HE HEA LTH I H IN A GI GING G – A GE GE FRIENDLY LY HE HEA LTH H SYST STEM S - ? Commo mon s n sens nse K AT HRYN BORGE NI CHT , M.D. F ACP CHMD
Nothing to disclose • K b o rg e nic ht@ g ma il.c o m
What makes this so important – Health in Aging • NOT he a lthy a g ing • L e a ding c a use of de a th is now multiple c hronic c onditions • L ife e xpe c ta nc y – USA on pa r with CUBA, e ve ry othe r ma jor industria l c ountry is hig he r the n us e xc e pt Cyprus, Ire la nd, Portug a l • Howe ve r, we spe nd more mone y pe r c a pita on he a lth c a re the n a ny othe r c ountry ($4500/ pe r c a pita )
WHY I IS THIS – ROOT OT C CA USE? WE HAVE PUT T HE SHOUL D BE – WHAT DISE ASE AT T HE MAT T E RS T O YOU I S CE NT E R, RAT HE R WHAT I S T HE T HE N T HE PE RSON MAT T E R WI T H YOU
Why should health systems want to be age friendly – what’s in it for them
Re duc e s c o sts a sso c ia te d with po o r q ua lity c a re CA SE F FOR Suppo rts b undle d A GE GE pa yme nts FRIENDLY LY HE HEA LTH H I nc re a se d utiliza tio n o f o f SYTEM S SY c o sts e ffe c tive se rvic e s E nha nc e d re ve nue a nd ma rke t sha re
Ca n b e a pplie d to multiple se tting s SO W O WHA HA T DO DOES S Ne e d to a sse ss THIS yo ur o wn se tting LOOK OOK LIKE KE Will g ive yo u so me e xa mple s
Dr. L • Dr. L is a 78 yo re tire d pe dia tric ia n who ha s pa rkinsonism, CAD, a nd de pre ssion. Most re c e ntly his ha s ha d some inc re a se d proble ms with swa llowing with one e pisode of c hoking . He a lso ha d a re c e nt fa ll off his e le c tric bike whic h re sulte d in roa d ra sh a nd a bruise to his shoulde r. • He live s with his ve ry c a ring wife , who wa tc he s him c lose ly. He ha s fa mily tha t live s ne a rby. • He ta ke s 8 diffe re nt me dic ine s, a nd multiple vita mins
The 5 e 5 M s M s – Institu tute te of Health th C Care Improvem emen ent – Busi siness c s case se f for becoming an age f e frien endly h hea ealth s system WHAT MAT T E RS ME DI CAT I ON MOBI L I T Y ME NT AT I ON MUL T I PL E MORBI DI T I E S
Ma ny mo de ls WHAT So little time ? MATTERS Wha t ha s wo rke d
PICK ONE PRE PARE F ORYOURCARE .ORG A DVA VA NCE Ultimate ly c re ate s a doc ume nts CA RE CA PLA NNI NING NG BUT first - talk and disc uss With COVID e ve n more important - PC Wisc onsin we b site for re sourc e s
Current care GE RIPALWE BSIT E planning Mary T O L IST E N T O HE R Tinetti, M.D. DISCUSSION
” CURRENT CARE PLANNING” – Mary Tinetti, MD. I de ntify pa tie nts prio ritie s – wha t o utc o me s do the y wa nt fro m the ir he a lth 4 a re a s to stre ss • F unc tio ning a nd a uto no my • Re la tio nships a nd c o mmunitie s • Ma na g ing yo ur he a lth • Me a ning ful thing s in yo ur life Sta rt with o ne g o a l Use pa tie nts o wn o utc o me s a nd pre fe re nc e s ra the r the n the ir dise a se . F o c us o n func tio n, no t ne c e ssa rily sympto ms
• Re a lly drill do wn, g e t spe c ific – wha t is the thing tha t is ke e ping yo u fro m do ing tha t. Wha t the n me dic a lly c a n we he lp yo u with. Are the re o the r a c tivitie s tha t mig ht ma tc h up with wha t yo u More Tinetti a re do ing • T his c a n b e do ne b y a tra ine d fa c ilita to r • E x – wha t do yo u mo st wa nt to us fo c us o n _____ (fill in he a lth pro b le m) so tha t yo u c a n do (fill in de sire d a c tivity) mo re o fte n o r mo re e a sily
Sta te me nt A – Yo u ha ve b e e n in a nd o ut o f de to x 6 time s in the la st ye a r. Yo u a re n’ t fo llo wing thro ug h with yo ur LET ETS a ppo intme nts. Yo u b e tte r sto pe drinking o r yo u will die … TA TA LK A BOU OUT Sta te me nt B – Ho w is yo ur do g Buste r? I BUST STER kno w he g ive s yo u a re a so n to ke e p g o ing . Whe re do e s he g o whe n yo u a re in the ho spita l. Wha t do yo u sa y we ta lk a b o ut wa ys to sta y o ut o f the ho spita l so yo u c a n ta ke c a re o f Buste r? Wha t ide a s do yo u ha ve a b o ut tha t?
Dr. L • Whe n a ske d a b o ut his “living will” b y his physic ia n siste r he sta te s” • Ye s, I ha ve o ne a nd I ha ve disc usse d it with my wife . My kids kno w a b o ut it b ut do no t kno w whe re it is. I ha ve no t lo o ke d a t it fo r pro b a b ly 10 ye a rs • Wha t a dvic e wo uld yo u g ive him?
• Me dic ation r e c onc iliation • E valuate patie nts goals r e late d to life M EDI DICA TIONS e xpe c tanc y and adjust me ds for that – some th thoughts ts • E valuate me ds for pote ntially and i d ide deas inappr opr iate me ds • De pr e sc r ibing • E xample – Me di c og
1- Purpo se o f me dic a tio n Medication 2 – Ho w is pa tie nt using deprescribing 3 - “Ho w’ s tha t wo rking fo r yo u” 123-ABC A – Adve rse e ffe c ts B – Be ne fits/ b urde ns C – Co nve rsa tio n
S – se tting P – pe r c e ption I – invita tion What if they say no K – knowle dg e - SPIKE E – e motion S – Summa r ize r e c omme nda tions AND RE PE AT
Dr. L • He take s 8 diffe r e nt me dic ations – lithium, c italopr am, me topr olol, r osuvastatin, Sine me t, r opinor ole , mir tazapine , Ritalin • His wife give s him a handful of vitamins in the am • He has se e n his ne ur ologist r e c e ntly who que r e d him about whe the r he notic e d any diffe r e nc e fr om his Par kinson's me ds • What would you like to make sur e you do whe n you visit with him? • How would you addr e ss his r e c e nt c hoking e pisode ?
T hink T hink a bout a pa tie nt in the hospita l a b o ut T hink T hink a bout PT Me dic a r e r ule s a b o ut MOBILITY T hink COVID a nd de lir ium – we ha ve g one T hink ba c kwa r ds T hink loss of mobility inc r e a se s r isk of de a th, T hink hospita liza tions, fa lls, de c lining func tiona l sta tus
F ac to r s – balanc e , me ds, se nso r y issue s, fo o twe ar , e nvir o nme nt, func tio n M OB OBILITY – CA N B CA BE Pic k a to o l and use it – T GUG COM OM PLEX Co mmunic ate
Dr. L • Afte r his re c e nt fa ll, he is c onc e rne d a bout g e tting on a bike a g a in. • He c ontinue s to pa rtic ipa te in va rious Pa rkinsons mobility c la sse s, inc luding pila te s, boxing a nd da nc e a lthoug h some of this ha s be e n re stric te d by COVID • How would you a pproa c h his re c e nt fa ll a nd his de sire to c ontinue to ride his bike
De pre ssio n M ENTA TION De me ntia De lirium
E ac h de se r ve s a se par ate disc ussion THE 3 DS E ac h inte r ac ts with e ac h othe r All have Unde r diagnosis Unde r pr e ve ntion Unde r tr e atme nt
HE HELP – • T ar ge te d patie nts at r isk for de lir ium Hospital E l Eld lder • Pr e disposing c onditions (c ognitive impair me nt, se ve r e illne ss, visual or Life P Li Prog ogram auditor y impair me nt • Hospital ac quir e d c onditions – Dr. Sharon me dic ations, pr oc e dur e s, be d r e st Inouye • T e am of tr aine d volunte e r s
Interventions What they provide • Da ily visito r pro g ra m • Orie nt, so c ia lize • T a rg e te d a c tivitie s • K e e p c o g nitive ly e ng a g e d • E a rly Mo b iliza tio n • Wa lking a nd ROM • F e e ding a ssista nc e • Co mpa nio nship a t me a ls • He a ring a nd visio n pro to c o l • Ada ptive e q uipme nt • No n-pha rma c o lo g ic a l sle e p • So o thing e nviro nme nt, pro to c o l music , he rb a l te a , ha nd fo o t ma ssa g e
Dr. L • On que stioning , he ha s be e n on his multiple psyc hia tric me ds for ye a rs a nd is not willing to c ha ng e the m • His wife a nd c hildre n ha ve e xpre sse d c onc e rn a bout his me mory a lthoug h he de nie s a ny issue s • He re ma ins a n a c tive re a de r a nd is ve ry soc ia lly e ng a g e d • Would you c ha ng e a nything a t this time
MULTIPLE • AL L OF T HE ABOVE DIAGNOSES • NOT JUST T RE AT ING ONE DISE ASE , T RE AT ING ONE PE RSON
FOC OCUS • T RANSIT IONS – hospital, NH, AL F , inde pe nde nt living, home A R A REA S A S he alth, hospic e • Annual We llne ss visit – c ove r s 4/ 5 Ms • Me ntation – mini Cog • Me dic ations – me dic ation r e c onc iliation • Mobility – ADL s, IADL s, ?T GUG • What matte r s
Dr. L • He re ma ins ve ry a wa re of his multiple me dic a l proble ms a nd how the y a ffe c t his da ily life • He de c ide d to g ive up driving 6 months a g o • He c ontinue s to pla y te nnis with his brothe r but ha s a da pte d his style to fit his mobility ne e ds • He is a n a vid fishe rma n but now ma ke s sure he doe s not g o a lone
Recommend
More recommend
