Objectives 1. Recognize the social and cultural factors that - - PDF document

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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Removing Barriers that Prevent Older Adults from Being Safe, Healthy and Independent

Barbara Nichols, DNSc (h), MS, RN, FAAN Chair, United Way’s Self-Reliance & Independence Community Solutions Team Toya W. Johnson, MBA Community Impact Director, Self-Reliance & Independence United Way of Dane County MetaStar's Health Care Quality Symposium November 8, 2017

• 1. Recognize the social and cultural factors that

influence the health of older adults

• 2. Identify several major barriers that prevent older

adults from achieving optimal health

• 3. Evaluate several community exemplars for keeping
• lder adults safe, healthy and independent

Objectives

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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• International (Global)
• National (United States)
• Local (State of Wisconsin)

Objective 1: Recognize the social and cultural factors that influence the health of older adults Globally Without Precedence the World is Growing Older

• It is estimated that 524 million

people are ages 65 and older (8 percent of the world’s population)

• By 2050, older adult population

expected to triple to 1.5 billion representing 16 percent of the world’s population

• Aging phenomenon is being driven by

declines in fertility, improvements in longevity and a shift in the leading causes of death

* Source: World Health Organization

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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• Many problems of older adults are

rooted in early life experiences and living conditions, thus social and cultural factors impact the health of

• lder adults
• Ensuring good child health can yield

benefits for adults as they age

• Preventative Care vs Reactive Care

* Source: World Health Organization

Globally Without Precedence the World is Growing Older

• 47.8 million people are ages 65

and older in the U.S.

• 98.2 million is the projected

population of 65 and older in 2060

• Of the 98.2 million, 19.7 million

people will be ages 85 and older

* Source: U.S. Census Bureau

Unprecedented Growth of Older Adults in the United States

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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• In the U.S., multiple concurrent

chronic conditions with degenerative diseases impact older adults

• According to the American

Community Survey, older adults ages 65 and older identify:

• 1. Ambulatory difficulty such as:
• Walking and climbing stairs
• Reaching
• Lifting or Carrying
• 2. Cognitive difficulty such as:
• Remembering and concentration
• Making decisions
• Hearing Difficulty

Unprecedented Growth of Older Adults in the United States

• In 2010, the population of older adults age 65 and older in Wisconsin was

777,500 (13.7 percent of total population) and increased rapidly, nearly doubling in 30 years so that in 2040, the population is projected to be 1,575,000 or 23.7 percent of the total population

• Dane County has fastest growing population in the state with over 64,000

residents age 65 and older representing 12.3 percent of the total population and is projected to be 121,470 by 2040

• Similar to Global and National trends, Dane County residents 85+ are the

fastest growing segment

The Tremendous Impact of Local Rapid Growth of Aging Population

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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• Due to chronic health conditions, older adults consume increased

medications, which puts them at risk for negative drug reactions and falls

• Falls are the leading cause of injury-related deaths in both the state of

Wisconsin and in Dane County

• 21.9 percent of Wisconsinites ages 65+ reported that their health was fair
• r poor in 2014

The Tremendous Impact of Local Rapid Growth of Aging Population Key Barriers that arise across all areas are:

• 1. The impact of aging on health care

and social cost

• 2. Infrastructure requirements needed

to be in place to sustain well-being among older adults

• 3. Cultural and racial differences based
• n socio-economic class
• 4. Impact of evolving technology and

globalizing economies Objective 2: Identify several major barriers that prevent older adults from achieving optimal health

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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Objective 3: Evaluate several community exemplars for keeping older adults safe, healthy

and independent

Improve Coordination of Care between Physicians and Pharmacists

Provide Caregivers Access to Resources Expand Reach of Nutritional Supports to Rural Communities and Communities of Color Foster a Greater Sense of Purpose and Contribution to Society Recommended Strategies to reduce the rate and percentage of Adverse Drug Events (ADEs) and Falls by 20 percent by 2022

Our Strategies Keep Older Adults Out of Hospitals and Institutions

Comprehensive Medication Review In-Home Safety Assessments (SAFE Program) Evidence-Based Falls Prevention Classes

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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What is a Comprehensive Medication Review?

• Trained pharmacist – Wisconsin Pharmacy Quality

Collaborative (WPQC) use evidence-based comprehensive screening tools to help detect the risk of adverse drug events for low-income older adults

• All-inclusive review of a person’s medications, including

prescription and over-the counter medications, herbal therapies, and dietary supplements

United Way of Dane County/Wisconsin Pharmacy Quality Collaborative

Comprehensive Medication Review Event Process

Community Model:

• 1 day event with 2 pharmacists: 12 patients
• 1 hour long appointments

 Student: intake and medication history  Pharmacist/student: comprehensive medication review  Geriatric syndromes focus (Aprexis-guided)  Follow-up

 Recommendations to prescriber/med list  Three follow-ups annually with the older adult (via phone/in person)

United Way of Dane County/Wisconsin Pharmacy Quality Collaborative

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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POTENTIALLY INAPPROPRIATE MEDICATIONS (PIMS) FOUND ON THE BEERS LIST

(PIMs) recommended for discontinuation

• Lorazepam (Ativan)
• Citalopram (Celexa)
• Diphenhydramine (Benadryl, Tylenol PM)
• Oxybutynin (Ditropan)
• Terazosin (Hytrin)
• Naproxen (Aleve)
• Gabapentin (Neurontin)

United Way of Dane County/Wisconsin Pharmacy Quality Collaborative

• In-home safety assessments coordinated by our Safe at Home

Coordinator and follow up administered by a masters-prepared medical social worker with extensive experience in older adults

• Trained volunteers go into homes of older adults to do

environmental scans

• Target Population: Low-income seniors ages 60+ at

risk for adverse drug events and falls in their home

• Average Age: 83

Home Health United-S.A.F.E. at Home/United Way of Dane County

Established in 2011, supports United Way’s Safe and Healthy Aging Initiative to reduce the rate of ADE and Falls by 20 percent by 2022

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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Assessments Include:

• Written Recommendations
• Comprehensive Medication Review
• Safety Aids (pillbox, nightlight)
• Community Resource List
• Detailed List of Exercises/Balance/Tai-Chi classes

Home Health United-S.A.F.E at Home/United Way of Dane County

• Evidence-based falls prevention classes that are offered throughout

Dane County include:  Stepping On –partnership with Safe Communities- offered at locations throughout Dane County https://safercommunity.net/falls-prevention/prevention-programs/  Tai Chi and Gentle Balancing Exercise offered at Goodman Community Center  Latino Falls Prevention Exercise Class & Chair Based Exercise Class at North/Eastside Senior Coalition

Falls Prevention Classes

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

10 Facts about Stepping On:

• Stepping On has been researched and proven to

decrease the risk of falls in their (Wisconsin) participants by 50 percent

• Research has also shown that Stepping On participants

have a 70 percent reduction in the emergency department visits.

Stepping On

Evaluating Our Results

1229 SAFE Program in- home safety assessments were completed for seniors at very high risk for falls (average age over 80), yielding a fall rate of 19.69 percent compared to a national average rate of 50 percent. 30 Dane County WPQC pharmacists have completed 1005 comprehensive medication reviews for seniors at very high risk for ADEs (average taking more than 13 medications) 1266 older adults participated in evidence-based falls prevention classes (Tai-Chi, Stepping On, Balancing, etc.).

Safe and Healthy Aging Signature Initiatives

• All participants are low-income older

adults 65+

• Results from 2011(Q4) thru 2016(Q4)

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017

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Removing Barriers that Prevent Older Adults from Being Safe, Healthy and Independent

Questions?