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Promoting The Health Of Elderly And Disabled
 

Promoting The Health Of Elderly And Disabled

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Presentation demonstrating the social work nature of housecall medicine

Presentation demonstrating the social work nature of housecall medicine

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    Promoting The Health Of Elderly And Disabled Promoting The Health Of Elderly And Disabled Presentation Transcript

    • AMY BRAUER, LCSW VISITING PHYSICIANS ASSOCIATION Promoting the Health of Your Elderly Clients and Those with a Chronic Disabling Condition: A Home-Based Medical Approach
    • Outline
      • Understanding the Homebound Patient
      • Risks Unique to the Elderly and Disabled
      • Health Promotion versus Health Prevention
      • Strategies to Promote Health and Prevent Health Risks in Homebound Patients
      • Interventions that Promote Health in the elderly and disabled
      • Summary
    • Understanding the Homebound Patient
      • Definition of “homebound”
      • To be considered homebound, the patient does not have to be bedridden, but must have an illness or injury that makes is difficult to leave home without supportive devices or another person’s help.
      • This means, but is not limited to, the patient’s inability to effectively access appropriate medical care due to a “taxing effort”.
    • Understanding the Homebound Patient
      • Undiagnosed Diseases and Silent Pathology
      • Frail patients have multiple diseases and functional impairments, many of which may be undiagnosed.
      • For example, atherosclerotic or cardiac conduction disease may not be apparent in a patient who rarely gets out of bed.
    • Understanding the Homebound Patient
      • “ Old Age” Complaints
      • New complaints should never be ignored or attributed to “old age”. Elderly patients respond to medical problems by reducing their functional status.
      • Health care providers should have a high index of suspicion when a patient reports that he or she is eating less, in bed more, walking less, more forgetful, etc.
    • Understanding the Homebound Patient
      • Polypharmacy Effects
        • Polypharmacy can have highly unusual effects in the elderly such as delirium or incontinence.
        • Compliance with a drug regimen can be compromised due to environmental factors and can lead to overdosing or under dosing.
        • Over-the-counter medications can induce major problems which may lead to the prescription of other medications.
    • Risks Unique to the Elderly and Disabled
      • Frequency of acute decompensation
      • Patients with multiple chronic illnesses are likely to exhibit an increased frequency of acute illnesses as their condition progresses, often resulting in increased hospitalizations and visits to the Emergency Department.
      • Hospitalization places seniors at risk for outcomes such as delirium, functional decline, pressure sores, and other adverse effects
    • Risks Unique to the Elderly and Disabled
      • Frequency of acute decompensation
      • Loss of quality of life due to illness
      • More than 1.7 million Americans die of a chronic disease each year, accounting for 70% of all deaths in the United States.
      • Americans lose an average of 15 years of life from chronic diseases—valuable time with family or friends gone forever ( 1 ).
    • Risks Unique to the Elderly and Disabled
      • Frequency of acute decompensation
      • Loss of quality of life due to illness
      • Increased healthcare costs
      • The National Medical Expenditure Survey data shows that older people with severe disabilities spend, on average, a greater percentage of family income on health care than do people without disabilities--12% versus 3%. Not only do they have high expenditures, but they have average lower family incomes ( 2 ).
    • Risks Unique to the Elderly and Disabled
      • Frequency of acute decompensation
      • Loss of quality of life due to illness
      • Increased healthcare costs
      • Learned helplessness
      • Learned helplessness is the perceived lack of control over the events in one's life, which may result from prior exposure to (actually or apparently) uncontrollable negative events, such as illness. Learned helplessness effects self-efficacy and self-confidence.
    • Health Prevention vs. Health Promotion
      • Health Prevention is participation in specific activities that prevent illness or disease from occurring
      • Health Promotion is an approach geared toward improving well-being and optimization of health potential
    • Strategies to Promote Health and Prevent Health Risks
      • Evaluation and Screening
        • Biopsychosocial Model
        • Patient-Centered Model
        • The assessment approach in home-based medicine is based on the culmination of a biopsychosocial model and a patient-centered model of care.
    • Strategies to Promote Health and Prevent Health Risks
      • Evaluation and Screening
        • Biopsychosocial Model: biological, psychological, social
        • Patient-Centered Model: focus on the patient in their network
        • Focus on Function: a patient’s ability to function within his/her home setting has a profound impact on his/her overall health status because of its effect on ADLs, nutrition, quality of life and ability to access community medical and social support services.
    • Strategies to Promote Health and Prevent Health Risks
      • Ongoing Management
        • Medical- regular and consistent visits by a clinician to monitor illness and changes in condition
          • Trends which represent decline can be identified and treated as soon as possible in the interest of avoiding dramatic acute decompensations
          • Frail seniors living at home are at risk of nursing home placement when they lose self-care abilities
          • Patients with 4 or more chronic conditions are 99 times more likely to be hospitalized for a condition that could have been prevented with appropriate ambulatory care or home-based health services (3).
    • Strategies to Promote Health and Prevent Health Risks
      • Ongoing Management
        • Medical
        • Pharmaceutical- ensuring patient knowledge of appropriate medication use and dosing, set up and ability to swallow the pills
          • Patients with multiple chronic conditions are typically taking multiple medications simultaneously, placing them at a higher risk of adverse drug interactions
          • Regular monitoring of pharmaceutical issues assists in medication adherence
    • Strategies to Promote Health and Prevent Health Risks
      • Ongoing Management
        • Medical
        • Pharmaceutical
        • Psychological- frequent visits to the patient’s home allows the clinician to follow a patient-centered approach, and monitor well-being and mental health
          • A Patient’s overall mental health effects health outcomes due to depression, sleep patterns, nutrition and level of self-care.
    • Strategies to Promote Health and Prevent Health Risks
      • Ensure Proper Resource and Referral
        • Home Health Services
        • Personal Attendant Services
        • Specialist Services
        • Meals on Wheels
        • Durable Medical Equipment
        • Mental Health
        • Ancillary Aging Resources: Case Management, Social Activity and Networking, Mail order pharmacy, etc.
    • Strategies to Promote Health and Prevent Health Risks
      • Reduce Non-Adherence/Non-Compliance
        • Regular community physician visits may be difficult to achieve by patients who have limited access due to transportation issues, health or self-efficacy
        • Often patients do not choose to be maliciously non-compliant with a medical regime; they have most likely faced barriers that have placed their health in low prioritization.
        • It is important to implement strategies and interventions which limit or eliminate barriers to accessing healthcare, such as home-based health services.
    • Interventions to Promote Health and Prevent Health Risks
      • Home-based Medicine allows homecare professionals to better understand the obstacles that the elderly and disabled face daily
        • Housing and Handicap Accessibility: Although handicap accessibility is available in most affordable housing, many still face challenges to daily operations such as bathing and cooking within their own apartments or homes.
        • Handicap Accessibility may only mean entrance accessibility such as ramps or elevators, but may not mean that the patient has wide doors, lowered countertops or a walk-in shower.
    • Interventions to Promote Health and Prevent Health Risks
      • Home-based Medicine allows homecare professionals better understand the obstacles that the elderly and disabled face daily
        • Economic and Financial Resources: The average family expenditures are greater when the patient has a deficit or 2 or more activities of daily living (2) . Copays, medications and deductibles are direct costs and transportation and/or specialized living may be indirect costs faced on a fixed income.
    • Interventions to Promote Health and Prevent Health Risks
      • Home-based Medicine allows homecare professionals better understand the obstacles that the elderly and disabled face daily
        • Social Network: It is helpful to know whether a patient has friends or family nearby who may be helpful resources for a variety of needs. Gaining insight into the quality of the relationships between the patient and caregivers or family can be invaluable.
    • Interventions to Promote Health and Prevent Health Risks
      • Home-based Medicine allows homecare professionals better understand the obstacles that the elderly and disabled face daily
        • Patient Beliefs and Treatment Goals : Patients and their families may have very strong opinions as to their own expected diagnostic and treatment options. These may be influenced by a variety of sources such as belief systems, financial resources, social support, caregiver strain, transportation availability and end-of-life trajectories.
    • Interventions to Promote Health and Prevent Health Risks
      • Education
        • The British Medical Journal published an article in 1999 on improving the health behaviors of elderly people.
          • A general practice educational program was studied using a group of general practitioners and their patients.
          • Intervention variable was the effect of educational practices by physicians on health promotion for the elderly.
          • The study showed that the intervention group had increased preventative behaviors, greater frequency of social activity and an increase in the patient’s perception of overall health.
          • Although no significant change was seen in functional status or psychological well-being, the educational facet of health care had a positive effect on health outcomes (4).
    • Interventions to Promote Health and Prevent Health Risks
      • Education
        • Frequency
          • Studies on compliance in elderly women illustrate that about 25% of information is remembered during a one-time educational session (5).
          • Increased frequency and ongoing health education is crucial in promotion of health in the elderly. Additionally, it is important to involve caregivers in the education process in order to build confidence of care within the family system.
          • Home-based medicine allows the educational process to be tailored to the patient and his/her family in order to help diminish additional barriers and obstacles to health.
    • Interventions to Promote Health and Prevent Health Risks
      • Education
        • Frequency
        • Self-Efficacy
          • Self-Efficacy is the perception or belief that you are able to accomplish or achieve a specific behavior
          • For patients and their families, education enhances their own self-efficacy. When a patient believes that they are able to achieve better health this empowers them and promotes healthier behaviors.
    • Summary
      • In a study done at the University of Nottingham (2001), mortality, hospitalizations, LTC placement, functional status and health status were measured to evaluate the effectiveness of home visiting programs that offer health promotion and preventative care to older people (6) .
      • Results of this study demonstrated a significant reduction in mortality and LTC placement.
        • The results stated that hospitalizations may not have been significant due to the clinicians finding a need for hospital care that might otherwise have been neglected.
    • Summary
      • Overall, studies have shown that home-based health services including physicians, nursing, personal attendants and case management have a positive effect on health-promotive behaviors.
      • For these services to be effective; however, it is important to understand the unique risks to the homebound elderly and disabled patient and implement strategies and interventions that promote health and prevent these risks.
    • References
      • Center for Disease Control. (retrieved online: March 6, 2008) http://www.cdc.gov/nccdphp/publications/brochure/brochure.htm
      • ASPE Research Notes. (retrieved online: March 6, 2008) http://aspe.hhs.gov/daltcp/reports/rn08.htm
      • Wolf, Starfield and Anderson. (2002). “Prevalence, Expenditures and Complications of Multiple Chronic Conditions in the Elderly”. Archives of Internal Medicine (162, November 11).
      • Kerse, N., Flicker, L., Jolley, D., Arroll, B. and Young, D. (1999). “Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme.” BMJ (319, September 11): 683-687.
      • Hannan, M., Cheng, D., Green, E., Swift, C., Rubin, C. and Kiel, D. (2004). “Establishing the compliance in elderly women for use of a low level mechanical stress device in a clinical study.” Osteoporosis International (15): 918-926.
      • Elkan, R., Kendrick, D., Dewey, M., Hewitt, M., Robinson, J., Blair, M., Williams, D. and Brummell, K. (2001). “Effectiveness of home based support for older people: systematic review and meta-analysis.” BMJ (323, September 29): 1-7.