New Year, New Administration: It’s time to pay attention to policy

As everyone knows, a new administration is about to begin in the federal government.

So I have been thinking about what this might mean for the health and well-being of older adults, and family caregivers.

In terms of impact on the lives of seniors, the actions of federal, state, and local governments are MUCH more powerful than the impact of the health and aging innovation sector. Really, what government agencies do — and most importantly, pay for — often leads the tech innovators, rather than the other way around.

In particular, Medicare’s policies drive the health care experience for older adults, Medicaid is a major source of long-term supports and services in aging, and the services funded by the Older Americans Act provide (not yet enough) information and assistance to older adults and families.

Donald Trump, as far as I know, did not really emphasize aging or family caregiving issues during his campaign. His campaign proposed tax deductions for family caregiving.  And I’m not aware of his addressing aging issues other than saying he’d leave Medicare and Social Security alone. [Read more…]

How to address the “#1 health issue” in aging?

  1. healthy-aging-older-womenWhat is the #1 health issue that threatens quality of life as we age?
  2. And what is the #1 thing that can be done to prevent that health concern?

These are two questions I received by email recently, on behalf of a woman who is part of the “health and healthy lifestyles subcommittee” for a “village information network” that aims to support older adults in her community.

She also asked the following related questions:

  • Do you know of a best practice somewhere, that could serve as a model for that prevention of that health issue?
  • Do you know of a small town somewhere that is doing a great job with livability for older adults?
  • Do you know of any inter-generational healthy lifestyle programs that might work well in our college town?

I was invited to provide very short one sentence answers, presumably for my convenience but also perhaps to keep things simple for the committee, who surely doesn’t want to wade through long dissertations on barriers to better aging and better approaches.

But I found myself unable to promptly respond with short answers. To begin with, because I have a health services research background, my initial reflex is to want to check on the “evidence” rather than fire off a response related to my own hunches or personal experience.

But any evidence related to the first two questions will depend on which population is being studied. How old, and with what underlying health conditions? Urban, suburban, or rural? Socioeconomic status and ethnicity? Community-dwelling or in facilities?

And how to define “quality of life as we age”? Quality-adjusted life years? Or perhaps other metrics that take into account autonomy, purpose, and social connectedness? (See here and here for scholarly articles addressing this issue.)

As you see, it’s easy to fall down a rabbit hole when considering the “simple” question of what is the #1 threat to quality of life while aging.

Still, the questions are compelling, especially when considered in light of the practical needs at hand. A community group is trying to support the older adults living in a small college town. When it comes to health, what should they focus on?

Three top health issues that threaten quality of life as we age

I don’t have time to research this in depth right now, so, for now, I am going to go with my hunches and personal experience.

My initial hunch is to suggest these three issues, when it comes to threatening quality of life while aging: [Read more…]

The geriatrician & social media: On goals & motivations

Social media

Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: how to encourage more clinicians in geriatrics and long-term care to use social media?

In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”

This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older population. We also each have only so much time and energy in every day.

So how should each of us be spending our time? How much should be on social media, and do we all need to be using it?

I myself really like blogging — obviously — but was a reluctant adopter of shorter-form social media. To this day, I have a minimal personal social media presence. I only got going on Twitter because I started this blog in the fall of 2012. For me, Twitter was a good way to learn about digital health and connect with others interested in tech and aging.

Then I started using Facebook in 2014, mainly because I was focusing more on my geriatrics content for the public, and at that time Facebook seemed to be a better platform for interacting with the general public, compared to LinkedIn or Twitter. (I would say this is still true.)

In adopting social media for these reasons, I was manifesting something that is very important to consider when it comes to physician behavior — or really any person’s behavior — with a respect to engaging in a certain activity:

  • What are the most important motivators and interests for the person? What are they most eager to accomplish? How does the activity address those?
  • What are the demotivators? What are the downsides to engaging in the activity?
  • How much friction or difficulty is involved in engaging in the activity?

You can also consider an activity in terms of “Return on Investment” (ROI), however, this term doesn’t usually take into account how soon the return is going to arrive. And we know that people are much more motivated by concrete returns that happen fast — and are related to something currently of great interest/appeal/fear to them — whereas they discount returns that are coming way off in the future.

Social media is about communication and networking

Back to social media itself. It is fundamentally about communicating and networking. So to use it sensibly, I recommend individuals — or larger entities — consider the following: [Read more…]

Epic Medication Reconciliation Fail: A True Story

pills isolated on white background

pills isolated on white background

Today I want to share a true story that I’ve been mulling over recently, as I ask myself when will we start to see more substantial gains in health care quality.

It’s the story of a 94 year old woman who was sent from her memory-care residential unit to the emergency room, due to nausea and vomiting. She ended up being hospitalized for about 48 hours, for UTI.

(Sad but true aside: her family has asked for hospitalization to be avoided unless absolutely necessary for comfort. But the facility feels they have to send her to the ER if she falls, vomits, or otherwise looks seriously ill. Argh.)

Before hospitalization, she was only taking vitamin D and a daily aspirin and a multivitamin. She’d been in the memory unit for years due to dementia, and on minimal meds since “graduating” from a stint in hospice a few years ago. Because she’s chair-bound and it’s hard for her to leave the facility, she hasn’t been to her PCP’s office in years. Instead, I come and see her at the facility once or twice a year.

Guess how many medications she was discharged from the hospital on? Fourteen.

As in, fourteen new daily medications to be taken indefinitely! (There was also a course of antibiotics for UTI plus a few new PRN medications.)

I thought I was hallucinating when I saw her med sheet at the facility. [Read more…]

Physician Autonomy vs Patient Participation & Information

This image went viral on Facebook earlier this week. It generated over 125,000 shares and over 7000 comments.

There’s been some good commentary on it (I especially like e-Patient Dave’s post), which I won’t recap here.

Instead, I want to share some thoughts as to how these issues might affect our quest for improving the healthcare of older adults.

Here are some specific things that I’ve either observed or had reported to me over the past several years:

1.Many doctors do not, in fact, provide optimal care to older adults. It pains me to say this, as  I know these clinicians are usually working very hard, have good intentions, and are badly hobbled by a dysfunctional practice environment. But it’s true, and I want to call out two variants of the problem. [Read more…]

The Physician and the Fitbit

IMG_4643About six weeks ago, I lost my Fitbit Flex.  I’d been wearing it for two years, almost to the day.

This apparently makes me an anomaly. Consumer surveys suggest that many people — perhaps even most — lose interest in their devices within a few months.

I’m not surprised that many people would abandon using their tracking devices. People have a lot going on in their lives. It never seemed very plausible to me that vast numbers of “ordinary” people would adopt technology to change their health habits.

But does that mean wearables will be useless in healthcare (the organized part of the system) or “health care” (the way people take actions to improve their health or the health of someone else)?

It is really too soon to say. So much depends on whether a company like Fitbit can better understand what different types of users want and need from a device. I personally believe that the people who are most likely to benefit health-wise from the data-gathering capabilities of a device are also the ones who are most likely to be involved with healthcare professionals. People like Joan, for instance.

This is actually why I purchased a Fitbit in the first place. In the fall of 2013, it was a popular wearable device and I wanted to see whether it might be able to help address some common issues that we often help people with in primary care.

In this post, I’m going to share my own experience with my Fitbit, including how I can envision it being useful in the context of primary care. But if you are interested in wearables for older adults, I highly recommend reading this AARP report (July 2015), in which they studied the experience of 92 older adults using sleep and activity trackers. (Lots to pick apart in that report; perhaps in a future post.)

There is also some extremely interesting information on the state of the digital health industry here, summarizing Rock Health’s 2015 report on consumer adoption trends in digital health.

Could a Fitbit Help With These Two Primary Care Issues?

[Read more…]

Health 2.0 in 2015: Big steps forward

This week I attended Health 2.0’s Annual Fall Conference for the third year in a row.

I came away more impressed than I’ve been in previous years. Here’s why.

The Unmentionables Focuses on Aging, Caregiving, and Hospice

The Unmentionables session hosted by Alex Drane is always terrific, but this year was especially so, since it focused mainly on aging and caregiving.

If the video is ever made available I’ll post it here. In the meantime, you’ll have to make do with my Storify collection.

Particularly notable: [Read more…]

Aging, Health & Innovation as Geritech turns 3

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

[Read more…]

Infographic: The Cost of Aging in America

Excerpt from Cost of Aging in America Infographic
An excerpt from the infographic; be sure to see the whole thing below!

[This is a guest post by Emily Newhook, of the George Washington University School of Public Health. Earlier this year, they published this interesting infographic, titled “The Cost of Aging in America.” 

I like that this infographic mentions chronic conditions and multimorbidity, although it would be stronger if it included more information on just how common multimorbidity is (and the association with cost). I also very much like that the infographic mentions long-term care cost and the impact on family caregivers. 

Now how to integrate life and care models? That’s literally a trillion dollar question, and hopefully this graphic will spur people to keep thinking about it.

Last but not least, I would say to GW that perhaps we shouldn’t frame the key question as “Can we afford to get older?”

Instead, we should ask ourselves: “How can we effectively and compassionately care for an aging population, at a cost we can all sustain?” This way we put the care before the money.]

The Cost of Aging in America: What’s at Stake?

Americans are living longer, but can we afford to get older?

[Read more…]

7 Types of Help People Want from Healthcare

What do people want from their health care, and their medical care?

In my last post I shared a rough taxonomy of patient types, based on stage of life and type of chronic health problems.

Similarly, I think it’s useful to sketch out the types of help that people seek from the healthcare system. So far I’ve come up with seven.

But before I share them, let’s step back and consider the big picture of health care.

What’s the point of health care and our healthcare system?

The overarching purpose of health care, and the overall thing people want from healthcare, is:

To optimize the ability to participate in life, today and in the future.

This is the underlying reason that people want help with their health.
(What is health? See my practical definition here, and yes I’m still hoping for feedback on it!)

Just what it takes help optimize a person’s abilities depends on the details of their health situation. For instance, for a person who has recently suffered a stroke, it might be things like speech therapy and physical therapy to optimize function, adaptive equipment and home modifications to facilitate getting around safely, treatment of post-stroke depression, and medical management to reduce the risk of a future stroke.

7 ways the healthcare system helps people with their health

[Read more…]