2. At the end of the session, you will be
able to:
• Understand the health system for
ageing population;
• Discuss challenges and opportunities
to provide health care for ageing
population;
• Develop a plan of action responding to
the disease burden of ageing
population.
3. Introduction
• Changing causes of death and morbidity.
• WHO estimated, in 1990 about 50% of the
burden of disease in developing countries
was attributable to communicable
diseases, around 40% to NCDs.
• By 2030 NCDs are expected to be over
three-quarters of the disease burden in
developing countries.
4. Con…
• Population ageing will bring challenges to
health care, policy makers. The changing
pattern of disease , disappear in future;
• but at the same time, NCDs will increase
in both prevalence and cause of death.
5. Align health systems
• Place older people at
the centre of health
care
• Shift the care focus
from managing
diseases to optimizing
what people can do
• Develop the health
workforce
https://www.who.int/ageing/pub
lications/icope-framework/en/
https://www.unescap.org/
6. Age-friendly Health Systems
What Matters
Know and align care with each older
adult’s specific health outcome goals
and care preferences across settings
of care
Medication
If medication is necessary, use age-
friendly medication that does not
interfere with other M’s
Mentation
Prevent, identify, treat, and manage
Mental health & psychological issues
Mobility
Ensure that each older adult moves
safely every day to maintain function
and do What Matters
7. What is different in 4Ms Health
System?
• 4Ms Framework: Not a Program, but a shift in
care
• Current health system probably practices at least
a few of the 4Ms in some places, at some times.
• The 4Ms are implemented together (i.e., all 4Ms
as a set of evidence-based elements of high-
quality care for older adults).
• The 4Ms are practiced reliably and consistently
(i.e., for all older adults, in all settings and across
settings, in every interaction).
8. Two Key Drivers of Age-
Friendly Health Systems
Age-Friendly
Health
System:
4Ms
Assess:
Know about the 4Ms for
each elderly people in
your care
Act On:
Incorporate 4Ms in
the Plan of Action
9. Common SocialIssues toAging
• Loneliness
• Dependency
• Economic
burden
• Isolation
• Abuse
• Neglect
• Generation Gap
10. Putting the 4Ms into Practice
Integrating the 4Ms into Care Using the PDSACycle
• Provide
care
• Study your
performance (M&E,
CBA, CEA etc)
• Understand
your current
state
• Describe care
consistent with
4Ms
• Design or adapt
your health
workforce
• Improve and sustain
care
Ac
t
Pla
n
D
o
Stud
y
11. Putting the 4Ms into Practice:
6 Steps
• Step 1: Understand the Current State
• Know the Older Adults in Your Health System
• Know the 4Ms in Your Health System
• Select a Care Setting to Begin Testing
• Set Up a Team
• Step 2: Describe Care Consistent with the
4Ms – Questions to consider:
• How does your current state compare to the actions
outlined in the 4Ms Care Description Worksheet?
• Which of the 4Ms do you already incorporate? How
reliably are they practiced?
• Where are there gaps in 4Ms? What ideas do you have
to fill
the gaps?
12. Assessment of elderly people
in hospital
• The holistic assessment of older people.
• The MDT members include doctors, nurses,
physiotherapist (PT), occupational therapist (OT),
dietician, clinical pharmacist, social worker (SW),
specialist nurses (e.g. tissue viability nurse and
Parkinson’s disease nurse specialist), hospital
discharge liaison team and care givers.
• Input from a clinical psychologist or old age
psychiatrist may be needed depending on
individual patients’ needs.
• All members engage with patients and care givers
to complete their assessments and intervention,
followed by multidisciplinary meeting (MDM) to
formulate ongoing care plan and follow-up.
13. Medical Assessment (1)
Common medical
conditions seen in
older people
• Alzheimer’s disease
• Normal pressure hydrocephalus
• Temporal arteritis (giant cell arteritis)
• Diastolic heart failure
• Inclusion body myositis
• Atrophic urethritis and vaginitis
• Shingles (herpes zoster)
• Benign prostatic hyperplasia
• Aortic aneurysm
• Polymyalgia rheumatic arthritis.
14. Medical Assessment (2)
Common medical
conditions in older
age group
• Degenerative osteoarthritis
• Overactive bladder with urinary
incontinence
• Diabetic hyperosmolar non-ketotic coma
• Falls and fragility hip fracture
• Osteoporosis
• Parkinsonism
• Accidental hypothermia
• Pressure ulcers
• Prostate cancer
• Stroke
• Glaucoma and cataract
15. Putting the 4Ms into Practice:
6 Steps
• Step 3. Design or Adapt Your Workflow
• Current workforce – numbers and skills
• What you need?
• Step 4. Provide Care
• Apply your draft standard procedure and workflow first with
one patient. Can your team follow the procedure in your
work environment?
• If necessary, modify your procedure
• Step 5. Study Your Performance – M&E, CBA, CEA
etc.
• Step 6. Improve and Sustain Care – 4 steps
• Engage all;
• Choose a pilot with the organization
• Build the changes into the standard, well-defined work
processes
• Use early wins to build momentum, motivate and carry-on.
16. Assessment and Management of
elderly people
• Multiple co-morbidities, physical limitations, increased
functional dependence and complex psychosocial
issues are common health problem of elderly people.
• The elderly people are more vulnerable and could
easily decompensate with minor stressors, resulting
in increased frailty.
• To improve outcomes for frail older people with multiple
co- morbidities, admission should be to an Emergency
Frailty Unit (EFU) having Acute Medical Unit (AMU) for
elderly.
• The physical illness or adverse effects of drugs are
more pronounced in atypical presentation among
elderly people and cognitive decline, delirium or
inability to manage routine activities of daily living
(ADLs) are common.
17. • Ask the older adult What Matters most,
document it, and share What Matters across the
care team
• Align the care plan with ‘What Matters’ most
• Review for high-risk medication use and
document it
• Avoid high-risk medications, and document
and communicate changes
• Ensure sufficient oral hydration
• Orient to time, place, and situation
• Ensure older adults have their personal
adaptive equipment
• Support non-pharmacological sleep
4Ms in an Age-Friendly Health
System Hospital & Practice
18. • Screen for delirium at least every 12 hours
and document results
• Screen for dementia/cognitive impairment
and document the results
• Screen for depression and document the results
• Consider further evaluation and manage
manifestations of dementia, educate older adults
and caregivers, and/or refer out
• Identify and manage factors contributing to
depression and/or refer out
• Screen for mobility limitations and document
the results
• Ensure early, frequent, and safe mobility.
4Ms in an Age-Friendly Health
System Hospital & Practice
19. Challenges & Opportunities
for 4Ms
Lack of a framework for the technological ecosystem
Wide variety of country socio-economic-cultural
contexts
Need to engage all!
Need political commitment and champions
Put it within the existing health system – no parallel
Need evaluation/assessment – resources,
framework
Appropriate regulatory approaches
Affordability! (Inequities are increasing)
Multiple morbidities; need for integrated action
