The Importance of Age-Friendly Health Systems for Older Adults
The Growing Senior Population in America
According to recent statistics, America’s senior population has grown by 34.2% over the past decade, with around 54 million Americans aged 65 and above. This demographic faces unique healthcare challenges, including the management of multiple medications, frequent doctor visits, and the presence of chronic health conditions. Unfortunately, many older adults feel that their healthcare providers do not adequately listen to their preferences or fully involve them in decisions about their care.
The Issue of Age Discrimination in Healthcare
A study published in the Journal of General Internal Medicine revealed that one in five older adults experienced age discrimination from their doctors or during hospital visits. Even more concerning, nearly 6% of older adults reported that their health worsened over the following four years due to frequent age discrimination. This highlights the need for a shift in the approach to healthcare for elderly patients to address their specific needs and concerns.
Introducing Age-Friendly Health Systems
Recognizing the need for a tailored approach to healthcare for older adults, the Age-Friendly Health Systems (AFHS) initiative was developed by the John A. Hartford Foundation and the Institute for Improving Health Care. This program emphasizes the importance of healthcare professionals being attentive listeners and explicitly asking older patients about their personal priorities. The fundamental question of “what matters to you” should be at the forefront of every medical interaction with elderly individuals.
Expanding on Age-Friendly Care
Age-friendly healthcare goes beyond simply addressing medical conditions and treatments. It focuses on understanding the personal preferences and health goals of older adults as they age. To achieve this, healthcare professionals should follow the 4Ms framework, encompassing the following pillars of high-quality care:
- What matters to the individual in terms of lifestyle and health goals
- Medication review, ensuring the necessity and impact of each medication
- Mobility assessment and support for daily activities
- Mention, for the prevention and management of memory loss, dementia, and/or depression
The Role of Healthcare Providers
While the concept of age-friendly care is essential, a recent study in the Journal of the American Geriatrics Society reveals that while healthcare providers acknowledge the need for a different approach to care for older patients, the application of the 4Ms framework is not consistently integrated into their practice. Physicians, nurse practitioners, and physician assistants often fail to explicitly consider the patient’s age in routine care, and only a minority inquire about what truly matters to their elderly patients.
Addressing Medication and Mobility Concerns
High-risk medications and limited mobility are critical issues for older adults. While healthcare providers are aware of the need to review medications and screen for depression, there is a gap in actively addressing these concerns. The importance of creating a dialogue with older patients about their medications, physical activity, and fall prevention cannot be overstated. Furthermore, health professionals should strive to go beyond screening and provide support for improved mobility and fall prevention through proactive measures.
A Call for Patient-Centered Care
Ultimately, age-friendly healthcare requires a shift towards a patient-centered approach that prioritizes the individual needs and preferences of older adults. Healthcare providers must engage in meaningful conversations with their elderly patients, asking about their goals, values, and personal preferences. Effective care for the elderly benefits not only the individual but also sets a standard for comprehensive healthcare that can be beneficial across all age groups.
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America's senior population has grown 34.2% over the past 10 years, and today about 54 million Americans are over age 65.
If you are in this group, you may take four or more medications, see up to five doctors each year, and have at least one chronic health condition. You may also feel that your doctors and nurses often do not listen to your preferences or fully include you in decisions about your own care.
According to a 2015 report Journal of General Internal Medicine In a study of more than 16,000 older adults, one in five said they experienced age discrimination from their doctors or during hospital visits. Nearly 6% of older adults said they frequently faced age discrimination and that their health worsened over the next 4 years.
“We must recognize that the way we manage health care for elderly patients is not the same as that of those in their 30s or 40s. We don't talk enough to our patients about what matters to them. We are getting better at managing his medications, but we are not doing as well at stopping them. We don't focus enough on their fall risk,” says John Whyte, MD, medical director of WebMD.
Whyte recently played a key role in the development of Age-Friendly Health Systems (AFHS), a new approach to the care of older adults developed by the John A. Hartford Foundation and the Institute for Improving Health Care, in partnership with the American Hospital Association and the Catholic Association. American Health Association. Doctors, nurses and other health professionals who treat older people need to be better listeners, she says. “We need to ask ourselves what matters to our older patients. It's a simple question, but every doctor should ask it explicitly. “We need to change the way we approach the treatment of our elderly patients.”
Could health care focus on your personal preferences and health goals as you age, and not just what your doctor thinks is best for you or your test results? AFHS recommends that doctors and nurses plan care for older adults based on what they or their caregivers value most. Every visit or medical decision must cover the 4Ms, four pillars of high-quality care:
- What matters is for older adults to set their personal lifestyle and health goals, and for healthcare professionals to plan their treatment with these goals in mind.
- Medications they take for any condition, including whether they need each medication and whether any side effects interfere with what matters to them.
- Mobility, so they can move safely, function in their daily lives and do what matters to them.
- Mention, to prevent or diagnose, treat and manage memory loss, dementia and/or depression.
Many health care systems, such as the 1,200 CVS MinuteClinics, include the 4Ms in every appointment with a senior, says John A. Hartford Foundation President Terry Fulmer, PhD. Your doctor or nurse may ask you about your goals, values, and personal preferences, but these questions can be difficult for some older people to answer.
“If I say to an older patient, 'What are your goals?' Maybe they say, 'You're the nurse, don't you know?'” Some seniors may think they need to defer to their doctor or nurse during care and let them make all the decisions, Fulmer says.
“We need people to feel comfortable with this question of what matters to you. Very often, it is difficult to start that conversation. You could say, “I want to talk to you about my mobility, my mood, and my medications, all based on what matters to me.” “That’s a very solid conversation.”
What do doctors and nurses think about an age-friendly approach to care when treating older people?
Fulmer and Whyte are among the co-authors of a new study in the Journal of the American Geriatrics Society. The results show that most primary care providers believe they should approach care for older patients differently and consider age when making treatment decisions, but do not always include the 4Ms in care.
The study is based on a survey of 1,684 primary health care providers randomly selected from the Medscape database during fall 2020. Respondents included 575 physicians, 613 nurse practitioners (NPs), and 496 physician assistants ( PA).
They were asked their opinion on age-friendly care or the 4Ms and how they care for their elderly patients. While more than 90% of providers agreed that older patients “require a different approach to care than younger patients,” only 50% of physicians and personal assistants and 69% of nurse assistants said who always consider the patient's age in routine care. Only 36% of doctors surveyed said they ask their older patients what matters to them.
High-risk medications for seniors include medications that can cause harmful side effects or interact with other medications, says Marcus R. Escobedo, vice president of communications at the John A. Hartford Foundation and co-author of the study.
Many medications to treat anxiety, insomnia or pain can have side effects that reduce an older person's quality of life or are even unsafe for them, he says. Antipsychotic drugs often prescribed to older people with dementia can make them drowsy and increase the risk of falls, for example.
As we age, our body and metabolism change, Escobedo says, so there may be medications that are not suitable for older adults and are still prescribed too frequently. “They may be taking too many medications in general. If you have many different providers, or if you are admitted to the hospital, you may be prescribed medications. Then, you go home and you don't stop taking these medications.”
While 84% of doctors said they review older patients' use of high-risk medications and screen for depression, only 78% said they stop their patients or reduce their dosage of high-risk medications or avoid them. the use of these medications at all.
“If older adults recognize the possible side effects of their medications, are we listening to them? They might say something like, 'I feel bad,'” Fulmer says. That's why one of the 4Ms is to review your medications and see if any need to be changed. “We need to start that conversation about your medications with what matters to you.”
The AFHS framework urges doctors and nurses to ensure that older patients can move around safely so they can do what matters to them. Your healthcare provider may prescribe physical therapy or exercises to help you stay mobile.
“One of the best ways to prevent falls is to encourage older people to do physical activity and just some movement. We help them develop strength and balance. That will help you have more confidence when moving,” says Escobedo.
The survey found that 73% of physicians, 82% of NPs, and 76% of PAs said they always examine older patients to determine if they have limits on their ability to move. However, only 56% of doctors, 61% of nurses and 56% of personal assistants said they “ensure early, frequent and safe mobility” when treating older people.
Health care providers can screen older people for mobility problems, but they must do more to help them move better and prevent falls, Fulmer says.
“My older patients and I often talk about prehabilitation. That's working to get stronger before an event occurs, like a fall that causes a fracture, she says. “People want to have control over their lives. You can work with your physical therapist to overcome your challenges. We can say, 'Let's do some strength training.' You can take charge of your mobility.'”
Mention is another of the 4Ms. Only 60% of physicians, 70% of NPs, and 67% of PAs surveyed said they refer their older patients who test positive for cognitive impairment, or who have some problems with memory or decision-making. decisions, for further testing and treatment for your symptoms.
Health care visits typically last as little as 10 minutes, so doctors and nurses should ask seniors how they are feeling and what activities they can do, such as going to the movies, or if they can walk more than a block, Fulmer says. .
The survey found that 43% of physicians, 37% of NPs, and 38% of PAs agreed that “it's up to the patient to tell me what their needs are.” Fulmer believes providers should ask these questions and listen more carefully to their older patients' responses.
“It's a conversation: 'What's most important to you right now?' We need to give a voice to older people. Let them start this conversation,” she says. The survey results suggest that health care providers need more training on how to put the needs of older adults at the forefront of their care.
Future generations will benefit from a more integrated healthcare system where all of your medications, health conditions and, most importantly, your personal goals and preferences are all in your file, he says. “Good care for the elderly is usually good care for everyone.”
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