GeriTech

In Search of Technology that Improves Geriatric Care

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

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

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…] about The geriatrician & social media: On goals & motivations

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…] about Epic Medication Reconciliation Fail: A True Story

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…] about Physician Autonomy vs Patient Participation & Information