This blog is taken from a recent HealthStream webinar entitled “Fresh Approaches to Care for an Aging Population.” The webinar was moderated by HealthStream’s Andrea Zalewski, Clinical Program Manager, and featured the following expert panelists:
Adults 65 and older are expected to outnumber their children by 2034. With this increase in the population of older adults, comes an increase in healthcare needs which unfortunately is occurring at the same time as healthcare faces a decrease in the availability of healthcare employees. The situation means that healthcare leaders will need to be more creative and strategic in their approach to caring for this patient population.
Zalewski began by asking Moccia to share some of the challenges and solutions for nurses caring for an aging population in the Emergency Department setting. Moccia stressed that, after dealing with any emergent issues, it was essential to take the time to listen to the patient’s story. She also acknowledged that even in the chaotic environment of the ED, it is important to realize that the ED may be functioning as that patient’s primary care provider and that it may be necessary to address more than just their chief complaint. She also pointed out the helpfulness of tools that lend some structure to the process, such as the 4M Framework that provides a foundation for age-friendly care. This framework also provides the structure to begin conversations about cognitive issues and mental health issues such as depression.
Wharton stressed the importance of the role of caregivers in the ED. She encouraged caregiver preparedness – making sure that the ED staff is provided with a complete list of medications, being honest with their observations about the patient’s physical and mental health, and to be an advocate for the patient. She also stressed that they should be seen as assets to patient care rather than just visitors.
Deger was asked to address the importance of mental health and its’ role in physical health and what treatment for this population should look like. Deger stressed the importance of recognizing that for many adults over the age of 65, there is a complex interplay between physical and cognitive change. “Those changes can include sensory processing changes,” said Deger. He went on to share that more than 20% of adults over the age of 60 have a mental health or neurological condition with neurocognitive changes being the most prevalent followed by depression and substance abuse. He also shared that even before the pandemic 25% of adults over the age of 65 were considered socially isolated which can increase feelings of loneliness and exacerbate mental health disorders.
However, Deger also shared that this demographic exhibits skillful coping from the learned resiliency. Depression is not a normal part of aging and there is a richness to this state of life.
Wharton explained that home-based care is the future of healthcare. People have always wanted to be cared for at home and we learned this from COVID. This was made more easily available through telehealth. Telehealth is more affordable care where providers can expect better volume and better value. Home Care Pulse conducts regular surveys that prove that being at home improves outcomes. Zalewski added “with the population shifting we have to deliver services more quickly and more cost effectively.”
Zalewski shared the good news that healthcare providers are beginning to make changes to the standards of care for this large and growing patient population. Moccia added that an increasing number of Emergency Departments are seeking geriatric accreditation. The American College of Emergency Physicians have created the standards for EDs wishing to achieve this accreditation. She also shared that the Emergency Nurses Association (ENA) have created geriatric-focused education modules for nurses, including the incorporation of Age-Friendly Health System requirements. The education is important as hospitals seeking accreditation must be able to demonstrate that they have addressed such topics as fall prevention, lacerations, delirium, neurocognitive impairment, and sepsis.
Moccia also stressed the importance of appropriate patient handoffs to ensure that the patient can transition successfully to another facility, their primary care physician or home. She also emphasized the importance of sharing what treatment the patient received while in the ED and the plan for follow-up care. Moccia also recommended post-discharge phone calls to ensure that the patients have really understood their discharge instructions particularly those related to medications and follow-up care. In addition, Wharton shared that the information gleaned from these calls can help inform additional changes in how this population is cared for.
In closing, Deger spoke to the power of collaborative care models with an embedded mental health professional that can normalize talking about mental health. He added that so much of these health issues are treatable as long as we get someone in the door to a provider. Aging is a gift and hopefully all of us have the gift of entering into elderhood.
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