased Risk ◽

Wear And Tear

Abstract LGBTQ older adults are at significantly increased risk for poor mental and physical health, likely consequential to lifelong bias. Allostatic load (AL), the net effect of “wear and tear” on the body resulting from repeated, chronic over-activation of the psychophysiological stress response system. Utilizing the Health Equity Promotion Model, the aim of this study was to test potential life course predictors of AL, including interpersonal violence, legal marriage, and identity management in a sample of LGBTQ adults 50 to 97 years of age (n=317). Results from a series of hierarchical linear regression models showed that adult physical abuse and late identity disclosure for those who had been in an opposite-sex marriage predicted higher AL in this sample of LGBTQ older adults, indicating need for increased research on bias over the life course as contributory to AL and biopsychosocial dysfunction among LGBTQ older adults.

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‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

BMC Public Health ◽

10.1186/s12889-021-10573-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheryl Johnson ◽

Moses Kumwenda ◽

Jamilah Meghji ◽

Augustine T. Choko ◽

Mackwellings Phiri ◽

...

Keyword(s):

Older Adults ◽

Life Course ◽

Hiv Testing ◽

Sexual Risk ◽

Age Groups ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

Sexual Risk Taking ◽

Rural And Urban ◽

Self Testing

Abstract Background Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. Methods We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. Results Midlife-older adults (30–74 years of age) associated their age with respectability and identified HIV as “a disease of youth” that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying “lack of wisdom”. These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. Conclusions Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

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A Confluence of Policy Inequality: Health Disparities in Old Age Among American Indian and Alaska Native Populations

Innovation in Aging ◽

10.1093/geroni/igaa057.120 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 37-37

Author(s):

Sadie Giles

Keyword(s):

United States ◽

Health Disparities ◽

Life Course ◽

American Indian ◽

Old Age ◽

Alaska Native ◽

Political History ◽

The United States ◽

The Political ◽

The Life Course

Abstract Racial health disparities in old age are well established, and new conceptualizations and methodologies continue to advance our understanding of health inequality across the life course. One group that is overlooked in many of these analyses, however, is the aging American Indian/Native Alaskan (AI/NA) population. While scholars have attended to the unique health inequities faced by the AI/NA population as a whole due to its discordant political history with the US government, little attention has been paid to unique patterns of disparity that might exist in old age. I propose to draw critical gerontology into the conversation in order to establish a framework through which we can uncover barriers to health, both from the political context of the AI/NA people as well as the political history of old age policy in the United States. Health disparities in old age are often described through a cumulative (dis)advantage framework that offers the benefit of appreciating that different groups enter old age with different resources and health statuses as a result of cumulative inequalities across the life course. Adding a framework of age relations, appreciating age as a system of inequality where people also gain or lose access to resources and status upon entering old age offers a path for understanding the intersection of race and old age. This paper will show how policy history for this group in particular as well as old age policy in the United States all create a unique and unequal circumstance for the aging AI/NA population.

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Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

Journal of Holistic Nursing ◽

10.1177/08980101211025372 ◽

2021 ◽

pp. 089801012110253

Author(s):

Verónica G. Walker ◽

Elizabeth K. Walker

Keyword(s):

Older Adults ◽

Life Course ◽

Health Beliefs ◽

Long Term Care ◽

Life Course Theory ◽

Nursing Research ◽

Term Care ◽

Holistic Nursing ◽

Care Facilities

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

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