MAY/JUNE 1996

Aging

A newsletter of the Office of Minority Health
Office of Minority Health
Public Health Service
U.S. Department of Health and Human Services

In This Issue: (Contents)

Many of the people who participate in the Asian Seniors Health Project have been denied health care in the past. A history of discrimination tends to obscure any desire they have to get help, says Carlina Yeung, director of the project. The result is that "older Asians in our area seek health care on a crisis basisþwhen a health problem becomes a real emergency."

The seniors find they are unable to communicate health needs because of language barriers. They are discouraged by the lack of cultural understanding that plagues the mainstream health care system. Recent immigrants view the system as intimidating and too hard to understand. Some harbor a general distrust of western medicine. Recognizing how these factors influence the help-seeking behavior of a population is critical to delivering high-quality health services, Ms. Yeung said.

The Asian Seniors Health Project, a grantee of the Office of Minority Health, is part of Asian Americans for Community Involvement (AACI), a community health center in San Jose, California. The project targets Chinese, Vietnamese, Cambodian, and Laotian individuals who are aged 55 years and older. Services include mental health and nutrition counseling, health education seminars, and screenings to test for diabetes and hypertension.

The project takes a health promotion and case management approach. "We make doctor's appointments, provide transportation and translation services, and ensure that appropriate steps are taken for follow-up care," Ms. Yeung said. It's a holistic method that requires the project's health educators to understand a client's family relationships, advocate on a patient's behalf, and refer a client for additional services when necessary.

Across all four Asian populations that the project reaches, hypertension and stroke persist as the biggest health problems. While the groups share some similarities, their differences are just as notable. For example, Chinese and Vietnamese seniors are more independent, Ms. Yeung said. "They're much more willing to take the bus to get to appointments, whereas Cambodians and Laotians are inclined to confine themselves to home."

To meet the needs of those seniors who are more homebound, the Asian Seniors Health Project is developing teams of nurses and health promoters to conduct home visits more frequently. Additionally, the center is recruiting bilingual/bicultural volunteers who can provide cultural competency training to health providers.

This training is essential because of the limited choice of providers offered through managed care. Managed care is overwhelming to AACI clients, said Ms. Yeung. "They sign up for health plans and then don't understand how they're supposed to use the system," she said. Most health plans don't have literature in English that is easily understandable, she added. And finding material in Asian languages is much harder. A major point of conflict is that a managed care system, by its nature, seeks to cut costs. So spending the money it takes to make a plan more accessible to minority groups may be regarded as more costly.

Surviving Managed Care

The pressing question is whether clinics that serve elderly Asians can survive in a managed care climate, says Don Watanabe, executive director of the National Asian Pacific Center on Aging (NAPCA) in Seattle, Washington.

Small clinics are in a precarious position, he said. "They are trying to access and maintain the funding and resources they need to keep operating." But with the build-up of health maintenance organizations, their livelihood is threatened.

Clinic directors are wondering whether to compete with HMOs or join them. "There are no easy answers," said Mr. Watanabe. "But without community clinics, health care for the Asian elderly is likely to fall by the wayside." Asian and Pacific Islander (API) advocacy and direct service provider organizations are urging legislators and other mainstream decision makers in the health care industry to address this issue of inclusion for API elderly.

One role of NAPCA is to develop coalitions and get as many agencies as possible talking about shared concerns such as managed care, said Jeffry Young, PhD, director of advocacy and demonstration projects.

"The goal is to increase dialogue about alternatives for those individuals whose needs aren't being met by the one-size-fits-all health care system," he added.

To address the lack of Asian language materials, NAPCA has launched a new program called Facsimile Information in Translation (FAX-IT). Callers can dial into FAX-IT and choose from more than 300 documents in 15 languages on health, nutrition, culture, and social services. Callers make selections using the touch-tone keys on the telephone handset of their fax machine. When a caller hangs up, FAX-IT immediately faxes back the requested information. Callers may reach FAX-IT at 206-624-0185.

For more information about APCA, call 206-624-1221. For more on the Asian Seniors Health Project, call 408-975-2730.

Administration on Aging: Promoting Olders Americans Month

The Administration on Aging is an agency of the U.S. Department of Health and Human Services. For more information about the agency's mission and services, call 202-619-0724. The address to the AOA Home Page on the Internet is http://www.aoa.dhhs.gov

Minority Health Perspective

Recognizing the Value of Elders

As the 21st century approaches, graying baby boomers will cross the threshold into the "older generation." Many in this group will become primary caregivers for their parents. Many will be over 85 years of age. These "oldest old" already comprise the country's fastest growing age group.

Boomers have established themselves as leaders of grassroots organizations, national programs, business, and government. They live in an era characterized both by expanding cultural diversity and increasing anxiety about the future of the next generation. They are healthier and better educated than their parents.

But their parents were the pioneers. They established valuable programs and policies. On their watch, Social Security, Medicare, and pension plans were created. They made it possible for older people to remain healthy and be of service to their communities.

As Liz Carpenter, former secretary to President Johnson, said at the kick-off of Older American's Month last year, "We all know someone--many someones--who are stretching their savings and their energies to make life better for America: the four million grandparents; the thousands of aunts and uncles who are having to be born-again surrogate parents for many of the parentless kids who must be raised by someone if civilization is to save them."

We must preserve our commitment to health and social service programs that serve older people's needs. We need trained and culturally competent professionals in gerontology and geriatrics. This will help our racial and ethnic minority elders receive high-quality care and services. As we work to make improvements, we must remember elderly persons with disabilities, who are living longer because of strides in assistive technology.

It is time to honor and learn from the remarkable elders of our nation. The Office of Minority Health has examined health issues affecting elderly persons in this month's Closing the Gap. As always, we would like to hear from you about how you are addressing these issues in your community. Write the Resource Center with your ideas and suggestions: OMH-RC, PO Box 37337, Washington, DC 20013-7337. Make this the beginning of a "Lifetime of Opportunity" for elders in your community.

Among the factors that affect mental health in the elderly are confusion, cognitive or memory impairment, sleep disorders, depression, and other psychopathologies. Many elderly persons suffer from anxiety, stress, loneliness, social isolation, and fear of abandonment and abuse.

Elderly persons generally have an enormous pool of "tolerated" illness that has been normalized, denied, ignored, or underreported. One of the problems frequently observed is a delay in seeking treatment. Our health care system relies on the patient to initiate care, which is precisely what elderly persons do not generally do.

Though the elderly typically suffer from multiple health problems, they often describe themselves as being in good health, which can make it difficult for health care providers to care for their needs.

The co-morbidity or the clustering of diseases is another characteristic of the elderly population. Surveys of community-dwelling elderly have found, on average, one to five disabilities per person. Some of the most common problems that co-exist in the elderly are substance abuse and mental illness; and diabetes, hypertension, and depression.

One nurse practitioner in New York described her diabetic clinic as a depression clinic because more than 50 percent of the diabetic patients were depressed. Sixty percent of her patients were over 65 years of age.

Practitioners must recognize not only the unique characteristics related to aging, but also the impact of the race, ethnicity, and culture of a patient. Older minorities share many of the same concerns and features as those in other elderly populations, but have added issues such as prejudice, race, and the impact of language barriers and discrimination, all factors that frequently result in "color coded" care.

Meeting the needs of our elderly community requires provider training in mental health and aging.

Dr. Harper's federal service career spans more than 50 years. She served as a consultant to the 1995 White House Conference on Aging, and was co-chair for Health Care Reform, Mental Health/Public Sector, White House.

AARP Works to I'mprove Minority Health

At age 55, Jim, an African American man, told his wife he was having difficulty urinating. At his wife's urging, Jim visited a urologist who diagnosed prostate cancer. He was given a number of choices for treatment, and after much deliberation he opted for radical surgery. This would ensure a healthy life.

Jim's story is explored in a video called "Difficult Choices, Difficult Decisions." Produced by the Office of Minority Affairs at the American Association of Retired Persons (AARP), the video presents a thought-provoking look at the effect of prostate cancer.

Among African American men aged 65 years and older, the rate of prostate cancer is two times higher than that of Whites the same age.

"The video addresses the high rates of prostate cancer in African American men, and takes a family approach to coping with the disease," said Carrie Bacon, director of AARP's Office of Minority Health.

Wives of prostate cancer victims share their feelings and the role they play in helping loved ones deal with difficult choices.

Hosted by actors Ossie Davis and Ruby Dee, the video features an African American urologist and a prostate cancer support group. Along with showing straight talk from cancer victims, the video takes viewers on a visit to a clinic to show what it's like to undergo prostate cancer screening and treatment.

For more information about the videotape, call the Office of Minority Affairs at 202-434-2460. The video (stock # C1161) is available on free-loan basis through AARP's Program Scheduling Office, 601 E St., N.W. (B-4), Wash., DC 20049.

Office of Minority Affairs

AARP's Office of Minority Affairs works to change the thinking and actions of older minorities, their families, and the general public, in order to advance the health and well-being of this population. The office provides health education in a range of areas including nutrition and disease prevention. "We work to help reduce the incidence of diseases endemic to minorities," Ms. Bacon said.

Minority Health Facts

Leading causes of death for African Americans aged 65 and older. Men: heart disease, lung cancer, stroke, chronic obstructive pulmonary disease. Women: heart disease, stroke, diabetes, lung cancer, and colorectal cancer.

Leading causes of death for Hispanics/Latinos aged 65 and older. Men: heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and prostate cancer. Women: heart disease, stroke, diabetes, lung cancer, and colorectal cancer.

Leading causes of death for Asians and Pacific Islanders aged 65 and older. Men: heart disease, stroke, lung cancer, chronic obstructive pulmonary disease, and colorectal cancer. Women: heart disease, stroke, lung cancer, diabetes, and colorectal cancer.

Leading causes of death for American Indians/Alaska Natives aged 65 and older. Men: heart disease, lung cancer, stroke, diabetes, and chronic pulmonary disease. Women: heart disease, stroke, diabetes, chronic obstructive pulmonary disease, and lung cancer.

The Growth of the Older Population

According to one study of the American Association of Retired Persons (AARP), religious beliefs were a major reason that Hispanic elders postponed medical appointments and failed to seek health education. The study, which assessed health attitudes of Mexicans, Salvadorans, Guatemalans, Puerto Ricans, and Dominicans in New York City and Los Angeles, sought to identify cultural barriers to delivering health education.

In addition to holding strong spiritual convictions, many of the elders practiced folk medicine, especially for colds and stomach problems. The study also found that the respondents considered Hispanic physicians, friends, and family members the most credible sources of health information. And the most effective way to deliver health messages to large audiences turned out to be through Spanish-language radio and television stations, churches, and social clubs. Also popular are toll-free 800 lines with Spanish-speaking operators.

"Mainstream health personnel should be aware of these factors," said Amelia Castillo, a clinical consultant for El Paso Senior Opportunities and Services in Texas. "Knowing that older Hispanics, more so than younger ones, really adhere to religion and traditional medicines," she said, "would help health providers and educators tailor their services."

Other elements that can affect health education for older Hispanics, she added, include a lack of resources, lack of transportation, and lack of mobility. At the top of the list of prevalent diseases among Hispanic elderly persons is diabetes, hypertension, cancer, cardiovascular disease, and glaucoma, she said.

Also of significance are arthritis, substance abuse, and smoking, said Marta Sotomayor, executive director o the National Hispanic Council on Aging (NHCoA), located in Washington, DC. NHCoA works to improve life for Hispanic/Latino elderly persons. This includes improving health status and education. As an advocacy network with chapters and affiliates across the country, the council shapes policy, conducts research, and administers programs.

NHCoA conducts a multi-site, national program funded by the Centers for Disease Control and Prevention. The program aims to increase the number of older Latinas who seek screening services for breast and cervical cancer. Hispanic women are twice as likely as non-Hispanic Whites to suffer from cervical cancer, and are much less likely to know the warning signs.

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With funding from the Administration on Aging, NHCoA also carries out a program called "Protecting Older Latinas Against Domestic Violence." NHCoA works in conjunction with community-based organizations to sponsor public awareness campaigns and train health providers to deliver culturally competent care.

NHCoA's most current endeavor involves educating Hispanic/Latinos about managed care. "There isn't a lot out there in Spanish on how to navigate the managed care system," said Dr. Sotomayor. "So this is one of our top priorities." NHCoA is coordinating a series of community forums on managed care and Medicaid throughout the summer. The forums will take place in Miami, Florida; Houston and Dallas, Texas; Kansas City, Missouri; and Los Angeles, California.

Finding organizations that will fund the effort and finding Hispanic health professionals who can speak about the latest legislation on managed care have presented the largest stumbling blocks, said Dr. Sotomayor. In many ways, NHCoA is in a difficult situation. There is certainly a need to educate Hispanic consumers about managed care, but there seems to be limited access to resources to do so, she added.

If you are interested in assisting the National Hispanic Council on Aging with its efforts to educate the public about managed care, contact Dr. Sotomayor, at 202-745-2521. NHCoA publishes a series of educational materials in Spanish for the elderly, and has produced books targeted to service providers: Hispanic Elderly: A Cultural Signature; Empowering Hispanic Families: A Critical Issue for the 90's; and Elderly Latinos: Issues and Solutions for the 21st Century.

The I'mpact of Falls

A large number of elderly African Americans treated for falls suffer pain and limited activities long after the fall, according to a study conducted by the Philadelphia Department of Public Health and the University of Pennsylvania, and supported by a grant from the Centers for Disease Control and Prevention (CDC).

The study, which was published in the Journal of the American Geriatrics Society a few years ago, was the first to assess falls in elderly African Americans and to identify predictors of recovery. And it is the most recent CDC study to examine falls in this population.

After examining medical records and conducting a series of interviews with 197 African Americans age 65 and up in Philadelphia who were treated in the emergency room after a fall, researchers found that 61 percent were hospitalized for injuries related to the fall.

"The circumstances of the fall were such that if they had occurred in younger persons, in all likelihood few persons would have been injured and even fewer would have been subsequently disabled," the authors state.

Factors related to poor recovery included leg injuries. Those who recovered slowest were less likely to be married and more likely to be female.

Twenty-six percent of those who had reported continued pain or restricted activity at the time of the first interview had not seen a doctor since the emergency room visit. Because of the apparent lack of follow-up care in some cases, researchers recommend that follow-up programs be implemented for elderly persons who seek emergency room treatment.

Results revealed that the most common time of day for falls was in the morning. The most common

stairs. Though researchers couldn't assess whether the pattern of falls among African Americans are different than those among Whites, there was a need to conduct specialized study because race had not previously been considered.

"The impact of falls in this elderly community is substantial," the authors write. "Not only did a number of persons sustain fractures and require hospitalization, but even more importantly, the ability

to carry out basic activities of daily living was restricted in a large proportion of cases."

Physical frailty, which affects millions of older Americans, is a major contributor to disability from injuries caused by falls. CDC continues to support studies that explore this problem.

Among the current projects of the National Center for Injury Prevention and Control is a study called "Preventing Falls in the Nursing Home Elderly." For more information on CDC studies related to injury prevention, call 770-488-4652.

Asians Among those at High Risk for Osteoporosis

The older we get, the faster bones break downþsometimes faster than new bone can be formed. The National Osteoporosis Foundation (NOF) says that osteoporosis occurs when too little bone is formed, when too much bone is lost, or a combination of both.

Osteoporosis is preventable and treatable, and it affects both women and men. Women are at high risk for the disease largely because women have less bone mass and lose bone faster than men, particularly with the onset of menopause.

At highest risk for osteoporosis are women who are post menopausal and small-boned, as well as those whose diets are low in calcium and Vitamin D. Being white or Asian is also a high risk factor. Whites and Asians have the

disease more often than African Americans and Hispanics because of differences in bone mass and density between these groups. Still, African Americans and Hispanics are at significant risk for the disease.

Persons with osteoporosis are susceptible to hip, spine, and wrist fractures. Each year, more than 300,000 hip fractures occur in older people. NOF reports that one out of every five persons who has a hip fracture will not survive more than one year.

The Osteoporosis and Related Bone Diseases National Resource Center (ORBD-NRC), which collects information on materials, programs, and support services on bone diseases, is operated under a grant to NOF from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Publications include a fact sheet on osteoporosis in Asian American women. For more information, call ORBD-NRC, 202-223-0344, TTY: 202-466-4315.

American Indian/Alaska Native Elders Face Challenge of Long-Term Care

"One of the key issues," Baldridge said, "is that American Indians/Alaska Natives are served on an entirely different health care system than the mainstream elderly population." Since 1955, the Indian Health Service (IHS), part of the U.S. Department of Health and Human Services, has been the federal entity responsible for delivering public health service functions to American Indians/Alaska Natives in IHS service areas, generally defined as those areas on or near reservations. This includes 1.3 million people.

Baldridge acknowledged that IHS has made significant strides, such as improving Indian life expectancy, which has gone up to age 72 from age 61 since 1972. "But the fact remains that IHS does not operate nursing homes or other long-term health care facilities," he said.

Some members of the public believe the myth that all Indian tribes participate in gamingþthe practice of gambling, Baldridge said. "And they take it a step further to say that gaming tribes are making so much money that they have enough to invest in long-term care. But as of 1993, there were only 12 tribally operated nursing homes in the United States."

IHS is beginning to address the issue of long-term care through its Elder Care Initiative, which IHS director Michael Trujillo, M.D., M.P.H., introduced in October of 1995. According to Louise Kiger, M.N., R.N., coordinator of the initiative, "the effort will explore ways to improve Indian health care and increase community/tribal capacity to develop community-based elder care services."

It's important to know that long-term care does not only encompass nursing homes, said Patrick Stenger, D.O., a member of the Elder Care Initiative. IHS uses a definition that was published in 1995 White Papers called A National Agenda for Geriatric Education: "Within medicine, long-term care refers to a comprehensive range of medical, psychological and social services developed and coordinated to meet the physical, emotional, and social needs of chronically ill persons over a period of time, and may be delivered in a person's own home, in the community, or in an institutional facility."

"Many needs assessments and elders health surveys done in Indian Country have shown that Indian elders and tribal leaders want IHS to emphasize home and community-based services." Dr. Stenger said. Examples of these services include primary health care; alcohol, drug, and mental health care; social services; nutrition services; and home visits by public health nurses and community health representativesþall services which IHS provides.

So while IHS does not have future plans to start operating nursing homes, the agency's Elder Care Initiative will work to develop home and community care programs and supportive services for Indian elders.

Undoubtedly, the question of who has the primary responsibility for delivering long-term care services to American Indian/Alaska Native elders is complicated by budget constraints. Currently, the IHS Elder Initiative has no funding, and overall, the agency is funded at only 50 to 60 percent of the level it needs to be, said Cliff Wiggins, operations research analyst in the Office of the Director at IHS.

As NICOA put it in its 1995 report for the White House Conference on Aging: "Clearly, the momentum within Indian country has swung toward support for long-term care. But in a climate of federal budget cuts and extreme fiscal conservatism, the agency's (IHS's) uncertain future casts a shadow over its abilityþdespite its apparently increasing willingnessþto provide adequate geriatric and long-term care."

For more information on the National Indian Council on Aging, call 508-888-3302. For more information about the IHS Elder Care Initiative, call 301-443-1840.

More than half of all older American Indians/Alaska Natives live on reservations or in native villages. And more than half are concentrated in the Southwestern states of Oklahoma, California, Arizona, New Mexico, and Texas. Major health problems of American Indian/Alaska Native elders are heart disease, cancer, accidents, chronic liver disease and cirrhosis, diabetes, and pneumonia/influenza.

--American Association of Retired Persons

NIA Launches New Programs

This neurodegenerative disorder affects about four million Americans, with 2.4 to 3.1 million spouses, relatives, and friends serving as caregivers.

NIA's five-year effort is looking primarily at caregivers of older people with mild to moderate Alzheimer's, with a focus on African American and Hispanic families.

Called REACH, for Resources for Enhancing Alzheimer's Caregiver Health, the group of studies is sponsored primarily by NIA, with additional support from the National Institute of Nursing Research. Both are components of the National Institutes of Health.

"Family caregivers are an important national resource and they need special attention," says Marcia G. Ory, PhD, chief of NIA's Social Science Research on Aging program. "This research will test some new techniques and services that may be of great benefit to them, in addition to the current support networks that are now available." Ory points out that Alzheimer's disease caregivers can be hidden patients because of having to deal with emotional stress and physical and financial burdens.

One study, to be conducted by the University of Miami in Florida, will compare Cuban American and White families. An in-home intervention will involve visits by a therapist to the families on a regular basis. The goal of the therapy will be to improve communication and reduce conflict, and to increase the amount of support given to caregivers by other family members. Some caregivers involved in the study will use a Computer Telephone Integration System, a special telephone with a screen that will assist caregivers in communicating with therapists and others.

The REACH Initiative is a critical part of NIA's support of research on Alzheimer's disease, which mostly affects older people and leads to complete dependence.

Established in 1974, the National Institute on Aging leads federal efforts on aging research. The agency supports research on many topics, with emphasis on Alzheimer's disease, genetic and environmental factors associated with aging; frailty, disabilities and rehabilitation; health and independence in later years; long-term care for older adults; minority populations; demographics of aging; and women's health.

NIA is currently sponsoring a study of women's health that includes a large proportion of African Americans, Hispanics, and Asian Americans. The University of California at Davis and San Francisco and Kaiser Permanente of Oakland will evaluate hormonal changes, diet, body size, smoking, and reproductive factors of Chinese and White women living in the Bay area. And the University of Michigan, Ann Arbor, will compare bone mass and bone loss of African American and White women. The researchers will study risk factors for obesity, osteoporosis, hypertension, and arthritis.

For more information, contact NIA Programs and Research, Public Information Office, Building 31, Room 5C27, Bethesda, Maryland 20892, 301-496-1752.

OMH Web Page Goes Live

The Web site includes information About OMH initiatives, a message from the director, Clay E. Simpson, Jr., PhD, and a What's New? and Conferences/Exhibits. An overview of services provided by the OMH Resource Center, Closing the Gap newsletter, OMH Press/Public Affairs contacts, and a listing of historically black colleges and universities are also available, as well as a directory of minority health contacts for federal, regional, and state entities.

From the OMH Web site, Internet users can link to other minority health organizations and agencies of the U.S. Department of Health and Human Services. In addition, students interested in the health professions and financial aid can access information through the Student Information Page.

OMH-RC will join OMH on the World Wide Web this summer. Publications to be available include the OMH Funding Guide and minority health updates for members of the Resource Persons Network. OMH-RC staff will also maintain "what's new" pages to highlight new publications, funding opportunities, conferences, and programs.

"OMH prides itself on providing OMH constituents with information in a timely manner," said Everett Carpenter, computer specialist of OMH. "So we're excited about our efforts to broaden our outreach and to provide minority health information via the Information Super Highway."

Smoking Patterns of Older Americans

Some people question whether quitting smoking is worth it at a late age. But there are proven health benefits. "When an older person quits smoking, circulation improves immediately, respiratory symptoms decrease, and repair begins. In one year, the added risk of heart disease is cut almost in half, and the risk of stroke, lung disease, and cancer diminish," said Anne Davis, MD, a pulmonologist and past president of ALA.

Research has also shown that there are important racial and ethnic differences in attitudes about smoking. According to a study conducted by researchers at the University of California, San Francisco, white smokers reported smoking more cigarettes per day and being more addicted to cigarettes than African American, Asian, and Hispanic smokers.

African American smokers were less likely to believe that smoking harmed their health and were less concerned about the effect of smoking on health. Hispanics and Asians were most likely to report wanting to quit so as not to expose their children to smoking.

Such differences in thinking, the researchers said, could be the clues to designing more effective smoking prevention and cessation plans. Many materials take a generalized approach and fail to take racial and ethnic factors into consideration.

Letting go of cigarettes is challenging for Americans because of the popularity of high nicotine brands with this population. Those who do quit cite reasons such as taking control of their lives and disliking the smell of cigarettesþpossible factors to play on when trying to influence people to quit.

According to ALA's 1995 report on lung disease data, smoking is the cause of 87 percent of all cases of lung cancer, the major cause of emphysema and chronic bronchitis, and a major cause of coronary artery disease and stroke.

ALA offers smoking cessation workshops, audiotapes, videotapes, and self-help manuals, as well as general information on smoking, nicotine addiction, and second-hand smoke. For more information, call 1-800-LUNG-USA (1-800-586-4872).

Delivering the Message through Seniors

When the St. Patrick Senior Center in Detroit, Michigan, presented breast cancer awareness programs in large, lecture-style groups, the audience response was luke-warm. Then the center took another approach. They arranged for breast cancer survivors in the center to serve as speakers, and they scaled their groups down to smaller, more intimate meetings.

"People were more open to a personal setting," says Sister Mary Watson, director of the center. "And at the same time, we created leadership opportunities for those who were interested in speaking about their experiences."

Some of the seniors at St. Patrick's, which serves mostly African Americans, don't think taking care of their health makes a difference anymore. What gets through to them the best is hearing health messages from each other. "That works like medicine," said Sr. Mary Watson. "It shows them that living as an older person is possible."

St. Patrick's is one of five community agencies in Detroit chosen to participate in the Karmanos Cancer Institute's Breast Cancer Awareness Program last year. With a grant from the Susan G. Komen Breast Cancer Foundation, the institute designed the program to educate African American, Hispanic, and hearing impaired elderly persons.

Working in collaboration with the five program sites of Detroit's Area Agency on Aging, Karmanos trained each agency's staff persons to deliver breast cancer education. They also learned to give referrals for mammography, a vital step since a lack of physician referrals is the most common reason that African American women over 65 fail to get mammograms.

After agency staff members received training, they in turn trained seniors who served as lay health educators. Along with the use of role models, agencies employed a range of information materials, including newsletters aimed at seniors and one-on-one sessions.

"Many elderly people are closed to the idea of talking about breast cancer, so finding strategies that work can be hard," said Jane Hoey, assistant director of breast cancer community outreach and education at Karmanos. "The idea is to bring in people affected by the disease. And when you train lay health educators to do this kind of work, it has a ripple affect. Not only does it help their clients, but they take that information home to their friends and families."

For more information about the Breast Cancer Awareness Program targeted to special audiences, call Jane Hoey, Karmanos Cancer Institute, 313-833-0715, ext.245.

NCBA Provides Substance Abuse Education

These are among of the questions that the New Directions program of the National Caucus and Center on Black Aged, Inc. (NCBA) addresses for its workshop participants. Founded in 1970, NCBA is a national organization

that focuses on improving life for African American and low-income elderly persons.

"New DirectionsþLinkages to Wellness" is a health education program that helps elderly public and assisted housing residents with problems related to alcohol, tobacco, and other drugs. NCBA runs the project with a grant from the U.S. Administration on Aging.

According to NCBA, it is currently estimated that the prevalence of alcoholism ranges from 3 to 15 percent in community dwelling elderly.

Initial research involved administering a health profile survey at five public and assisted housing sites in Washington, DC. The most common problems for which residents were taking medications were heart disease, diabetes, and high blood pressure, says Brinille Ellis, manager for the New Directions program.

"Based on our survey results," she said, "we decided to implement the health education program in three phases." The first phase, already underway, is a series of educational seminars on alcohol and medication misuse. The second phase will involve training elderly persons to be peer leader educators.

And the third phase will consist of workshops, scheduled for this summer, to teach housing managers to recognize the signs of alcoholism and drug misuse in their buildings.

"The discussion will be expanded to diseases," Ms. Ellis added. For example, a topic might be understanding the effect of alcohol use on diabetic patients.

Alcohol and drug use also increase the risk of falls and accidents, Ms. Ellis added. "Older persons take more drugs compared to younger people," she said, "and even a little alcohol can disturb already impaired balance and reflexes."

The New Directions program aims to encourage national replicability. There are future plans to develop and distribute a project manual that outlines the program development process.

The New Directions program is part of NCBA's Wellness Promotion and Disease Prevention Program, which covers several health topics. Topics include nutrition, glaucoma, heart disease, and cancer.

Betty Brown, a 76-year-old Washington, DC resident, participates in Circle of Friends, a project that educates women about breast and cervical cancer.

"We thought we knew how to do breast self exams," Ms. Brown said, "but a doctor came in and showed us a lot we never knew."

For more information about the National Caucus and Center on the Black Aged, call 202-637-8400.

NCBA Statement to White House Conference on Aging

Under health and long-term care, the following were cited as the most critical areas: implementing comprehensive health reform, preserving Medicare and Medicaid; preventing discrimination under managed care; closing the gap between minority and majority group mortality rates; and assuring equal access and utilization by minorities of nursing homes and other long-term care services.

The statement also included a section on "Quality of Life" which includes older Americans' fear of crime and violence. "Our nation should emphasize crime prevention techniques for seniors, such as security checks, escort services, neighborhood watches, and the installation of security devices," the report states.

The 1995 White House Conference on Aging was held May 2-5 in Washington, DC. The theme of the conference was "The Road to Aging Policy for the 21st Century." The Final Report from the conference includes the complete text of the final resolutions; a brief history of the White House Conferences on Aging; an overview of the conference process; and conference outreach and information dissemination activities.

Copies of the Executive Summary of the Final Report may be obtained from the National Aging Information Center, 202-554-9800, 500 E St., SW, Washington, DC 20024.

Resources: Aging Information

National Association for the Hispanic Elderly. 3325 Wilshire Blvd., Suite 800, Los Angeles, California 90010, 213-487-1922.

Administration on Aging. 330 Independence Ave., SW, Room 4755, Washington, DC 20201, 202-619-0724.

National Asian Pacific Center on Aging. Melbourne Tower, 1511 3rd Ave., Suite 914, Seattle, Washington 98101, 206-624-1221.

National Caucus and Center on Black Aged. 1424 K St., NW, Suite 500, Washington, DC 20005, 202-637-8400.

National Center on Aging. 409 Third St., SW, Washington, DC 20024, 202-479-1200.

National Hispanic Council on Aging. 2713 Ontario Rd., NW, Washington, DC 20009, 202-745-2521.

National Indian Council on Aging. 6400 Uptown Blvd., City Centre, Suite 510W, Albuquerque, New Mexico 87110, 505-888-3302.

National Institute on Aging. National Institutes of Health, Public Information Office, PO Box 8057, Gaithersburg, Maryland 20898, 1-800-222-2225.

American Association of Retired Persons. Office of Minority Affairs, 601 E St., NW, Washington, DC 20049, 202-434-2460.

National Resource Center on Minority Aging Populations. University Center on Aging, San Diego State University, College of Health and Human Services, San Diego, California 92182, 619-594-6765.

Funding Alert

The Foundation Center offers the National Guide to Funding on Aging. The guide includes facts on more than 1,000 grant makers, foundations, state, and federal programs and voluntary organizations. Contact: The Foundation Center, 79 Fifth Ave., New York, NY 10003, 1-800-424-9836.

The American Federation for Aging Research sponsors The Paul Beeson Physician Faculty Scholars in Aging Research Program. The program offers awards to physicians who are full-time faculty members within 12 years of receiving their MD degree. Deans of medical schools are to nominate the candidates. Candidates must have research skills related to aging. Deadline: November 15, 1996. Contact: AFAR, 1414 Avenue of the Americas, 18th Fl., New York, New York 10019, 212-752-2327.

Clarification: Information about funding opportunities from the Public Welfare Foundation (PWF) ran in the March/April issue. The foundation does provide grants to organizations focused on the needs of disadvantaged populations, particularly low-income groups. However, PWF does not provide replacement funding and is generally unable to respond quickly enough to most emergency requests. Letters of inquiry may be submitted at any time. Rolling deadline. For application guidelines, call PWF at 202-965-1800.

HRSA Supports Alzheimer's Program

Closing the Gap is published by the Office of Minority Health Resource Center, a service of OMH. If you have comments please call 1-800-444-6472 with comments, write to OMH-RC, P.O. Box 37337, Washington, DC 20013-7337, or e-mail us at info@omhrc.gov.

Executive Editor	Blake Crawford
Managing Editor	Michelle Meadows
Copy Editor	Symra Spottswood
Production Coordinator	Becky Hardaway

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