Keeping seniors healthy and out of institutions

Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lisa Price, MD, board certified in internal medicine and geriatrics and has expertise in managed care, electronic health records, quality improvement and geriatrics. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Dr. PriceIt’s well-established that older adults want to live in their own homes in the community. The report Aging in Place: A State Survey of Livability Policies and Practices says nearly 90% of those over 65 want to age in place. Family caregivers echo the wishes of older loved ones: “In-home care is one of the top three options people think their loved ones would prefer,” according to Care.com’s 2016 Senior Care Survey.

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Many physicians and healthcare organizations spend a significant amount of time and effort to help elders realize their wish to age in place. There are times, however, when living on one’s own becomes overshadowed by issues related to aging. These issues often are experienced firsthand by providers and family caregivers, who are responsible for the ongoing health and well-being of older adults.

Along with the challenges come solutions, like the Program of All-inclusive Care for the Elderly (PACE) to help older adults remain on the path they desire. PACE is a safety net that keeps elders from being institutionalized.

The challenges of staying in the home

Older adults often suffer from a number of conditions that can keep them from living on their own unless the conditions are treated and addressed by providers and caregivers.

Next: Creating a holistic plan avoids institutionalization

Two triggers that often force older adults to be institutionalized are incontinence and behavior issues. Both can be minimized with some attention. Older adults with toileting needs-including incontinence and the need for physical assistance-move into senior living facilities much more quickly than those older adults without issues. This occurs because family and the older adult are often uncomfortable and unable to resolve the issue on their own.

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In addition to physical challenges, behavioral issues often arise in older age and are frequently difficult to fully address at home. About 25% of older adults have some form of mental health problem, such as a mood disorder, according to the Substance Abuse and Mental Health Services Administration. An example of a behavioral issue is Sundown syndrome, which often presents  as “confusion and agitation” around sunset or early evening.

Creating a holistic plan avoids institutionalization

PACE’s interdisciplinary team helps solve these problems through individualized care plans, including comprehensive medical and mental health services. For older adults who qualify, the program is a viable solution. PACE helps caregivers with help managing loved ones during the day and provides ideas and tips on how to manage the care of older adults at night while remaining in their own homes.

With the implementation of a well-thought-out care plan, the team helps the older adult achieve goals by, as appropriate, reducing the number of medications consumed, assisting with strategies to reduce at-home issues and addressing psychosocial challenges, including those associated with incontinence and behavioral issues.

Next: A valuable asset for older adults and their caregivers

Through this holistic care, PACE services have proven to successfully reduce the chance that older adults will need to be admitted to a nursing home.

A 2015 study published by The Gerontologist found 31% of PACE participants had a lower risk of long-term nursing home admission. In addition, quality of life can improve and be maintained for older adults who have less than optimal health, provided other areas of their life-mental health and relationships-deliver satisfaction, according to a 2013 article published in the Journal of the American Geriatrics Society.

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For the older adult, PACE provides important healthcare options and other services to engage the mind and body, both of which can have a profoundly positive effect. The program has a long history of providing necessary care and socialization and has proven itself time and again as a valuable asset for older adults and their caregivers.

Lisa Price, M.D. is Chief Medical Officer at Denver-based InnovAge, a provider of health and wellness services for older adults in California, Colorado and New Mexico. Price was a private practice geriatrician for 11 years, and then attended on the Acute Care of the Elderly (ACE) service and taught Quality Improvement at the University of Colorado. She is Board Certified in Internal Medicine and Geriatrics, and has expertise in managed care, electronic health records and quality improvement. http://MyInnovAge.org.