By Dr. James Mittelberger. MD, MPH
Does your healthcare system meet your needs as an older adult?
If you are a senior or you are caring for an elderly loved one, you probably understand that many people need extra support as they age. Seniors need more medical care, often with multiple complex problems. Seniors are more vulnerable to complications from these problems and from their treatments.
For a vulnerable older person, being able to live safely in a home setting often requires both individualized expert medical care and social support. That combination can mean the difference between coping or not coping; even between not surviving and thriving.
To help older adults get the most out of life, many healthcare organizations are moving toward becoming “age-friendly health systems.” According to the Institute for Healthcare Improvement (IHI), age-friendly organizations systematically address the 4Ms — four core elements of high-quality care which implemented together guide health systems to focus on the needs of older adults.
The 4Ms of Age-Friendly Healthcare
Consider the following questions to help you evaluate whether your healthcare provider is meeting your needs as an older adult.
1) What Matters Most—Does your doctor know what matters most to you in your life so they can direct your care toward meeting those goals? Do they know how much you are willing to go through? Maybe you don’t want all available tests and therapies. Or maybe you do. Taking the time to see you as a whole person and to understand your needs and preferences helps your doctor determine what kind of treatments are right for you.
2) Mobility—Does your doctor make sure that you are mobile and help you stay that way? Do they recognize and address your risk of falls? Mobility can make the difference between living independently or moving to a nursing facility. Age-friendly providers will give you exercises to build strength and balance and to stay active. If needed, they will provide canes, walkers and other equipment and show you how to use them. They may also evaluate your home to make it as safe as possible.
3) Mentation—Does your doctor keep track of your mentation (your cognition, mood, memory) and check to make sure you are not developing cognitive problems? Older vulnerable people are at high risk for cognitive problems and there are many reversible causes. Further, if someone starts to have memory issues that are not recognized, they are likely to experience a cascade of other problems, such as forgetting to take medicine, which leads to more complications.
Older people are also at risk for depression, which can show up as withdrawal from engaging in life. Age-friendly providers understand this and reach out proactively to help lonely elders get to appointments and make social connections. They actively monitor mental health and work to keep older adults vibrant and engaged.
4) Medication—Is your doctor making sure that you are taking the right medicines? Many older adults have an overwhelming number of prescription medications, some of which may be redundant or have adverse effects. Older adults can be more sensitive to medication side effects. The same medicines that work well for young people may severely impact cognition, mobility and mood in older adults. Also, it is estimated that on average, people take only about half the medicines prescribed to them.
Age-friendly clinicians do an in-depth review of your medications to see if any can be reduced or eliminated. It is important to know the risks of each medication, and that you are taking what they think you are taking. Optimal management of medications requires a provider who is knowledgeable in the care of older adults and who has a special interest in getting the medicines right.
Make Sure You Advocate for Age-Friendly Care
Healthy aging is a continuous process of optimizing opportunities to maintain and improve physical and mental health, independence and quality of life. Age-friendly healthcare supports older adults with the care and resources to be functional and vital for as long as possible.
This kind of comprehensive support offers much more than medical care alone. Age-friendly healthcare also may help older adults access transportation, home care, social services, nutritious food, senior exercise programs and socialization. This requires looking at the whole picture of someone’s life and doing what it takes to support their health and well-being.
To optimize healthy aging for yourself or your loved one, consider talking with your doctor about your specific care needs and encourage them to work with you to support your overall wellness and quality of life.
There are several emerging systems of care that will meet the special needs of an older adult. If you are not in such a system, it is a good idea to find one.
James Mittelberger, MD, MPH, is a Clinical Professor of Medicine at UCSF, and is board certified in Internal Medicine, Geriatrics, and Hospice & Palliative Medicine. He is the Chief Medical Officer at Center for Elders’ Independence in Concord.