View stunning SlideShares in full-screen with the new iOS app!Introducing SlideShare for AndroidExplore all your favorite topics in the SlideShare appGet the SlideShare app to Save for Later — even offline
View stunning SlideShares in full-screen with the new Android app!View stunning SlideShares in full-screen with the new iOS app!
Cutting Edge: Update on Research Advances in Geriatrics Janet E. McElhaney, MD, FRCPC, FACP Professor of Medicine Allan M. McGavin Chair, Geriatrics Research UBC, PHC and VGH Division Head, Geriatric Medicine
What’s hot, what’s not – but should be; transforming seniors’ care
Assessment of the older patient – Right view, Right care, Right discharge and follow-up
Interprofessional collaborative practice to integrate clinical strategies, optimize best practice, and improve quality of care – in BC, it’s the law!
Seniors’ Health: Adding Life To Years 60 70 80 90 Age 2000’s 1990’s 1980’s
Chronic diseases increase risk for catastrophic disability Successful Aging Usual Aging Frail Seniors Seniors in LTC
Risks Associated with Hospitalization 65+ population are hospitalized 3X more often than younger adults; 36% of hospitalizations and 50% of hospital expenditures At discharge, 33% are more disabled 5% die in hospital, 20-30% die in the year after hospitalization Elixhauser A et al; AHRQ Pub. No. 00-0031, HCUP Fact Book No. 1, 2000 Covinksy KE et al; J Am Geriatr Soc; 51:451, 2003 Transforming Seniors Care – what’s not hot but should be
Strategy: Implement Best Practice Informed Geriatric Care
Consistent, evidence-informed guidelines
Catheter use (bladder and bowel care)
Medication use in elderly
Nutrition and hydration
Delirium (including PPO)
Functional mobility – “Every day is an activation day”
Rapid development and implementation
Build on existing structures and processes
Complement Evidence Based work
Seniors Care: Estimated “recoverable” acute days
Local evidence shows 5 times the savings:
Geriatric Medicine Unit at PHC reduced ALOS:ELOS ratio by 0.5 (1.35 to 0.83)
Acute Care for Elders (ACE) unit at VGH ALOS reduction of 4.8 days
Conservative demand savings account for:
Different implementation approach, Broader scope (entire HA)
Reallocation of existing network/continuum staff to support coordination and evaluation at each entity
Identify existing guidelines and support local implementation
Demand savings from Seniors Transformation ALC ELOS LOS Acute days that exceed ELOS Prevent 20% of cases from becoming ALC Remove 50% of acute days that exceed ELOS Acute Reduction of acute days by 16,556 per year Total Savings Possible for “Target Group” Includes: CMGs grouped by guideline Seniors aged 70+ VCH residents only Excludes: COPD (CMG 139) & Stroke
Manages complexity and risk for increased frailty - TSC
Right follow-up – perpetuating factors
Managing transitions across the points of care
Patients (and their families) as partners to establish goals of care
One presentation of dynamic frailty Picture an 82 year old woman who presents in the ED with a cough and increasing SOB while walking with her 3 K-a-day Club on the Sea Wall.
Dynamic frailty can be a mask that limits our view of possible outcomes Picture an 82 year old woman who presents in the ED with confusion and a cough. She was walking with her 3 K-a-day Club on the Sea Wall 2 days ago .
ICP integrates clinical strategies, optimizes best practice, and improves quality of care
Reasons for ICP
Patient safety – evidence is unequivocal
Staff recruitment and retention
Quality of care
Health Professions Act (April 2008) – it’s the law
Regulations pursuant to the Act were amended to state that all colleges of health disciplines will require its members to work in a way that supports “interprofessional collaborative practice”
Collaborative Practice : Care that integrates best available research evidence with professional judgment and patient values First, think of collaboration as a continuum … Then, see the continuum from the patient’s perspective
Accommodate: Multidisciplinary professionals intervene on an autonomous, parallel basis.
Cooperate then Coordinate: Interdisciplinary team members cooperate then coordinate assessments and care plans.
Collaborate: Professionals have a narrower margin of autonomy but the team as a whole is more autonomous and its members better integrated