NCMB314 Care Of Older Adults PDF

NCMB314: CARE OF OLDER ADULTS WEEK 13: RESEARCH AGENDA ON AGING PROFESSOR: DR. CAROLINE V. SAN DIEGO | OLFU VAL COLLEGE OF NURSING 3RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: JHON OLIVER MARFE OUTLINE dependent...

NCMB314: CARE OF OLDER ADULTS WEEK 13: RESEARCH AGENDA ON AGING PROFESSOR: DR. CAROLINE V. SAN DIEGO | OLFU VAL COLLEGE OF NURSING 3RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: JHON OLIVER MARFE OUTLINE dependent elderly I. OLDER ADULT population. II. DEMOGRAPHICS OF AGING They might not have the III. ALL NATIONS HAVE AN AGING necessary institutions POPULATION and financial systems in IV. FUTURE OLD (BABY BOOMERS) place (e.g., efficient V. NATIONAL: NIH PUBLICATION and well-managed a. Objective pension and healthcare b. Study Setting programs) c. Study Design d. Principal Findings FUTURE OLD (BABY BOOMERS) e. Conclusions VI. INTERNATIONAL: UN PROGRAM ON Born between 1946 and 1964 AGING High-tech orientation a. Expert Group Meeting on Global Most have children, but a low birth rate means Ageing and the Data Revolution fewer biological children to assist them in old b. Description age VII. AGEING, OLDER PERSONS AND THE 2030 Their income tends to be higher than other AGENDA FOR SUSTAINABLE DEVELOPMENT groups VIII. TERMINOLOGIES Their leisure time is scarcer than other adults; they are more likely to feel stressed OLDER ADULT They exercise more frequently than other adults Young Old – 60 to 74 Healthier old age attainable for baby-boomers Middle Old – 75 to 84 Informed and Educated Old Old – 85 and older Presently: 12.8% of population They are the best-educated generation ever 2030: Will increase to 20% of population The toughest challenge for healthcare is looking everything up on the internet and DEMOGRAPHICS OF AGING coming in “knowing” their condition Must help them sort out what is right for them In 2005, 13% of the U.S. population was over 60 o 18.3 million aged 65-74 Predictions for Baby-boomers o 12.9 million aged 75-84 They will have a highly active role in their health o 4.7% aged 85 or older care This number is estimated to increase: Their ability to access information will keep o To 20 million in 2010 (6.8% of total) them informed o To 30 million in 2030 (9.2%) They will not be satisfied with the conditions of o To almost 50 million in 2050 (11.6%) today’s nursing homes By mid-21st century, old people will outnumber Current nursing homes will not work for this young people for the first time in history generation ALL NATIONS HAVE AN AGING POPULATION Their blended families may need special assistance with caregiving demands The greatest increases will be in developing Coordinating care with family members will countries pose a problem as a family is typically spread o Asian countries have less time to throughout the country prepare for aging because aging occurs more rapidly than economic NATIONAL: NIH PUBLICATION growth. 2030 Problems on Caring for Aging Baby Boomers ▪ Adequate healthcare services for the elderly may simply be OBJECTIVE beyond the reach of many Asian countries To assess the coming challenges of caring for They may not be able to large numbers of frail elderly as the Baby Boom afford a large generation ages. JHON OLIVER MARFE 1|NCMB314 WEEK 13: RESEARCH AGENDA ON AGING STUDY SETTING the challenge of assuring that sufficient resources and an effective service system are A review of economic and demographic data available in thirty years when the elderly and simulations of projected socioeconomic population is twice what it is today. Much of this and demographic patterns in the year 2030 growth will be prompted by the aging of the form the basis of a review of the challenges Baby Boomers, who in 2030 will be aged 66 to related to caring for seniors that need to be 84—the “young old”—and will number 61 faced by society. million people. In addition to the Baby STUDY DESIGN Boomers, those born before 1946—the “oldest old”—will number 9 million people in 2030. A series of analyses are used to consider the This paper assesses the economic dimensions challenges related to caring for elders in the of the 2030 problem. The first half of the paper year 2030: reviews the literature and logic that suggest 1. Measures of macroeconomic burden that aging in general, and long-term care are developed and analyzed services in particular, will represent an 2. The literature on trends in disability, overwhelming economic burden on society by payment approaches for long-term 2030. Then, a new analysis of burden is care, healthy aging, and cultural views presented to suggest that aggregate resources of aging are analyzed and synthesized should not be a major issue for the midcentury 3. Simulations of the Baby Boom economy. Finally, the paper presents four key generation's future income and asset challenges that represent the real economic patterns are developed. burden of long-term care in the twenty-first century. These challenges are significant but PRINCIPAL FINDINGS different from macro cost issues. The economic burden of aging in 2030 should What type of economic burden might be be no greater than the financial burden of considered overwhelming? Existing literature raising large numbers of baby boom children in never explicitly defines this but the sense is that the 1960s. The real challenges of caring for the the burden might be considered elderly in 2030 will involve: overwhelming if: (a) tax rates need to be raised 1. Making sure society develops payment dramatically, (b) economic growth is retarded and insurance systems for long-term due to high service costs that preclude other care that work better than existing ones social investments, or (c) the general well- 2. Taking advantage of advances in being of future generations of workers is worse medicine and behavioral health to than that of current workers due to service keep the elderly as healthy and active costs and income transfers. as possible The discussion has significant implications for 3. Changing the way society organizes public policy and private actors focused on community services so that care is more developing an effective care system for the accessible mid-twentieth century. Public policy goals 4. Altering the cultural view of aging to related to an aging society must balance the make sure all ages are integrated into need to provide adequate services and the fabric of community life. transfers with an interest in maintaining the economic and social well-being of the CONCLUSIONS nonelderly. The economic challenges To meet the long-term care needs of Baby discussed are such that public and private Boomers, social and public policy changes progress that begins shortly will make the future must begin soon. burden substantially easier to handle. Meeting the financial and social service INTERNATIONAL: UN PROGRAM ON AGING burdens of growing numbers of elders will not be a daunting task, if necessary, changes are The UN Programmed on Ageing is part of the made now rather than when Baby Boomers Division for Inclusive Social Development (DISD), need long-term care. United Nations Department of Economic and Keywords: Long-term care, financing, Baby Social Affairs (UNDESA). Boomers, community-based delivery system It is the focal point within the United Nations A major public policy concern in the long-term system on matters related to aging. care field is the potential burden an aging As the focal point, its primary action is to society will place on the caregiving system and facilitate and promote the Madrid public finances. The “2030 problem” involves JHON OLIVER MARFE 2|NCMB314 WEEK 13: RESEARCH AGENDA ON AGING International Plan of Action on Ageing, DESCRIPTION including designing guidelines for policy The concept of National Sustainable development and implementation; Development Strategy (NSDS) was proposed in advocating means to mainstream aging 1992 in Agenda 21 (§ 8.7) where countries were issues into development agendas; called upon to integrate economic, social, engaging in dialogue with civil society and and environmental objectives into one the private sector; and information strategically focused blueprint for action at the exchange. national level. EXPERT GROUP MEETING ON GLOBAL AGEING AND The NSDS “should be developed through the THE DATA REVOLUTION widest possible participation”. And it “should be based on a thorough assessment of the Population aging has profound implications for current situation and initiatives”. In the many facets of human life. An aging Programmed for the Future Implementation of population will affect everything from Agenda 21 adopted at the 19th Special economies, and labor markets to health and Session of the General Assembly (23-28 June social care. This prospect requires a better 1997), Member States reaffirmed the understanding of the implications and importance of NSDS and set a target of 2002 for possibilities posed by population aging as well the formulation and elaboration of NSDS that as the situation of older persons themselves. reflect the contributions and responsibilities of While the older population is growing at an all interested parties. accelerated speed, many gaps in aging- However, by 2002, based on national reports related statistics and data exist, affecting the received from governments, only about 85 ability to develop targeted policies and countries had developed some form of programs that address aging-related national strategies and the nature and challenges. effectiveness of these strategies varied Recently, demand for evidence-based data considerably from country to country. The and statistics on older persons has been Johannesburg Plan of Implementation (JPOI) generated by the negotiations on the Post- adopted at the 2002 World Summit on 2015 Development Agenda. To implement a Sustainable Development (WSSD), through comprehensive Post-2015 Development paragraph 162 b, recommitted the Member Agenda, efforts to define a strategic States to “take immediate steps to make framework for statistics under the so-called progress in the formulation and elaboration of ‘transformative agenda for statistics’, point at national strategies for sustainable integrating and broadening the scope of development and to begin their statistics and data collection. The agenda implementation by 2005.” introduces innovations to incorporate non- During the preparatory process for the 2002 traditional sources that so far have not been WSSD, the International Forum on NSDS was utilized in official statistics. These developments held in Accra, Ghana in 2001, which led to the provide an opportunity for addressing the gaps launch of the Guidance in Preparing a and needs posed by aging. National Sustainable Development Strategy. It In this context, the Focal Point on Ageing is defined the National Sustainable Development organizing an Expert Group Meeting on Strategy (NSDS) as “a coordinated, “Global aging and the data revolution – the participatory and iterative process of thoughts way forward in the post-2015 environment” in and actions to achieve economic, New York on 7-9 July 2015. The meeting aims to environmental and social objectives in a explore how and which new and non- balanced and integrative manner”. Most traditional data sources can support the policy importantly, NSDS is a call for institutional and programmed development on aging change. It aims at a transition from the issues. The outcome of the EGM seeks to traditional static putting-a-plan-on-paper respond to the need for sound aging-related exercise towards the establishment of an statistics and data as well as the needs that will adaptive system that can continuously arise from the targets contained in the improve. It should be a process that Sustainable Development Goals and the Post- “encompasses situation analysis, formulation of 2015 environment. policies and action plans, implementation, monitoring, and regular review. It is a cyclical and interactive process of planning, participation, and action in which the JHON OLIVER MARFE 3|NCMB314 WEEK 13: RESEARCH AGENDA ON AGING emphasis is on managing progress towards many older persons in the implementation of sustainability goals rather than producing a the new agenda, it is even more important to ‘plan’ as a product.” go beyond treating older persons as a Every country needs to determine, for itself, vulnerable group. Older persons must be how best to approach the preparation and recognized as the active agents of societal implementation of its national sustainable development to achieve truly transformative, development strategy depending upon the inclusive, and sustainable development prevailing political, historical cultural, and outcomes. The current brief acknowledges the ecological circumstances. A "blueprint" importance of a life-course approach to aging approach for national sustainable and calls for protecting and promoting the development strategies is neither possible nor rights of older persons in the implementation of desirable. The label applied to a national the 2030 Agenda. sustainable development strategy is not Older persons are important actors in communities, important, if the underlying principles making key contributions in the following characterizing a national sustainable interrelated areas: development strategy are adhered to and that economic, social, and environmental 1. Economic Development objectives are balanced and integrated. Older persons make substantial contributions to Today, when incorporating the 2030 Agenda the economy through participation in the for Sustainable Development and its 17 SDGs formal or informal workforce (often beyond into a national context, although countries do retirement age), taxes and consumption, not necessarily label them as “national transfers of assets and resources to their families sustainable development strategies”, all the and communities, and their broader retention underlying core principles are deeply in the workforce (among those who wish or embedded in the national implementation of need to continue working) has the potential to SDGs worldwide. As seen in the Voluntary enhance labor productivity. National Reviews at the High-Level Political Today more older persons are contributing to Forum on Sustainable Development, issues an entrepreneurial ecosystem (Lee 2017), while such as country ownership and strong political embracing new technologies, by providing commitment, the integration of economic, services through digital platforms, car or social, and environmental objectives across accommodation sharing, and peer-to-peer sectors, territories, and generations; broad lending. participation and effective partnerships, the In the contexts affected by the absence of development of capacity and enabling breadwinners, migration, disease outbreaks, environment, as well as the mobilization of and conflicts, older persons’ work can be the means of implementations remain at the only source of monetary or in-kind income to center of policy debates at all levels. sustain families. AGEING, OLDER PERSONS AND THE 2030 AGENDA 2. Unpaid Care Work FOR SUSTAINABLE DEVELOPMENT Older persons, particularly older women, play a The 2030 Agenda for Sustainable Development vital role in providing unpaid care for spouses, sets out a universal plan of action to achieve grandchildren, and other relatives, including sustainable development in a balanced those with disabilities (UNFPA and HelpAge manner and seeks to realize the human rights International 2012). of all people. It calls for leaving no one behind Furthermore, with changes in family structures, and for ensuring that the Sustainable the HIV/AIDS pandemic, and growing Development Goals (SDGs) are met for all migration, grandparents have become central segments of society, at all ages, with a and indispensable to the well-being of families, particular focus on the most vulnerable— especially in the absence of public care and including older persons. Preparing for an aging other social services. population is vital to the achievement of the integrated 2030 Agenda, with aging cutting 3. Political Participation across the goals of poverty eradication, good With variation across contexts, older persons in health, gender equality, economic growth, some countries, notably in advanced decent work, reduced inequalities, and democracies, can carry significant weight sustainable cities. Therefore, while it is essential which is mostly associated with the to address the exclusion and vulnerability of— concentration of economic resources and a and intersectional discrimination against— JHON OLIVER MARFE 4|NCMB314 WEEK 13: RESEARCH AGENDA ON AGING tradition of political participation (UNDESA 2007). As older persons continue to constitute an ever-greater proportion of the total population, they have the potential to be more influential in society. This can have important implications for social, economic, and political outcomes in those countries (progressive but also regressive), as older persons tend to vote in greater numbers than young people (Goerres 2009) and are increasingly forming their associations such as lobbying groups, political parties and grassroots organizations (UNFPA and HelpAge International). 4. Social Capital Many older persons tend to be actively involved in community and civic life through volunteering, governance of public institutions, and participation in community-based institutions. This can contribute to strengthening social capital in terms of facilitating cooperation and improving interactions within and between groups based on shared values, trust, and solidarity (OECD 2007). Older generations are also often the important sources of historical memory and wisdom, guardians of culture, and repositories of social traditions and rare knowledge and skills, which can critically complement those of young people. TERMINOLOGIES NIH (National Institute of Health) – The steward of medical and behavioral research for the Nation. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. JHON OLIVER MARFE 5|NCMB314 NCMB314: CARE OF OLDER ADULTS WEEK 14: TRENDS/ISSUES AND CHALLENGES OF THE CARE OF THE OLDER PERSONS PROFESSOR: DR. CAROLINE V. SAN DIEGO | OLFU VAL COLLEGE OF NURSING 3RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: JHON OLIVER MARFE OUTLINE GERONTOLOGIC NURSE I. EDUCATIONAL TRENDS IN GERONTOLOGICAL NURSING The nurse must meet all the following a. Gerontologic Nurse requirements: b. Gerontologic Nurse Practitioner Currently, hold an active registered c. Clinical Specialist in Gerontologic nurse license in the US or its Nursing territories. d. Life Care Planning Hold a baccalaureate or higher e. Certification degree in nursing. f. Future Potential Have practiced 2000 hours within g. Financial Gerontology the past 3 years i. Chartered Advisor for Senior Have had 30 contact hours of Living (CASL) continuing education applicable to ii. Registered Financial gerontology/Gerontologic nursing Gerontologist (RFG) within the past 3 years. iii. Certified Senior Advisor (CSA) h. Recent Trends in Health Promotion GERONTOLOGIC NURSE PRACTITIONER and Disease Prevention Activities II. TRENDS IN LONG-TERM CARE The nurse must meet the following III. LONG-TERM CARE INSURANCE requirements: IV. EMERGING MODELS OF CARE Currently, hold an active RN license in a. A Shift to Different Living Facilities the US or its territories V. CONTINUING CARE RETIREMENT Hold a master’s or higher degree in COMMUNITIES (CCRCs) nursing. VI. COMMUNITY LIVING DESIGNS Have been prepared as a nurse VII. TERMINOLOGIES practitioner in either of the following: ▪ A GNP master’s degree in EDUCATIONAL TRENDS IN GERONTOLOGICAL Program NURSING ▪ A formal postgraduate GNP Opportunities in gerontological nursing are track or program Within a somewhat correlated with education level. school of nursing granting Many levels of preparation are available for graduate-level academic nurses in gerontology such as: credit o Special education in caring for adults CLINICAL SPECIALIST IN GERONTOLOGIC NURSING during basic preparation (LPN, RN associate degree, diploma RN, or RN The nurse must meet all the following BSN level). requirements: o Post baccalaureate nurses choose a Currently, hold an active RN license in Clinical Nurse Specialist (CNS) or the United States or its territories Geriatric Nurse Practitioner (GNP) Hold a master’s or higher degree in o Online programs for graduate or post- gerontologic nursing master study and complete clinical Hold a master’s or higher degree in hours in their geographic location nursing with a specialization in o Certifications in gerontology currently gerontologic nursing. available from the American Have practiced a minimum of 12 Association of Colleges of Nursing months after completion of the (AACN) master’s degree o Working in long-term care facilities such Meet the following requirements in current as nursing homes, assisted living, practice: independent living centers, adult day If a clinical specialist must have care, or an acute care hospital. provided a minimum of 800 hours (post- masters) of direct client care or clinical management in Gerontologic Nursing within the past 24 months JHON OLIVER MARFE 1|NCMB314 WEEK 14: TRENDS, ISSUES AND CHALLENGES OF THE CARE OF THE OLDER PERSONS If a consultant, researcher, educator, or A good financial planner could provide a more administrator, must have provided a accurate and detailed projection of health minimum of 400 hours care cost over a lifetime of disability or illness. The demand for professionals in gerontology LIFE CARE PLANNING and rehabilitation is likely to grow quickly with The concept of life care planning was first the aging baby boomer group. developed in the 1980s, to meet a growing Gerontological nurses combine their need for an informed document that knowledge in health care with some financial presented actual estimated costs of care for training to offer distinctive services to the older persons who had experienced a catastrophic age group. injury or accident. FINANCIAL GERONTOLOGY Many settlements for those persons in devastating accidents were made arbitrarily Financial gerontology is a growing subfield of without actual calculation and consideration financial planning. of the multitudes of factors influencing these FG is defined as “The intellectual intersection of costs, such as doctors’ visits, equipment, two fields, gerontology and finance, each of medications, tests, cost of caregiving, and which has practitioner and academic potential complications over a lifetime. components” which combines the knowledge LCP is a comprehensive document designed to and skills associated with financial planning help meet the long-term financial and health and asset management with expertise in needs of a person who experienced a meeting the unique needs of older adults. catastrophic injury. Certification for FG: Life care planners generally develop plans for Chartered Advisor for Senior Living (CASL) insurance companies or lawyers representing individual clients, but the goal is to promote the A person with CASL certification assists older best outcome for the person for whom the life persons with retirement savings, pension and care plan was written. social security planning, health and long-term The best life care planners have a nearly equal issues, estate planning, and managing life mix between work for insurance carriers and course transitions, family relationships and living work for lawyers who present patients, thus arrangements. maintaining a neutral and professional A person must complete five courses that take reputation for fairness. approximately 60-80 hours of study each. After the course the individual must pass a CERTIFICATION computerized exam. The Certified Life Care Planner (CLCP) Maintenance of the certification with designation may be earned through 128 continuing education credits. continuing education hours, successful A code of ethics must also be agreed to in completion of a sample life care plan, and writing before being granted the designation. passing an examination (MediPro Seminars, Registered Financial Gerontologist (RFG) 2004). The CNLCP (Certified Nurse Life Care Planner) The RFG certifications are a similar designation designation is offered by the American to the CASL but are offered through the Association of Nurse Life Care Planners American Institute of Financial Gerontology Certification Board. and supported by the American Society on It is like CLCP, but with additional requirements, Aging. and is designed for registered nurses with case The Individual must complete six courses, a management experience learning requirement, and a comprehensive examination. Course content is related to FUTURE POTENTIAL wealth span planning, ethics, and serving older Life care planning may be a concept that will adults. be carried into the senior population. Compared to CASL courses, the curriculum Not only are seniors living longer, but they appears more suited to gerontologists than continue participating in higher-risk activities financial planners. today than in generations past. Certified Senior Advisor (CSA) The principles of life care planning could also easily be extrapolated for use with those seniors The CSA is a designation offered by the Society who have long-term chronic health problems. of Senior Advisors. JHON OLIVER MARFE 2|NCMB314 WEEK 14: TRENDS, ISSUES AND CHALLENGES OF THE CARE OF THE OLDER PERSONS The curriculum includes many topics in aging, The cost of long-term insurance premiums (at chronic illness, end of life, and long-term care age 65) ranges from $1,000-$2,650 per year, as well as Medicaid and financial planning. depending upon several factors including It is a self-study program that takes 2-6 months health status and history. The average stay in a to complete. nursing home is 2 years. The average cost for a To obtain the CSA, the person must also pass a private room in a nursing home in 2003 was secured, computerized, final comprehensive $181.24/day (National Council in aging, 2005). examination online that consists of 150 multiple- This average cost increase to $194/day by 2006 choice questions within 3 hours. (over $70,000/year), though costs vary widely by geographic area. Assisted living facilities RECENT TRENDS IN HEALTH PROMOTION AND average $2,691/month for a one-bedroom DISEASE PREVENTION ACTIVITIES unit. Financial analysts predict that if nursing Such as: home care costs rise a bit faster than inflation, o Improved nutrition by 2026 a room in a nursing home could cost $ o Decreased smoking 177,000 per year; another cost projected the o Increased exercise cost to increase to $ 200,000 per year by 2030. o Early detection & treatment of risk Long-term care insurance can be purchased factors such as hypertension and at any time, but premiums increase with age. elevated serum cholesterol levels In, 2005, the annual premiums for a low-option policy for a person who was age 65 was about TRENDS IN LONG-TERM CARE $1,800 and increased to about $5,500 at age 79. Long-term care insurance may cover any Long-term care is the “broad range of medical, one or all the following types of care. custodial, social, and other care services that o Nursing Home care assist people who have an impaired ability to o Assisted living live independently for an extended period”. o Hospice The National Council on aging estimates that o Home health 6.4 million people all over the age of 65 and o Adult day care 50% of those over age 85 will need long-term o Respite care. o Caregiver training Thirteen million persons in the United States o Home health care coordinators currently report having long-term health needs. This number is expected to grow to 22 million in EMERGING MODELS OF CARE the next decades. A SHIFT TO DIFFERENT LIVING FACILITIES The nation spent $ 183 billion on long-term care services in 2003 (American Health Care One of the most significant changes in care for Association & National Center for Assisted older adults is the shift away from nursing Living, 2005). homes. As they have known traditionally. Some In 2005, Medicaid spent nearly $95 billion on predict that the only nursing homes that will long-term care. survive will be excellent ones. Persons must pay for many long-term care The institutional look of the older nursing home expenses from their savings and assets before that was modeled after the hospital, with long being eligible for Medicaid. hallways and a sterile-looking environment, is This has prompted new sources of funding for becoming unacceptable to many older adults future long-term healthcare needs. as a place to live out their final days. Newer long-term care facilities promote LONG-TERM CARE INSURANCE private rooms, residents’ choices and control, and a more home-like environment that mirrors Long–term care insurance is designed to cover the assisted living facilities of today. individuals needing health care outside of the hospital, including diagnostics testing, CONTINUING CARE RETIREMENT COMMUNITIES rehabilitation, and custodial care. Reasons for (CCRCs) purchasing long-term care insurance includes worrying about being a burden to their family, Growing trend for older adults, services by staying financially independent, having more promoting aging in place through offering choices for care if needed (such as remaining various levels of care on a continuum that in the home), preserving their assets, and might include independent living, assisted providing peace of mind. living, skilled care, and home health services all on one campus. The trend will be to bring JHON OLIVER MARFE 3|NCMB314 WEEK 14: TRENDS, ISSUES AND CHALLENGES OF THE CARE OF THE OLDER PERSONS services to the CCRCs versus transferring COMMUNITY LIVING DESIGNS persons to the next level of care on the Another fascinating trend related to continuum (for example, sending them to the gerontological Nursing is the emergence of “nursing home” when their care demands companies completely devoted to the increase). strategic planning, engineering, architecture, Green Houses building, and marketing of community living A movement to replace nursing homes with more designs that are tailored to today’s older home-like environments started through the vision adults. of a physician named Bill Thomas, consisting of 10- Older adults who choose to live in senior 12 residents in a home setting who enjoy private communities expect to have access to rooms and share a common living space. This transportation and needed services such as design provides a full range of care services, but in health care, appropriate housing, and a friendly atmosphere that reminds one of home. opportunities for socialization. Baby boomers are predicted to live in Geriatric Care Management suburban communities versus urban or rural Another emerging trend in gerontological nursing areas (Frey 2007), so the need for age- is the role of the geriatric care manager. The appropriate and friendly retirement Professional Geriatric Care Manager (PGCM) is a communities is projected to increase. Lehning, specialist who helps families care for older adults Chun, and Scharlach (2007) stated that: while encouraging as much independence as o An aging–friendly community has three possible. PGCMs may come from a variety of primary characteristics: 1) age is not a backgrounds such as social work, and psychology. significant barrier to the maintenance In sociology, geriatrics, and nursing, nurses have of life-long interests and activities; 2) emerged as natural leaders in this growing field. supports and accommodations exist to The educational background knowledge of the enable individuals with age-related aging process makes this role an excellent fit for disabilities to meet basic health and nurses who seek a position that affords social needs; and 3) opportunities exist independence and autonomy while using their for older adults to develop new sources skills. of fulfillment and engagement. Despite the need for such communities, PGCM performs the following: shortfalls in public policy and lack of creativity ✓ Conduct assessments in architecture have led to structural barriers ✓ Develop care plans that address pertinent related to the best use of land, housing policies, problems transportation, and opportunities for ✓ Arrange, interview for, and monitor in- involvement in the larger community. There home caregivers or other services remains a general lack of concern and ✓ Act as a consultant for caregivers who live investment in suburban communities in near or far providing housing for the aging portion of their ✓ Review financial, health-related, or legal citizens. This has created a gap in service that issues potentially can be filled by forward-thinking ✓ Provide referrals to other geriatrics companies that recognize the plight of long- specialists term care in this area and stand ready to assist. ✓ Intervene in times of crisis One such example of a company developed ✓ Act as an advocate and/ or liaison to assist organizations with designing and between families and service providers building appropriate and age-friendly living ✓ Coordinate or oversee care spaces is Community Living Solutions (2008) of ✓ Assist with transitions in living arrangements, Neenah, Wisconsin. This company advertises its including recommending the most purpose as “enlightening your life and appropriate settings and helping facilitate community with expert knowledge and the move sustainable solutions”. With a unique team of ✓ Provide education and links to resources professionals that includes engineers, ✓ Offer counseling and support architects, and other design experts, ✓ Some PGCMs also offer guardianship, companies such as Community Living Solutions caregiving, and/or financial services. work with organizations such as continuing care retirement communities (CCRCs), independent living facilities, and assisted living design and build attractive, contemporary JHON OLIVER MARFE 4|NCMB314 WEEK 14: TRENDS, ISSUES AND CHALLENGES OF THE CARE OF THE OLDER PERSONS living areas within a fiscally responsible budget. The ideal team takes into consideration the mission and needs of the community and understands the unique limitations and desires of their older clientele. A great deal of thought and effort goes into designing an environment that will be attractive and functional for older adults, and marketable for the institution. Attention to detail such as positioning of garden areas and windows to best use the space and sunlight is essential, and the savvy builder carefully plans all aspects of the environment with consideration to older residents. TERMINOLOGIES Gerontological Nursing - is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. JHON OLIVER MARFE 5|NCMB314 NCMB314: CARE OF OLDER ADULTS WEEK 15: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER PERSON PROFESSOR: DR. CAROLINE V. SAN DIEGO | OLFU VAL COLLEGE OF NURSING 3RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: JHON OLIVER MARFE OUTLINE ✓ Transitioning between aged care I. ADVOCACY PROGRAMS RELEVANT TO THE services CARE OF OLDER PERSONS ✓ Knowing and understanding their rights a. Advocacy Services ✓ Making decisions about the care they b. Who Can Access Advocacy receive Services? ✓ Options for having their aged care c. Legal Advocacy needs better met II. HEALTHY PEOPLE INITIATIVES ✓ Resolving concerns or complaints with a. Healthy People 2020 the aged care provider about the b. Healthy People 2020 Goals services they receive c. Healthy People 2020 Law and Health Policy ✓ Speaking with their service provider at III. ADVANCING PUBLIC HEALTH THROUGH their direction LAW AND POLICY ✓ Increasing their skills and knowledge to IV. LAW AND HEALTH POLICY RESOURCES advocate for themself. V. MODEL HEALTH PROMOTION PROGRAMS FOR OLDER ADULTS WHO CAN ACCESS ADVOCACY SERVICES? VI. SIX MODEL HEALTH PROMOTION Anyone who is receiving or seeking to receive PROGRAMS government-funded aged care services, a. Healthwise including family and representatives, is entitled b. Chronic Disease Management c. Project Enhance to access advocacy services. This includes d. Ornish Program for Reversing Heart people who: Disease ✓ Live in an aged care home e. Benson’s Mind/Body Medical ✓ Receive aged care services in their own Institute home f. Strong for Life ✓ Receive transition care VII. TERMINOLOGIES ✓ Are helping someone who is receiving aged care services. ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER PERSONS LEGAL ADVOCACY The role of an advocate in health and social A recognized strategy to address social factors care is to support a vulnerable or that influence the health of populations with disadvantaged person and ensure that their complex care needs. Such advocacy can rights are being upheld in a healthcare improve housing stability, increase access to public context. benefits that support a host of social needs, assure Health and social care advocacy means that medical and financial proxy decision-makers supporting people who are unable to ensure are in place, and reduce psychosocial distress. their best interests are being taken care of. Older adults are disproportionately likely to In the medical profession, activities related to have complex medical needs. Legal ensuring access to care, navigating the system, advocacy has been recognized as integral mobilizing resources, addressing health to the health and health care of older inequities, influencing health policy, and adults in the medical literature since 1988, creating system change are known as health and in current Medicare quality metrics. advocacy. Additionally, since 1965, the Older ADVOCACY SERVICES Americans Act has provided legal assistance as an “essential service” among Advocacy services support the rights of other aging supports such as nutrition, anyone receiving or seeking to receive aged transportation, and in-home care. Under care services and empower older people to the act, state area agencies on aging must make informed decisions about their care. An provide legal services free to adults older aged care advocate can assist with things like: than age 60 with the “greatest social or ✓ Interacting with the aged care system economic need.” JHON OLIVER MARFE 1|NCMB314 WEEK 15: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER PERSON Yet, while emerging care models for older and as such they recognize the complexity of adults with complex needs are highly the socioeconomic, lifestyle, and other multidisciplinary, none incorporate legal nonmedical influences that impact our ability advocacy in their design. This is in some to attain and maintain health. ways not surprising as clinicians are not HEALTHY PEOPLE 2020 trained to recognize or address the legal needs of older patients, and older patients Healthy People 2020 was the fourth iteration of are unable to self-diagnose their legal the Healthy People initiative. Launched in problems, thus making it unlikely that they December 2010, Healthy People 2020 set an will articulate legal needs as such to health ambitious yet achievable 10-year agenda for care providers, social workers, or case improving the nation’s health. managers. In addition, funding mechanisms for health Vision care and social services—especially civil The vision for Healthy People 2020 was “a society in legal services—are highly soloed and which all people live long, healthy lives.” deeply asymmetrical. Historical underinvestment in civil legal services for Its Mission was to: the poor has led to a shortfall in the legal o Identify nationwide health improvement workforce serving this population. This may priorities provide another explanation for why legal o Increase public awareness and advocacy has not been particularly visible understanding of the determinants of health, to health systems: Legal advocates are disease, and disability and the opportunities focused on emergency legal needs such for progress as loss of housing, neglect and exploitation, o Provide measurable objectives and goals and loss of public benefits. Although these that are applicable at the national, state, needs could be better served through and local levels preventive and primary legal advocacy o Engage multiple sectors to take actions to delivered holistically in coordination with strengthen policies and improve practices other social services and health care, that are driven by the best available funding levels have not enabled such an evidence and knowledge approach. o Identify critical research, evaluation, and data collection needs HEALTHY PEOPLE INITIATIVES HEALTHY PEOPLE 2020 GOALS The federal government has been establishing goals for healthy aging since 1980 when the Attain high-quality, longer lives free of U.S. Public Health Service published the report preventable disease, disability, injury, and Promoting Health/ Preventing Disease premature death Objectives for the Nation. This 1980 report Achieve health equity, eliminate disparities, outlined 226 objectives for the nation to and improve the health of all groups achieve over the following 10 years. It was Create social and physical environments that referred to by some as Healthy People 1990. promote good health for all A decade later, in 1990, another 10-year Promote quality of life, healthy development, national effort, Healthy People 2000, was and healthy behaviors across all life stages initiated by the U.S. Public Health Service in HEALTHY PEOPLE 2020 LAW AND HEALTH POLICY another effort to reduce preventable death and disability for Americans. A third effort is The Healthy People 2020 Law and Health Policy currently underway with the Healthy People project aimed to raise awareness of the impact 2010 initiative; however, the number of that legal or policy interventions can have on objectives has increased to 467, and these are public health. The project was a partnership distributed over 28 priority areas. between ODPHP, CDC, the CDC Foundation, There are some notable benefits to the Healthy and the Robert Wood Johnson Foundation. People initiatives. On the positive side, these These organizations worked with subject matter initiatives give recognition to health promotion experts and federal stakeholders to create rather than focusing exclusively on wars on reports, webinars, and products to highlight disease (e.g. tabulating the number of deaths laws and policies with the potential to impact from cancer or heart disease, and then specific Healthy People 2020 topic areas and organizing a campaign against them). The objectives. Healthy People initiatives are health-oriented, JHON OLIVER MARFE 2|NCMB314 WEEK 15: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER PERSON ADVANCING PUBLIC HEALTH THROUGH LAW AND 1. HEALTHWISE POLICY The best-known older adult medical self-care Law and policy are among the most effective program is Healthwise. It provides information tools to improve health. Many of the greatest and prevention tips on 190 common health public health successes in the United States are problems, with information periodically the result of legal or policy interventions, such updated. The Healthwise Handbook as smoke-free air laws and mandatory seatbelt (Healthwise, 2006) is now in its 17th edition. This laws. Yet many people may not be aware of handbook includes physician-approved the precise impact these interventions and guidelines on when to call a health professional approaches can have on population health. for each of the health problems it covers. With the assistance of a $2.1 million grant from LAW AND HEALTH POLICY RESOURCES the Robert Wood Johnson Foundation, Project partners worked with subject matter Healthwise distributed its medical self-care experts and federal stakeholders to develop a guide to 125,000 Idaho households, along with series of Healthy People 2020 topic-specific toll-free nurse consultation phone service and reports, webinars, and other evidence-based self-care workshops. Thirty-nine percent of products such as infographics and success handbook recipients reported that the stories, or Bright Spots. These resources and handbook helped them avoid a visit to the publications highlight laws and policies with the doctor. Blue Cross of Idaho reported 18% fewer potential to impact specific Healthy People visits to the emergency room by owners of the 2020 topic areas and objectives, including guide. Leading Health Indicators. 2. CHRONIC DISEASE MANAGEMENT Review different resources produced by the Law Kate Lorig, a nurse-researcher at the Standford and Health Policy project: University School of Medicine, and her medical ✓ Disability and Health colleagues have been evaluating community- ✓ Healthcare-Associated Infections based, peer-led, chronic disease self- ✓ Health Equity management programs for more than two ✓ Healthy People 2030 decades, beginning with the Arthritis Self- ✓ Leading Health Indicators Management Program (Lorig et al.,1986) This ✓ Maternal, Infant, and Child Health program has since evolved into a curriculum ✓ Mental Health and Mental Disorders that applies to a wide array of chronic diseases ✓ Nutrition and Weight Status and conditions. ✓ Oral Health Typically, each program involves about a ✓ Policy Levers dozen participants, led by leaders who have ✓ Substance Abuse received 20 hours of training. The peer leaders, like the students, are typically older and have MODEL HEALTH PROMOTION PROGRAMS FOR chronic diseases that they contend with. The OLDER ADULTS program consists of six weekly sessions about 2 One of the more recent efforts in this regard has ½ hours long each, with a content focus on been organized by the Health Promotion exercise, symptom management, nutrition, Institute (HPI) of the National Council on Aging. fatigue and sleep management, use of HPI started by summarizing 16 model programs medications, managing emotions, community or best practices and compiling them into a resources, communicating with health loose-leaf directory. professionals, problem-solving, and decision The summaries included information on the making. The program takes place in planning process, implementation of the community settings such as senior centers, program, and program evaluations. churches, and hospitals. The theoretical basis of the program has been SIX MODEL HEALTH PROMOTION PROGRAMS to promote a sense of personal efficacy Six model health promotion programs that among participants by using such techniques have been focused on older adults and have as guided mastery of skills, peer modeling, received national attention, received federal reinterpretation of symptoms, social persuasion funding and foundation support to evaluate through group support, and individual self- their effectiveness and to encourage their management guidance. replication. JHON OLIVER MARFE 3|NCMB314 WEEK 15: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER PERSON 3. PROJECT ENHANCE 6. STRONG FOR LIFE Senior Services of Seattle/King County began The Strong for Life Program is a home-based the Senior Wellness Project (later renamed exercise program for disabled and Project Enhance) in 1997 at the North Shore nondisabled older adults. It focuses on strength Senior Center in Bothell, Washington. It was a and balance and provides an exercise video, research-based health promotion program a trainer’s manual, and a user’s guide. The that included a component of chronic care program was designed by physical therapists self-management that was modeled after Kate for home use by older adults and relies on Lorig’s program (Lorig et al.,1999) The program elastic resistive bands for strengthening also included health and functional muscles. The exercise program led to a high assessments; individual and group counseling; rate of exercise adherence among older exercise programs; a personal health action participants, as well as increased lower plan with the support of a nurse, social worker, extremity strength, improvements in tandem and volunteer health mentor; and support gait, and a reduction in physical disability groups. A randomized controlled study of (Jette et al., 1999) chronically ill seniors reported a reduction in TERMINOLOGIES several hospital stays and average length of stay, a reduction in psychotropic medications, Advocacy - Public support for or and better functioning in activities of daily recommendation of a particular cause or living. policy. "Their advocacy of traditional family values" 4. Ornish Program for Reversing Heart Disease Dr. Dean Ornish, a physician at the University of California at San Francisco and founder of the Preventive Medicine Research Institute, has developed a program for reversing heart disease that has been replicated at several sites around the country. Dr. Ornish (1992) has recommended a vegetarian diet with a fat intake of 10% or less of total calories, moderate aerobic exercise at least three times a week, yoga and meditation an hour a day, group support sessions, and smoking cessation. Dr. Ornish and his colleagues have reported that because of their program, blockages in arteries have decreased in size, and blood flow has improved in as many as 82% of their heart patients (Gould et al.,1995). A five-year follow- up of this program reported an 8% reduction in atherosclerotic plaques, while the control group had a 28% increase. 5. BENSON’S MIND/BODY MEDICAL INSTITUTE Dr. Herbert Benson is a physician affiliated with Harvard Medical School, and best known for his best-selling books on the relaxation response and for popularizing the term mind/body medicine. For individuals feeling the negative effects of stress, Benson’s program teaches them to elicit a relaxation response, a Western version of meditation. The Benson-Henry Institute for Mind/Body Medicine’s clinical programs treat patients with a combination of response techniques, proper nutrition and exercise, and the reframing of negative thinking patterns. JHON OLIVER MARFE 4|NCMB314 NCMB314: CARE OF OLDER ADULTS WEEK 16: TELEHEALTH AND THE OLDER PERSON PROFESSOR: DR. CAROLINE V. SAN DIEGO | OLFU VAL COLLEGE OF NURSING 3RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: JHON OLIVER MARFE OUTLINE ✓ For older adults, there may be difficulties I. TELEHEALTH with light perception, sensitivity to glare, a. Sensory and Motor Changes reduced acuity, and impaired focus on b. Cognitive Changes nearby objects. c. Strategies for Providing Technology ✓ Discriminating between background noises Support becomes more difficult as we age, and d. Strategies for Establishing Rapport low-level sounds are muffled. And for some, II. USING TELEHEALTH TO CARE FOR THE there is an increased risk of developing ELDERLY Tinnitus, which can make certain sounds III. THE NEED FOR AFFORDABLE ELDERLY CARE difficult to discern. IV. HOW TELEHEALTH CAN IMPROVE ACCESS TO ELDERLY CARE ✓ There are also changes to muscle strength V. TELEHEALTH CAN HELP FAMILIES AND and tone that make muscles stiffer and less ELDERLY PATIENTS IN THE FOLLOWING COGNITIVE CHANGES WAYS VI. USING TELEHEALTH TO CARE FOR THE ✓ Most older adults experience some ELDERLY cognitive changes as a part of the normal VII. BENEFITS AND LIMITATIONS aging process, such as slowed speed of VIII. MENTAL HEALTHCARE PROVIDER, OLDER processing, difficulty in multitasking, and ADULTS, AND TELEHEALTH USAGE small declines in episodic memory, which IX. WHY IS MENTAL TELEHEALTH IMPORTANT FOR OLDER PATIENTS generally do not interfere with everyday functioning. However, many cognitive TELEHEALTH abilities, including semantic memory, reasoning, problem-solving, and executive Telehealth allows patients across the lifespan to functioning are preserved well into late life. receive care remotely in a manner that is often The relatively minor cognitive changes that more accessible and convenient than in- occur with aging should not prevent the person care. use of telehealth by older adults. A common misconception is that older adults ✓ Even adults who experience conditions have either no interest in the use of technology such as mild cognitive impairment (MCI) or cannot use technology platforms. can successfully learn new skills, especially Current data indicate otherwise; in fact, most if they use compensatory strategies like older adults (7 in 10) have and utilize a making notes or using reminders. This could computer, smartphone, or tablet with internet include making reminders about telehealth access at home. However, when it comes to appointment times in their calendar and the use of telehealth, there is limited reach using a series of written notes about how to among older adults (e.g., only 11% feel start their computer or tablet and launch a comfortable using telehealth). telehealth application. Beyond reimbursement limitations with health ✓ There are some older adults whose insurance, barriers to telehealth among older cognitive impairments may be too adults include provider misperceptions of advanced to use telehealth successfully interest, lack of telehealth training/orientation (for instance, in severe dementia). in older adults, and telehealth platforms that However, some older adults with mild forms do not account for the needs of older adults. of dementia can use telehealth effectively Here are some factors to consider and with some modifications or adjustments. For strategies to implement when providing instance, they may need a family telehealth to older adults. member’s assistance to set up the telehealth account or to get the telehealth SENSORY AND MOTOR CHANGES session started. ✓ Most older adults experience age-related changes in vision, hearing, touch, perception, mobility, and balance. Many of these declines begin at age 40. JHON OLIVER MARFE 1|NCMB314 WEEK 16: TELEHEALTH AND THE OLDER PERSON STRATEGIES FOR PROVIDING TECHNOLOGY patient. Be aware of noises such as HVAC, SUPPORT white noise generators, and other sounds, and seek to minimize these with the position ✓ Don’t assume older adults are uninterested of your equipment and the use of in telehealth. headphones. ✓ Just as you do with all patients, meet older ✓ To curb pain from muscle stiffness, ask your adults where they are and talk about the patient if they need movement pros and cons of telehealth. Provide a clear accommodations for their sessions (e.g., explanation of what to expect and let allow time for stretching, invite older adults them know that most people experience a to use items that may be of comfort like few “bumps” adjusting to new technology, heating pads, comfortable chairs, etc.). but you’ve been able to successfully work ✓ Providing an end-of-session summary of the with people with this modality. goals, reading, and exercises to be ✓ Providing technology support requires completed between sessions can be additional resources early in treatment but advantageous for all clients but especially avoids delays on the day of the valuable for older adults. appointment, so plan to provide additional instruction and individual tech support. STRATEGIES FOR ESTABLISHING RAPPORT Though telehealth platforms may not be ✓ Directly acknowledge that telehealth intuitive to older adults, many can sessions can feel awkward. Reassure older successfully use them. Contact the older adults that most people feel increasingly adult over the telephone before the comfortable over time. appointment to provide verbal instructions, ✓ Attempt to look directly at the camera as test the telehealth platform, and ensure the much as possible to mimic eye contact. older adult understands and is comfortable ✓ Use clarifying and reflective techniques to with the technology. Support staff may be avoid miscommunication and able to do this step. Additional benefits misinterpretation of the older adult’s include increasing older adults’ access to emotions. Clarify ambiguous body care and promoting treatment continuity language verbally with the by overcoming barriers to in-person acknowledgment that telehealth can sessions. make communication more difficult (e.g., ✓ Before the appointment, provide older “I want to make sure I understand how you adults with written instructions for using are feeling. Meeting over video can make telehealth (you may find this beneficial for that more difficult sense I can’t see you all your patients). Instructions that use completely. You seem to be frustrated—is concise language, a larger font size, and that how you are feeling?”). include screenshots of each step of the ✓ Implementing these strategies could process may be particularly helpful. increase the likelihood of older adults ✓ Older adults using telehealth technology successfully engaging in and benefiting will benefit from visual presentation from telehealth. modifications (e.g., raise display/screen illumination, and use matte surfaces USING TELEHEALTH TO CARE FOR THE ELDERLY instead of glossy surfaces). ✓ Auditory enhancements may also help the When we think of digital technology, we tend user experience (e.g., adjust volume to think of younger individuals using their settings, offer closed captioning options smartphones and other digital devices. But this with enhanced text size, consider the use of line of thinking doesn’t necessarily apply to headphone sets). telehealth. Older generations can use ✓ You can provide these suggestions in the telehealth technology to improve their access initial written information or discuss them to care and reduce the cost of healthcare during the setting up session. services. ✓ When using a video platform, a neutral, not The number of Americans aged 65 and older is “busy” visual background for you will rising dramatically. Estimates show this ensure the older adult with visual demographic will rise from 46 million today to challenges is better able to focus on you 98 million by the year 2060. With more elderly and no other stimuli in the background. patients seeking care, families will have to Similarly, reducing noise on the provider’s make difficult decisions when figuring out how end reduces auditory interference for the to best care for their loved ones. JHON OLIVER MARFE 2|NCMB314 WEEK 16: TELEHEALTH AND THE OLDER PERSON The cost of a nursing home can be out of reach ✓ Reduce the number of unnecessary for many Americans, which means many hospital visits families will need to stay at home to care for ✓ Reduce the stress put on at-home their loved ones. Telehealth can reduce the caregivers burden on these families by lowering the cost ✓ Improve overall patient satisfaction of essential healthcare services. Learn more USING TELEHEALTH TO CARE FOR THE ELDERLY about how geriatric patients and their families can benefit from telehealth. At-home caregivers can use telehealth to help better manage and treat a range of conditions THE NEED FOR AFFORDABLE ELDERLY CARE and diseases that tend to affect older patients. Elderly patients tend to have complex While in many of these cases, in-person visits will healthcare needs as they manage a range of still be required, telehealth makes it easier for conditions and diseases. However, getting family caregivers to care for their loved ones by access to healthcare can be a challenge for giving them direct access to healthcare many elderly patients, especially those who live professionals. in rural areas. Around 7 million older adults are If they have a question about caring for their considered homebound or have trouble loved one, they can always consult with a leaving their homes without help. licensed physician or specialist using Without a loved one to help them or a telemedicine video conferencing software. dedicated driver, these individuals may be Telehealth can be used to care for and manage unable to visit their healthcare provider in the following conditions and diseases: person, leaving them with few alternatives unless they have access to telehealth services. o Palliative Care: At-home caregivers can The price of putting an older patient in a use telehealth to report on the condition of nursing home is simply unaffordable for many their loved one as their health continues to families. Additionally, older patients tend to deteriorate while receiving valuable prefer at-home care to staying in a nursing feedback and advice from healthcare home. In many cases, a loved one will move in professionals. with the older patient to provide at-home care, o Transitional Care for Heart Failure: At-home but, without proper training, many of these caregivers can use telehealth to stay on family caregivers will still need the advice and top of their loved one’s treatment regimen support of the healthcare community. following an episode of heart failure, including dispensing medications, diet, HOW TELEHEALTH CAN IMPROVE ACCESS TO physical activity, and managing stress ELDERLY CARE levels. Telehealth gives patients the option to consult o Chronic Disease Management: Telehealth with their healthcare provider remotely using helps at-home caregivers report on the live video, audio, and instant messaging on a condition of their loved one, giving telemedicine app. This reduces the need for in- healthcare providers insight into how their person visits and consultations, making it easier disease is progressing over time. Caregivers for at-home caregivers to meet the needs of can use telehealth to stay on top of their loved ones. medications, dietary information, and Many of these at-home caregivers will have mental and physical changes. responsibilities of their own, from raising children o Primary Care for Frail Individuals: Patients to holding down a job. If they can consult with who have trouble moving or leaving the their loved one’s doctor from the comfort of house can use telehealth to consult with their own home, they won’t have to spend as healthcare professionals on a variety of much time shuttling their loved one to and from primary healthcare issues and concerns, the doctor’s office. At-home healthcare including joint pain, muscle stiffness, providers can quickly gain valuable insight and medications, and accident management knowledge from these remote consultations, and prevention. improving their loved one’s quality of care. There are so many ways elderly patients and family caregivers can use telehealth to their TELEHEALTH CAN HELP FAMILIES AND ELDERLY advantage. PATIENTS IN THE FOLLOWING WAYS Digital healthcare services reduce the need for in-person appointments, lower the cost of care, ✓ Reduce the burden and cost of certain reduce costly visits to the emergency room, travel expenses and improve patient satisfaction. JHON OLIVER MARFE 3|NCMB314 WEEK 16: TELEHEALTH AND THE OLDER PERSON As more patients reach the age of retirement, supporting primary care providers with mental more families will need to depend on these health care consultation and expertise.” services to care for their elderly loved ones. “Video-based telepsychiatry helps meet patients’ needs for convenient, affordable, BENEFITS AND LIMITATIONS and readily accessible mental health services,” As the COVID-19 pandemic continues, according to the APA. depression and anxiety are on the rise. As a According to the 2020 Survey of America’s result, mental healthcare providers are being Physicians, conducted by Merritt Hawkins in pushed to provide care to more patients, while collaboration with The Physicians Foundation, keeping themselves, their staff, and patients 48 percent of U.S. physicians currently are safe. treating patients through telemedicine Many are turning to telehealth to provide compared to only 18 percent in 2018. treatment to patients when they can’t be seen Meanwhile, 26 percent of people 50 to 80 years in person. The integration of telehealth into old reported having had a virtual medical visit traditional medicine could reach far beyond since the outbreak of COVID-19, according to the pandemic and into the future. the University of Michigan (U of M) 2020 Telehealth does have its positives and National Poll on Healthy Aging (NPHA). This is negatives, though. When implementing a plan compared to only four percent in the 2019 for seniors and telehealth, healthcare providers NPHA. should consider both the barriers and WHY IS MENTAL TELEHEALTH IMPORTANT FOR OLDER opportunities to conduct the most effective PATIENTS telehealth visits for their patients and themselves. At the top of the list is access, according to the APA. During the pandemic, access is vital, Are Mental Telehealth Visits as Effective as In-Office especially since some seniors may be Mental Health Visits? immunocompromised. Additionally, bringing Yes, they can be. According to an article care to the patient’s home or location via published in the Annual Review of Clinical telehealth may open possibilities for those who Psychiatry, evidence from more than 100 live in remote or rural areas to connect more controlled trials suggests that guided Internet easily with mental healthcare specialists. treatments for a wide range of psychiatric and somatic conditions “can be as effective as The APA suggests several other benefits of face-to-face treatments, lead to sustained telehealth including: improvements, work in clinically representative “Help integrate behavioral health care and ✓ conditions, and probably are cost-effective.” primary care, leading to better outcomes The Commonwealth Fund concurs in its To the Reduce the need for trips to the emergency Point blog post, stating “numerous studies have room demonstrated [telehealth’s] effectiveness ✓ Reduce delays in care across a range of modalities (e.g., telephone, ✓ Improve continuity of care and follow-up videoconference) and mental health ✓ Reduce the need for time off work, childcare concerns (e.g., depression, substance use