Update on Research in Geriatrics Presentation March 6-7 2009

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Update on Research in Geriatrics Presentation March 6-7 2009

Update on Research in Geriatrics Presentation March 6-7 2009

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  • 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