Age-Friendly Health Care: A New Approach

America’s elderly population has grown by 34.2% over the past 10 years, and today there are about 54 million Americans over the age of 65. If you are in this group, you may be on four or more medications, see up to five doctors each year, and have at least one chronic illness. You may also feel that your doctors and nurses often do not listen to your preferences and do not fully include you in decisions about your own care.

Based on 2015 data Journal of General Internal Medicine In a study of more than 16,000 older people, one in five said they had experienced age discrimination from doctors or during visits to the hospital. Nearly 6% of older people said they often experienced age discrimination and their health worsened over the next 4 years.

“We have to recognize that how we manage to care for older patients is different from how we manage 30 or 40-year-olds. We don’t talk enough to our patients about what’s important to them. We do better with their meds, but we don’t do as well with their withdrawal. We don’t pay enough attention to their risk of falling,” says John White, MD, WebMD’s chief medical officer.

White recently played a key role in the development of Age-Friendly Health Systems (AFHS), a new approach to care for the elderly developed by the John A. Hartford Foundation and the Health Improvement Institute in partnership with the American Hospital Association and the Catholic Association. US Health Association Doctors, nurses, and other healthcare professionals who treat the elderly need to be more attentive, he said. “We have to ask what is important for our older patients. This is a simple question, but one that every doctor should clearly ask. We need to change the way we treat our elderly patients.”

4M: Your Goals Shape Your Exit

Can health care focus on your personal health preferences and goals as you age, and not just what your doctor thinks is best for you or your test results? AFHS recommends that doctors and nurses plan to care for older adults based on what they or their caregivers value most. Every medical visit or decision should cover 4M, the four essential elements of high-quality healthcare:

  • What is important is that older people set their personal lifestyle and health goals, and healthcare professionals plan their treatment around those goals.
  • The medications they take for any condition, including whether they need each drug and whether any side effects are preventing them from doing what is important to them.
  • Mobility so they can move around safely, function in their daily lives, and do what matters to them
  • The ability to prevent or diagnose, treat and manage memory loss, dementia, and/or depression.
Many health care systems, like 1200 CVS MinuteClinics, include 4M per appointment with an older person, says Hartford Foundation president Terry Fulmer, Ph.D. Your doctor or nurse may ask you about your personal goals, values, and preferences, but some older people may find it difficult to answer these questions.

“If I say to an elderly patient: “What are your goals?” They might say, “You’re a nurse, don’t you know?” Some older people may feel they need to rely on their doctor or nurse during care and let them make all the decisions, Fulmer says.

“We need people to feel comfortable with this question of what is important to you. It is often difficult to start this conversation. You can say, “I want to talk to you about my mobility, mood, and medications based on what’s important to me.” This is a very serious conversation.”

Half consider age when planning to leave

How do doctors and nurses feel about an age-friendly approach when they treat older people?

Fulmer and White are co-authors of a new study in the Journal of the American Geriatric Society. The results show that most primary care providers believe they should approach care for older patients differently and take age into account when making treatment decisions, but do not always include 4M in care.

The study is based on a survey of 1,684 primary care providers randomly selected from the Medscape database in Fall 2020. The respondents included 575 physicians, 613 nurse practitioners (NPs) and 496 paramedics (PAs).

They were asked to give their opinion on elderly care or 4M and how they care for their elderly patients. While over 90% of providers agreed that older patients “require a different approach to care than younger patients,” only 50% of physicians and PAs and 69% of NPs said they always consider a patient’s age in their usual care. Only 36% of doctors surveyed said they ask their older patients what is important to them.

High-risk Drugs

High-risk drugs for older adults include drugs that can cause harmful side effects or interact with other drugs, says Marcus R. Escobedo, vice president of communications at the Hartford Foundation and co-author of the study.

Many medications to treat anxiety, insomnia or pain can have side effects that reduce the quality of life of older people, or even be unsafe for them, he says. For example, antipsychotics, often prescribed for older people with dementia, can make them sleepy and increase their risk of falls.

As we get older, our bodies and metabolism change, Escobedo says, so there may be medications that are not suitable for older people that are over-prescribed. “They may be taking too many medications in general. If you have many different providers, or if you are admitted to the hospital, you may be prescribed medication. Then you go home and these medications don’t stop.”

While 84% of physicians said they were checking older patients’ use of high-risk drugs and screening for depression, only 78% said they were stopping their patients or reducing high-risk drugs, or avoiding the use of these drugs altogether.

“If older people recognize the potential side effects of their medications, do we listen to them? They might say things like, “I just feel bad,” Fulmer says. That’s why one of the 4Ms is to review their medications and see if they need to be replaced. “We need to start the conversation about your medications with what’s important to you.”

Mobility and thinking

The AFHS structure calls on doctors and nurses to ensure that older patients can move around safely so they can do the things that matter to them. Your health care provider may prescribe physical therapy or exercises to help you stay moving.

“One of the best ways to prevent falls is to encourage older people to be physically active and just keep moving. We help them develop strength and balance. This will help you feel more confident while driving,” says Escobedo.

The survey found that 73% of physicians, 82% of OPs, and 76% of PAs said they always check on older patients to see how well they can move around. However, only 56% of physicians, 61% of OPs, and 56% of PAs said they “provide early, frequent, and safe mobility” when treating the elderly.

Health care providers can screen older people for mobility problems, Fulmer said, but they need to do more to help them move better and prevent falls.

“My older patients and I often talk about pre-treatment. It works to get stronger before you have an event,” like a fall that results in a fracture, she says. “People want to control their lives. You can work with your physical therapist to get ahead of your problems. We can say, “Let’s get into strength training.” You can take responsibility for your mobility.”

Skill is another one of the 4Ms. Only 60% of physicians, 70% of NPs, and 67% of PAs surveyed said they refer their older patients who test positive for cognitive impairment or have some problems with memory or decision making for additional testing and treatment for their symptoms.

Get the most out of short office visits

Doctor visits often only last 10 minutes, so doctors and nurses need to ask older people how they feel and what they can do, like go to the movies or if they can walk more than a block, Fulmer. He speaks.

The survey showed that 43% of doctors, 37% of OPs, and 38% of PAs agreed that “the patient should tell me what his needs are.” Fulmer believes healthcare professionals should be asking these questions and listening more closely to their older patients’ responses.

“This is a conversation: “What is the focus for you now?” We must give older people the right to vote. Let them start this conversation,” she says. The survey results suggest that health care providers need to learn more about how to put the needs of older people first in their work.

Future generations will benefit from a more holistic healthcare system, where all your medications, health conditions, and most importantly personal goals and preferences are all on your map, she says. “Good care for the elderly usually means good care for everyone.”

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