Social determinants of Health

Prompt:

Read the following case study and answer the questions that follow.

Maria Santos is an 85-year-old, Spanish-speaking, Venezuelan immigrant. She lives with her husband, who also only speaks Spanish, on a farm on the outskirts of a small town comprised mostly of migrant farm workers. The downtown area has a grocery store, a gas station, and a small Hispanic restaurant.

Two days ago, Maria’s husband arrived by taxi to the hospital to pick her up. She was being discharged after a 9-day stay. Her primary diagnosis was “viral pneumonia.” She has secondary diagnoses of “dysphagia” and “osteoporosis,” and she ambulates using a walker. During the hospital discharge process, the respiratory therapist, along with a language interpreter, ensured that Maria could adequately breathe the room air. The nurse ensured that the correct oral and inhaler prescriptions were issued. Maria would receive a follow-up appointment with the primary doctor and a referral for home care services.

After Maria arrived home, her prescriptions were never filled and she ate very little. Today, when the home care nurse arrives at the farm home, Maria is in bed and breathing with labored breaths. The nurse notices that Maria’s husband is acting odd. He appears to have early dementia. Clearly, the husband is incapable of assisting Maria with even the most basic tasks for daily living. Maria’s discharge plan failed.

Nurses need to understand how social, economic, and environmental factors, also known as social determinants of health (SDOH), impact chronic morbidity, survival, and the well-being of older adults. In Maria’s case, obvious and unique health challenges are present in her environment. Support systems, personal lifestyle, cultural beliefs, and language barriers impact her health behaviors.

1. Identify two socioeconomic-related questions that the nurse could have asked Maria that fall under the umbrella of SDOH.
2. Describe how the nurse could have addressed one of the following areas to better prepare Maria for discharge.
   • Language/literacy
   • Culture
   • Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
   • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
   • Access to healthcare services
   • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
   • Transportation options
   • Public safety
   • Social support
   • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
   • Residential segregation
   • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
   • Culture
3. Discuss a health policy currently in place or a health policy that is needed that would support Maria as she transitions back to her home environment
4. https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_…
5. https://health.gov/healthypeople/objectives-and-da…