Update on Research in Geriatrics Presentation March 6-7 2009

Uploaded on

Update on Research in Geriatrics Presentation March 6-7 2009

Update on Research in Geriatrics Presentation March 6-7 2009

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. 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
  • 2. Objectives
      • 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!
  • 3. Seniors’ Health: Adding Life To Years 60 70 80 90 Age 2000’s 1990’s 1980’s
  • 4. Chronic diseases increase risk for catastrophic disability Successful Aging Usual Aging Frail Seniors Seniors in LTC
  • 5. 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
  • 6. 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
  • 7. 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)
    • Resources:
      • Reallocation of existing network/continuum staff to support coordination and evaluation at each entity
      • Identify existing guidelines and support local implementation
  • 8. 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
  • 9.  
  • 10. Assessment of the Older Patient
      • Right view – predisposing factors
        • Confidence in mobility
        • Competence in decision-making ability
        • Connection to community
      • Right care – precipitating factors
        • Appropriate medical management – acute on chronic
        • Understands risks of proposed interventions
        • 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
  • 11. 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.
  • 12. 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 .
  • 13. Learn to look behind the mask …
  • 14. Catastrophic Disability Ferrucci et al. JAMA 277:728, 1997
  • 15. Acute Illness: Prevent or Minimize Disability 80 80 80 80 80 Age Cardiovascular Disease Diabetes Osteoporosis Chronic Lung Disease Cognitive Impairment Dynamic Frailty Usual Aging IADL Frailty ADL Frailty
  • 16. We’re all in the same boat!
  • 17. Interprofessional Collaborative Practice
      • 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
        • Sustainability
      • 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”
  • 18. 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
  • 19. Accommodate: Multidisciplinary professionals intervene on an autonomous, parallel basis.
  • 20. Cooperate then Coordinate: Interdisciplinary team members cooperate then coordinate assessments and care plans.
  • 21. Collaborate: Professionals have a narrower margin of autonomy but the team as a whole is more autonomous and its members better integrated
  • 22.
    • Transforming seniors’ care
      • Focus on best practice for common geriatric conditions
      • Appropriate management that understands risk
      • Predisposing, precipitating and perpetuating factors managed across the transitions in points of care
    • Potential for recovery:
      • Confidence in mobility
      • Competence in decision-making
      • Connection to “community ”
    • Knowledge translation through ICP
      • To optimize prevention strategies and maintain independence
      • Sustainable health care