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Better Care for Older Adults

Better care for older adults

Healthcare Providers are Taking a Fresh Look at How to Treat the Elderly

An elderly man who’d been admitted to the hospital was disoriented. “He thinks he’s talking to his father, who died years ago,” the man’s daughter told his doctor. “Does this mean he has Alzheimer’s?”

He did not. What he did have was delirium, brought on by the many changes in his routine caused by his admission to the hospital. It’s a common problem for elderly patients, according to Jessica Israel, MD Corporate Chair, Geriatrics and Palliative Care, for RWJBarnabas Health (RWJBH).

“Family members get alarmed, but in many cases, that confusion is treatable – though we may have to be a bit of a detective to find out what the problem is,” she explains. “It could be anything from untreated pain, to an electrolyte disturbance, to a urinary tract infection, to a sleep/wake cycle disturbance.”

Sensitivity to changes in routine is just one of many reasons older patients need thoughtful care, Dr. Israel says. As the U.S. population ages – by the year 2030, 1 of every 5 residents will be older than 65, according to the U.S. Census Bureau – RWJBH facilities are at the forefront of a national drive to develop age-friendly care.

“Throughout the system, we’re taking a very close look at what it means to be age-friendly, not just in hospital care, but in all areas in which we treat patients,” says Dr. Israel.

A NEW APPROACH

The American Hospital Association, in partnership with the Catholic Health Association of the United States, the Institute for Healthcare Improvement and the John A. Hartford Foundation, has created the “4M Model” to guide hospitals and health systems in providing age-friendly care. The four elements are:

  • What Matters: taking the time to sit down for a discussion with an older patient to understand his or her concerns, goals and preferences for treatment.
  • Medications: taking additional care with drugs. “Giving a new prescription to someone who is 90 years old is not the same as giving it to someone who is 19,” says Dr. Israel. ‘As we age, medications don’t work the same way in the body, and there’s a greater risk of interactions.”
  • Mentation: identifying and managing depression, dementia and delirium.
  • Mobility: making sure a patient is helped to move safely every day so he or she doesn’t lose to muscle tone needed for everyday tasks.

BEST PRACTICES

When Dr. Israel rook on her role as Corporate Chair, Geriatrics and Palliative Care, almost two years ago, she knew that the RWJBH system already had some exemplary age-friendly programs. To extend their reach and to share ideas across hospitals, she created a geriatrics collaborative.

“Every hospital in our system has a multidisciplinary team focused in geriatric care that may include doctors, nurses, social workers, physical therapists, administrators, pharmacists and health educators,” says Dr. Israel.

Two areas stood out as ripe for expansion. One was the James and Sharon Maida Geriatrics Institute at Monmouth Medical Center Southern Campus, where Dr. Israel is the Director, which specializes in all aspects of inpatient and outpatient geriatric care. The other is Better Health, a senior membership program offered by the Institute, with a full range of health, wellness and social events. Both the Institute and the Better Health Program will be replicated at Saint Barnabas Medical Center in Livingston and Robert Wood Johnson University Hospital Hamilton this year, with other RWJBH hospitals to follow.

The RWJBH system is moving ahead on multiple other fronts. Eight hospitals have or are working toward Nurses Improving Care for Healthsystem Elders (NICHE) certification, and all hospitals will ultimately have Geriatric Emergency Department Accreditation (GEDA). As part of the RWJBH partnership with Rutgers University, the geriatrics team also is working to enhance existing geriatrics fellowship training programs for physicians. And all RWJBH employees will take a computerized learning module, currently in development, that will help them understand what it means to be older.

The possibilities are endless, because geriatrics itself is so wide-ranging.

“Sometimes the best person to reach out to is not a doctor, but a physical therapist, nutritionist or social worker,” says Dr. Israel. “The thing I love most about geriatrics is that it’s not some group of doctors telling you what you have to do. It’s a team of people looking at your life and helping you live it to your best.”

HOW TO GET BETTER CARE

Jessica Israel, MD, Corporate Chair, Geriatrics and Palliative Care for RWJBarnabas Health, offers these tips for older adults.

  • Have an advocate. “Sometimes four ears are better than two when it comes to a doctor visit of hospital stay,” says Dr. Israel.
  • Ask questions. If you don’t understand sometime or it isn’t the way you thought it was going to be, ask.
  • Keep an accurate list of medications and physician contact numbers with you. This will help doctors treat you more quickly if an emergency arises.
  • Explore advance directives. “Patients of all ages should assign a healthcare proxy,” advises Dr. Israel. “But then also be sure to tell that person what your wishes are in the event that complicated medical decisions must be made.