Yearly Archives: 2015

Integrating Community Programs in Healthcare: A Personal Experience of Health Professionals Sharing a Lot More than Lunch!

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Michael Malone, MD
Professor of Medicine and Section Head of Geriatrics
University of Wisconsin School of Medicine and Public Health
Medical Director
Aurora Senior Services and Aurora at Home

Two years ago, members of Milwaukee’s Aurora Health Care geriatrics program where I work began doing something different for lunch. The geriatrics fellows (who are learning to be experts at caring for older persons with multiple chronic illnesses) started to share meals once a week with the nurses, social workers, and teaching doctors who also work with the patients we serve. The fellows and faculty enjoyed helping each other overcome struggles in providing “best care” for vulnerable older individuals. Over shared meals, physicians started reaching out to social workers and others at the table to get input, feedback, and recommendations. This was particularly helpful, as many of the challenges our doctors have encountered centered on the social aspects of a patient’s needs and where and how to find appropriate support.

Creating a Network to Achieve “Best Care”
Gradually, we started to use these lunches to discuss cases more formally. We would discuss patient needs in five specific areas: 1) medical needs, 2) medications, 3) social needs , 4) psychological needs, and 5) how patients understood and perceived their own illnesses. The in-person discussions have given our physicians, nurses, and social workers a chance to develop working relationships with one another. We’ve all developed a better understanding of programs provided by the ADRC, and our patients are better served as we work together.

Importance of the Older Americans Act
As I reflect on how our clinic serves older individuals in Wisconsin, I’m struck by the importance of integrating community programs into health care. The Older Americans Act (OAA), for example, provides for caregiver support, health promotion, meals, and transportation for vulnerable elders. Our sharing and learning together during lunch has resulted in a better understanding of the whole person (physical, mental, social needs), and how that person supports and is supported by a community shaped in one way or another by initiatives like the OAA. Reauthorizing the OAA represents an important opportunity to help modernize and improve the aging services network to meet the needs of our nation’s older adults.

Among other objectives, the bill aims to address

  • Elder abuse;
  • The importance of evidence-based care;
  • The effective coordination of services at the federal, state, and local levels; and
  • Several other challenges confronting older Americans and their health providers.

These are topics I hope to discuss at lunch with colleagues for many years to come not only because they are important but also because they can be addressed—effectively, reliably, and equitably—through sustained support of the OAA. I’d encourage you to do some digging of your own regarding legislation that supports older Americans—you might be surprised at just how expansive public support for healthy aging has become, but also how vital it will be to ensure this support not only remains constant but also shifts to reflect new realities as more and more of us turn 65.

The Older Americans Act Reauthorization Act of 2015 was approved by the U.S. Senate last week and has now been sent to the House of Representatives for a final vote.  You can help support swift passage of this important legislation by writing to your Representative to encourage her to stand behind the important services that the OAA provides.  Visit the Health in Aging Advocacy Center for more details.

About the Author
Dr. Malone is the Chair of the AGS Public Policy Committee.

Finally summer! Time to get some sunshine!

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Syed picQuratulain Syed, MD
Assistant Professor of Medicine,
Division of General Medicine and Geriatrics,
Emory University School of Medicine

Now that the long, harsh winter is over and the Sun has finally decided to shine on people living beyond Florida, it’s time to take advantage of the warm weather while it lasts. So ladies and gentlemen, let’s head out to lose the pounds you put on eating your favorite pies the last holiday season.

Outdoor activities have many health benefits, including helping your body make vitamin D, losing unwanted pounds, helping lower your blood pressure, and keeping your heart healthy. While outside, it’s important to take some precautions to avoid getting sick from excessive heat exposure. Here are some tips to help you enjoy the sun:

  • Walk in the early morning (before 10am) or late evening hours (2-3 hours prior to sunset) to avoid excessive heat exposure.
  • Keep a bottle of water with you and sip from it while you are out to avoid getting dehydrated.
  • Wear light colored, loose fitting, and lightweight clothing (such as cotton).
  • Get your hats out and wear them. You get to show them off and avoid the direct heat of the sun.
  • To prevent sunburns and skin cancer, buy sunblock lotion or spray from your local pharmacy and apply it liberally on all exposed parts of your body.
  • Choose pavement or a shaded trail in a park to walk on. Make sure to select a trail which is clean and even, to avoid stumbling on slippery stones and rocks. If you have been under trees and walked through grass, check for ticks on your skin and in skinfolds. Ticks prefer to be in hot moist areas. Also check your scalp after you get home. Have a healthcare provider remove the tick if you find one attached to your skin.
  • Try going to an indoor shopping mall to walk. However, if you love to shop, you might want to leave your credit card at home!
  • Be mindful of your surroundings and be sure to walk in well-lit, clean, and safe walking spaces. Let someone know where you are going and when you expect to return. Take your cell phone with you!
  • Water exercises are a great way to stay in shape for everyone, including people with joint aches and arthritis who can’t walk or run long distances. If there is a swimming pool available at the community center near you, ask about their water exercise schedule. If there are no water exercise classes, put your swimsuit on and walk from one shallow end to the other.
  • Pack some light snacks as low-salt crackers, vegetables (e.g., carrots, cucumbers etc.), and peanut butter to enjoy while you sit on a bench to rest during and after a long walk.
  • Make sure to wear comfortable walking shoes with good support and cushioning. No high heels!
  • If you have one, remember to bring your cane or walker with you. You might need it if you get exhausted from the exercise.
  • Keep your medicine list and emergency contact information in your wallet or handbag at all times.
  • If you experience a severe headache, nausea, spinning of your head, too much sweating, or your heart racing very fast, it may be signs of a condition called heat exhaustion. If this happens, do not wait. Alert your companion or asking people passing by to help you to a shaded place and call for help.

Enjoy the summer and stay safe!

About the Author
Dr. Syed is a member of the American Geriatrics Society’s Public Education Committee.

A Good Day at the White House—#AGSProud

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Heading into the East Room of the White House.

The White House Conference on Aging (WHCOA) was this week. It’s a once-in-a-decade gathering of people who are passionate about older Americans. The next time this conference occurs, I’ll be 66 and my siblings will be in their 60s with one turning the corner to 70. With a little luck and some healthy choices, we’ll be active and engaged with our communities well into our golden years.

One thing that is clear from the 2015 conference is that, as a country, we still have a lot of hard work to do if our communities are going to be ready for me and my siblings. That said, I was proud to represent geriatrics health professionals at the WHCOA and it gave me hope that the type of future we envision for older adults could be a reality (especially on the cusp of some momentous news today from the U.S. Senate—you’ll just have to keep reading to find out more!).

WHCOAPresObama

President Obama giving his remarks.

First, the things that made me proud…

Falls Prevention Takes Center Stage at the Centers for Disease Control & Prevention: In 2001, the American Geriatrics Society (together with the British Geriatrics Society and the American Academy of Orthopedic Surgeons) released our first Guideline for the Prevention of Falls in Older Persons, with an updated guideline issued in 2010. This was seminal work, and not just for the AGS. In fact, our most recent guideline informed the U.S. Centers for Disease Control and Prevention (CDC) work on creating the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative that was announced at the WHCOA. STEADI provides educational tools to healthcare professionals that can help them identify individuals at risk for falls, understand how to modify certain risks that they are likely to find, and learn how to implement effective options for preventing falls altogether. The CDC has been working with Epic Systems Corporation (an electronic health record technology provider) and EPIC will be rolling out a clinical support tool for falls assessment. This resource will make it easier for ALL healthcare providers to screen for falls, intervene to reduce risk, and provide follow-up care. AGS members are leading the STRIDE study that is testing a multifactorial fall injury prevention strategy that is being co-funded by the Patient-Centered Outcomes Institute (PCORI) and the National Institute on Aging (NIA). I’m proud of AGS and our members—we built the foundation for STEADI and, looking towards the WHCOA in 2025, I expect that we will have progressed even further in our understanding of how to prevent older adult falls.

Medicare & Geriatrics Health Professions Funding: President Obama had some good news for geriatrics health professionals, as well—noting that we are working to implement Medicare payment models that support the quality rather than the quantity of care. AGS has been at the forefront of efforts that will benefit beneficiaries by ensuring that clinicians are supported to provide care coordination, care transitions, and advance care planning. We continue to advocate for payment models that support geriatrics health professionals in doing what they love to do: maximize the function and quality of life of the older adults they serve. Look for more news from us on the recently released 2016 proposed physician fee schedule rule in the coming weeks.

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Staying Sharp: Tips to Keep Your Brain Healthy

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A great way to keep your mental sharpness at its peak is to think of your brain as a muscle. Just as exercising your muscles helps keep you healthy and active, exercising your brain can help protect your memory and fight the effects of diseases affecting the brain, such as Alzheimer’s disease or other forms of dementia.

To help keep your mental skills sharp, make these healthy habits part of your daily routine:

Stay in shape. Physical activity isn’t just great for yourmuscles; it’s good for brain power, too. Being active for 30 minutes a day, at least three days a week, helps increase blood flow to the brain to keep it healthy. What’s more, exercise may even help new brain cells to grow! Walking is the perfect exercise for most people—you can walk outdoors on nice days or indoors at a mall or community fitness center. The only equipment you need is a well-fitting, comfortable pair of shoes. Other excellent activities include dancing, gardening, housework, cycling, and swimming.

Get regular health check-ups. High blood pressure, diabetes, depression, and not eating properly can interfere with mental sharpness. See your healthcare provider regularly to make sure your health problems are under control—and to nip any new problems in the bud. To stay on top of your health concerns, make sure to follow your healthcare provider’s advice, too.

Check your meds. Some medications, including ones taken for depression, anxiety, sleeping problems, or pain, can dull your memory. Talk to your healthcare provider about all the medications you may be taking and ask if any could be causing memory issues.

Get plenty of sleep. While you’re sleeping, your brain renews itself, so getting less than 7 to 8 hours of sleep a night (some people may require more or less sleep) can make it harder to concentrate and stay mentally sharp. Healthy sleep habits include:

  • Shutting off the TV, cell phone, tablet, and computer 30 minutes before bedtime.
  • Listening to soft, calming music before bed.
  • Making sure your bedroom is dark and quiet.
  • Avoiding caffeinated drinks like coffee after 3:00pm.
  • Avoiding heavy meals too close to bedtime.
  • Setting a regular time for going to bed and waking up.

Become a social butterfly. Spending time with others can help keep your brain sharp. You can try volunteering, joining a club, or taking on a part-time job. Sign up for discussion groups at a senior center, or learn how to play bridge or other group games. Doing crossword and jigsaw puzzles are other great options for staying mentally engaged.

Eat a varied diet. Meals that include plenty of fruits and vegetables, whole grains, low-fat dairy, lean proteins, and healthy fats such as olive oil and avocados are good for your brain. Fish is especially important because it contains omega-3 fatty acids, which your brain needs to stay healthy.

Defuse your stress. Stress can make even the sharpest people feel forgetful. Engage in activities that calm you down, such as yoga, prayer, or meditation. Walking in nature is also a great way to relax.

Medicare Proposes Paying for Advance Care Planning

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Have you ever wondered about all those codes you see on a bill or chart at your healthcare provider’s office?  If you’re covered by Medicare—the nation’s largest insurer dedicated exclusively to helping older people with their health expenses—chances are they’re part of a payment system known as the physician fee schedule.  Medicare pays eligible providers for their services based on the codes they use to bill for the patient visit.

Each year, experts from the Centers for Medicare & Medicaid Services (CMS) review, refine, and tweak the types of services included in the physician fee schedule to make it more responsive to patient needs and professional advice. The proposed schedule for 2016 was just released this week, and it’s got some important new updates that will benefit older Americans.  In particular, CMS is now proposing covering advance care planning (ACP), which would offer patients an important outlet for talking with healthcare providers about their long-term needs and expectations.  Many people have questions about what ACP is and how it works, and the infographic below from the American Geriatrics Society is a helpful guide to the basics when it comes to this important new service.

ACP Infographic_07 06 15

Interested in learning more or taking action?  Consider sharing this post or some of the ACP-related resources posted by the Health in Aging Foundation to Twitter (@HealthinAging) and Facebook (Facebook.com/HealthinAging).  You can also submit a comment of support to CMS to let them know you value ACP as part of your care.