New guide helps providers make effective connection with senior patients

"Communicating With Older Adults: An Evidence-Based Review of What Really Works," the latest report from The Gerontological Society of America (GSA), provides 40 pages of recommended guidelines for health care providers interacting with the fastest growing age segment of America's population.

16 oct 2012--This publication is intended for physicians, nurses, pharmacists, biologists, psychologists, social workers, caregivers, economists, and health policy experts—anyone who seeks to have the best possible interactions with older patients. It was developed by GSA and supported byMcNeil Consumer Healthcare.

"The report is based in the scientific literature, yet the contributors created something extremely accessible," said Jake Harwood, PhD, head of the Advisory Board that crafted the report. "It covers the full range of communication issues experienced by older adults and health care providers, and gives concrete suggestions for dealing with problems when they arise."

The U.S. Administration on Aging forecasts that nearly one in five Americans will be 65 or older by 2030. At present, those age 65 and above make nearly twice as many physician office visits per year as do adults 45 to 65. According to the U.S. Centers for Disease Control and Prevention, two-thirds of older people are unable to understand the information given to them about their prescription medications.

The report provides 29 specific recommendations in four categories: general tips for improving interactions with older adults, general tips for improving face-to-face communication with older adults, tips for optimizing interactions between health care professionals and older patients, and tips for communicating with older adults with dementia.

The recommendations were contributed by experts in the fields of gerontology and communications. Each is accompanied by a brief explanation of the rationale, tips for implementing the recommendation in busy health care settings, and selected references for further reading. The objective is to encourage behaviors that consider the unique abilities and challenges of older adult patients and produce positive, effective interactions among everyone involved.

"The report distills a large body of empirical research findings and scholarship from several disciplines into a set of concrete recommendations for effective communication with older adults," said Advisory Board member Daniel G. Morrow, PhD. "The recommendations include nonverbal and verbal strategies that are often grounded in compelling examples that involve common communication challenges."

Among the specific steps outlined in the report, care providers are encouraged to avoid speech that might be seen as patronizing to an older person, verify listener comprehension during a conversation, and pay close attention to sentence structure when conveying critical information.

"This resource will be of great benefit to health care providers, and would also make good reading for older adults. Increasing awareness of some of these issues among the older population could help them seek more appropriate accommodation when needed," Harwood said.

GSA will distribute the report to its own members, as well as members of the American Geriatrics Society, the American Academy of Physical Medicine and Rehabilitation, the American Medical Association, the American Public Health Association, the American Society of Consultant Pharmacists, and the National Association of Professional Geriatric Care Managers.

"While focused on older adults, the recommendations are relevant to communication across the lifespan," Morrow said.

Provided by Gerontological Society of America

Multidisciplinary integrated care for seniors gives better quality care

Multidisciplinary integrated care of seniors in residential care facilities resulted in better quality of care, found a Dutch study published in CMAJ (Canadian Medical Association Journal).

02 july 2011--In the Netherlands, people living in residential care facilities — about 10% of seniors aged 75 or older — have increasingly complex health needs. More than 70% of residents, many of whom have multiple chronic diseases and related disabilities, need professional help with daily living, nursing care and housekeeping. Seniors homes are increasingly dealing with these more complex needs.

The study looked at 340 residents with physical or cognitive disabilities living in 10 residential care facilities near Amsterdam, the Netherlands, to determine the effects of multidisciplinary integrated care. All participants had primary care physicians who were responsible for their medical care. Terminally ill residents were not included in the study.

"By adapting the principles of disease management, we introduced the concept of multidisciplinary integrated care," writes Dr. Hein van Hout, VU University Medical Center, Amsterdam, the Netherlands, with coauthors. "This concept focused on identification and monitoring of the functional disabilities caused by chronic diseases."

The study included assessments every three months of functional limitations by trained nurse-assistants; discussion of priorities and outcomes with the family physician, patient and family members; and monthly meetings with the patient's health care team (nurse-assistant, family physician, psychologist and geriatrician.)

"Compared with usual care, our model of multidisciplinary integrated care resulted in substantially higher quality of care for elderly people in residential care facilities," write the authors. "Functional ability, number of hospital admissions and health-related quality of life remained comparable between the two groups."

Mortality also declined and people were more positive about the quality of their care in persons where the intervention protocol was fully applied.

The authors conclude that the results of the study can be applied to seniors in residential care facilities, those in nursing homes and those living at home.

In a related commentary, Dr. Robin Stadnyk of Dalhousie University writes, "this is an important contribution to improving care in nursing homes because it integrates process measures with outcomes that are important to the resident's functional status and quality of life. In contrast, much of the North American research on care in nursing homes focuses on effectiveness, improving quality or the culture of care."

Provided by Canadian Medical Association Journal

Seniors in Poor Areas More Likely to Die After Surgery

30 sept 2008-- Elderly Americans who live in low-income ZIP codes are more likely to die after surgery than those who live in higher-income ZIP codes, according to new research.
The study analyzed death rates among more than one million older adults who had one of six common high-risk heart or cancer surgeries between 1999 and 2003.
The risk of death was between 17 percent and 39 percent higher for patients in low-income ZIP codes, mainly because the quality of care is lower at hospitals in lower socioeconomic areas, the study authors said.
In fact, all patients (regardless of income) who had surgery at hospitals in the poorest areas were more likely to die, while all patients who had surgery at hospitals in the richest areas were less likely to die.
"It may be that hospitals that treat patients of lower socioeconomic status have lower quality of care due to fewer resources, such as technologically advanced equipment or specialists," lead author Dr. Nancy Birkmeyer, an associate professor of surgery at the University of Michigan, said in a Center for the Advancement of Health news release.
The study was published in the September issue of the journal Medical Care.
"While some prior studies have demonstrated socioeconomic disparities in the outcomes of individual procedures, ours is the first to show that the relationship is consistent across a wide range of surgical procedures," Birkmeyer said.
While the study can improve understanding of patterns of care, it doesn't offer concrete answers for elderly patients who need surgery, said Dr. Harlan Krumholz, a professor of medicine, epidemiology and public health at Yale University.
"The study can only really raise questions about inequalities in outcomes, because the authors have limitations in their ability to know the socioeconomic status of any particular patient and the condition of the patient when they had the surgery," Krumholz said in the news release. "Nevertheless, it is time for us to look closely at whether people are getting the same care and outcomes regardless of their financial circumstances."
More information
The U.S. National Institute on Aging has more about seniors and surgery.

A Little Help Can Boost Holiday Joy for Elderly


SATURDAY, Dec. 15 (HealthDay News) -- Older relatives who are frail or ill have special emotional, mental and physical health needs that require extra attention to help them enjoy the holiday season, geriatric specialists say.
So, experts at the University of California, San Diego, offer the following tips:If an older family member tires easily or is vulnerable to over-stimulation, limit the activities or length of time that person is included in the festivities. Consider planning a nap time or providing a "quiet room" where an older person can take a break from the noise and confusion. If there's a get-together at the home of someone with memory impairment or behavioral problems, don't rearrange the furniture. This could cause confusion and anxiety. If the family function is somewhere else, remove slippery throw rugs and other items that could be hazards or barriers to people who have difficulty walking. Avoid comments that might embarrass someone with short-term memory problems. Involve everyone in holiday meal preparation, assigning tasks to include the youngest and oldest family members. Make sure that older people adhere to their regular schedule of medications during the holiday hustle and bustle. Reach out to older relatives and friends who are alone. Loneliness in older people is associated with major depression and with suicidal thoughts and impulses.
More information
Find out more about geriatric care at the National Association of Professional Geriatric Care Managers.