Exciting times are afoot these days. The end of this month will mark three years of the Geritech blog, so seems like a good time to step back and consider how things are progressing with aging, health, and innovation.
What is kind of neat is that the blog’s anniversary coincides with two major health and innovation conferences: Stanford’s Medicine X, and Health 2.0 (the flagship Annual Fall Silicon Valley conference).
The medical education part of Medicine X is underway as I write, with the main conference events scheduled for Sept 25-27. I’m sad to not be attending Medicine X this year –have to be in New York for a family event — but I plan to attend Health 2.0 in early October. (I will also be attending — and speaking! — at the Louisville Innovation Summit in October, which will focus on aging.)
Both Medicine X and Health 2.0, which I attended in 2013 and 2014, are hugely influential, albeit in different ways. So it’s very interesting to review their programs (see here and here), and consider what they are presenting in terms of aging, the care of people with multiple chronic illnesses, and helping older people with functional limitations.
I’m happy to say that both conferences are featuring more programming specific to aging this year!
But first, my own gut impressions when thinking about what’s changed — and what hasn’t changed — over the past three years.
Then I’ll briefly share which upcoming sessions at Medicine X I’ll be especially sorry to miss. I can’t even watch the Medicine X livestream as I’ll be on planes or with family for the next three days. But you could watch! (And I’ll cover Health 2.0 in a future post.)
What’s changed in aging and health over three years
Honestly, at a high level and considering what counts the most — the experience of average older adults and their families — I would say not much, although good things do seem to be brewing. For instance:
The average healthcare experience of older adults and caregivers hasn’t changed much. This is my impression, based on what I hear patients and families complaining about and based on the stories I read in the mainstream press.
Now, many facilities and providers are innovating and trying to improve healthcare, and technlogy is playing a factor in that.
But the improvements seem to either be quite localized (I’m thinking of Mayo’s August 2013 study using Fitbits to improve recovery after surgery; this hasn’t become the post-op norm as far as I know) or of middling impact when it comes to people’s healthcare experience (e.g. more widespread patient portals, Blue Button downloads).
This isn’t to say that all the work on innovation and digital health has been useless, of course. It’s more to say that I don’t see major change. Yet. (Do you??)
Which means that either
- We haven’t hit the tipping point we need, or
- That change is going to be very slow and incremental, and in this case it will take at least 10 years — or more — before most people have a materially better experience getting the healthcare they need, at a price we can all afford.
In comparison, some innovations have spread and influenced people’s lives quite quickly. Think of the way Internet use took off in the late 90s, or the way smartphone adoption boomed — esp after the iPhone — or the way tablets use has become widespread. (I saw the home health nurse charting a visit on a tablet yesterday.)
My guess is that healthcare delivery — for lots and lots of reasons, many of which have to do with the flow of money — is intrinsically pretty resistant to fast changes.But I’d love to be proven wrong.
The average older adult is still often getting sub-optimal care that doesn’t leverage what we know in geriatrics. Don’t tell me about the shortage of geriatricians. Just because there aren’t many geriatricians doesn’t mean one can’t design healthcare in a way that leverages geriatrics, which is the art and science of modifying healthcare so that it works better for older adults. We actually know quite a lot about providing better healthcare to seniors, but as with many aspects of healthcare, the constraint is not lack of knowledge. It’s extreme difficulty with implementation. (And also, the mistaken belief that geriatric care is to be delivered by geriatricians. Don’t buy that! Insist on non-geriatricians upping their game and leveraging geriatrics.)
Consider Acute Care for Elders units, which are special units designed to implement what we know about better hospital care of older adults. They have been known to improve outcomes for hospitalized seniors since 1995, when the first randomized trial was published in the NEJM, and subsequent studies have confirmed their benefits.
The good news is that we have more of them available than we used to. The bad news is that there still aren’t that many; an article earlier this year in Modern Healthcare estimated that “more than 100 hospitals” have these units. (Whereas there are about 5600 hospitals in the country.)
The situation on the outpatient side seems about the same. We do have more outpatient clinics designed for seniors than we used to, and primary care innovators such as Iora are opening clinics specific for Medicare patients. Emergency rooms are starting to redesign. So it’s progress but things are still a long way from where they should be. Here is a hilarious and very important relevant quote from the end of the Modern Healthcare article:
“Thomas said many hospital leaders seem oblivious to the fact that more than 40% of their inpatients already are seniors. Beyond the ACE units and geriatric EDs, hospitals are filled with elderly patients, and their proportion is growing.
“Sometimes I do grand rounds for hospitals, and I say, “People, you do realize who’s in the hospital, right? You do realize that if you were really being fair about it, you’d be running a geriatric hospital with a side wing for adults, pediatrics and obstetrics,” he said. “It’s time to make the healthcare environment safe and friendly for seniors.”
My experience as a healthcare provider hasn’t changed much. Now, I am in some ways a special case. I have a small part-time solo consultation practice, and I’m opted out, so I’m not dealing with insurance or with ACOs.
That said, I spend a lot of time communicating with other doctors (usually in smaller private practices), with pharmacies, with home health agencies, and with facilities. It’s a pain and it hasn’t changed much over the past 5 years. It’s still mainly fax-based. It’s still crazy inefficient. Where are the improvements??
The promised availability of easy point-of-care diagnostics hasn’t materialized (yet). I mention this since there was a lot of hype about easier and cheaper and more available diagnostic tests at the innovation conferences a few years ago. I do housecalls, and I often see older adults who are having a hard time getting out of the house, due to mobility or other impairments. I was really looking forward to those easy diagnostic tests, but they aren’t available to me or my patients yet. So it’s still often a hassle and a production to get people the diagnostic evaluation they often need.
The national level of interest in aging is possibly increasing, but people still seem to be struggling with all the same problems. It’s hard for me to know exactly — the recent White House Conference on Aging may have skewed my perspective — but I think that perhaps the nation’s overall interest in aging is increasing. Possibly this is being driven by the aging of the large boomer population, who are understandably concerned about their own future and also are often struggling to help older parents. Plus, some recent high profile books have addressed aging, such as Atul Gawande’s Being Mortal and Ai-Jen Poo’s The Age of Dignity.
Again, this is progress but it hasn’t yet turned into what we really need, which is for most people to have an easier time navigating the health and life challenges associated with aging.
Bottom line: promising possibilities but we’re still waiting for a better healthcare experience to be available to most seniors and families. I plan to remain optimistic and hope you do too.
Medicine X features more on aging in 2015
I don’t recall there being much about aging, or even about multimorbidity, when I went to the health innovation conferences in 2013. Fortunately, that is changing, and there are some terrific sessions to look forward to.
This year Medicine X is featuring a section titled “Growing up, Aging, and Adjusting.” (And I’ll be on a plane during it, boo hoo.) Talks include:
- An e-patient talk, titled “On peer-to-peer healthcare for elderly patients“
- A talk on longevity research and healthy lifespans
- A talk with the marvelous nonagenarian designer Barbara Beskind, titled “Your life and work and factors to be considered when designing for older people“
I was also thrilled to see there will be a panel discussion lead by Amy Berman of the John A Hartford Foundation (which is the biggest foundation that focuses specifically on health and older adults):
- Older adults taking hold of their health: Technologies that foster transparancy and engagement (OpenNotes, online communities, and apps). Really fantastic that this topic is now on the main stage at Medicine X!
Other sessions I found especially noteworthy:
- Design Thinking for Chronic Condition Patient Engagement. Love that this workshop is based on a Stanford class which uses patient volunteers from Stanford’s Coordinated Care Clinic, a clinic for medically complex patients, many of whom presumably have multimorbidity.
- Senior patient engagement using iPad dashboards, connected health devices and pharmacogenomics. This short talk presents the results of a project in which 50 seniors living in “a high end senior home” were set up with iPads and connected health devices.
- Online social support for older adults with Type 2 Diabetes.
- Aging Projects Inc., a community-based website for aging support
- The Final Frontier: Making eHealth accessible for all patients — An exploration into elderly cancer patients and those with mental health issues
Of course most of Medicine X is interesting and worthwhile, in part because of the intense involvement of live patients. These “e-patients” are much more involved and engaged than the patients I’ve seen in clinic, and historically haven’t been very old or representative of the Medicare population.
Still, it’s wonderful that Medicine X has such a strong patient presences, and exciting that they have introduced more aging-related programming this year…that’s a change that I’m happy to see.
What do you think has or hasn’t changed over the past 3 years?
What’s been notable to you, when it comes to aging, health and innovation over the past three years? I’m curious to know what you’ve noticed, and what you’re excited about.