Best Practices for Improving Patient Outcomes in Older Patient Population - Episode 5
Stephanie Chow, MD, MPH: As we age, with our changing physiological conditions, we see more challenges with cardiac health, cancer diagnoses, and mental health struggles. With a growing list of chronic comorbid conditions, it is important for the patient and the provider to have a good grasp on all the multicomplexities—the multimorbidities. It’s important to have good communication among specialists and with families.
It’s important for the patient to understand the expected prognosis of their chronic condition if they’re able to do so, or at least their health care proxy should have this conversation with the medical provider.
In speaking about maintaining a healthy aging lifestyle without medications, it would be important for an older individual to focus on their physical and emotional health. Going outside for 30 minutes of exercise every day, or for 150 minutes a week would be highly recommended. It’s also recommended that patients maintain good social support and social interaction, given that oftentimes we are very social individuals. We’re a social community. This would also help with the cognitive exercise—cognitive stimulation. It’s important for good nutrition, balanced diets. Very similar to the instructions for a younger population, but for an older group of individuals, it’s good to recognize that as our bodies age we do have less reserve. And so maintaining these is much more important. Going for a walk every day to maintain walking and balance is much more important for an 85-year-old to reduce his or her fall risk versus a 27-year-old.
For individuals of any age, I do recommend getting the age-appropriate vaccines. For the elderly, population, it is important to maintain, for example, the flu vaccine, pneumococcal vaccine, especially around the seasons when these diseases are more prevalent. It’s important to protect oneself. As you age, your immunologic reserve, your physiological reserve is decreased. And so maintaining your best health with the appropriate vaccines is very important. It’s often a difficult conversation for those who, maybe throughout their whole life, have not been taking a specific vaccination. But in an older population, there are greater complications when one is affected by the influenza virus. Greater hospitalizations and greater mortality. So it is very important to stress that this is something for which the older population is more vulnerable. And so it is important for your patient to have proper vaccines.
Geriatricians are very strong components of getting the vaccines that are appropriate for that time. We always push for the flu vaccine. We want the pneumococcal vaccine. The varicella-zoster virus isn’t always covered; however, it is something that can reduce the complications after having the shingles. For all the vaccines, as primary care physicians we always promote strategies that will help reduce complications thereafter.
It’s always challenging if you have a patient who really just says they don’t like needles and/or never get vaccinated. Sometimes it’s worth it to explore deeper reasons why. Maybe they knew somebody who got the flu vaccine and consequently got the flu. Maybe explore that so you can counteract with, perhaps, reasons why you can debunk what their myth may be.
Other times, you may be able to persuade that individual to get the vaccine, so they can maintain their health in order to spend more time with family, grandchildren, and other individuals who may also be vulnerable to getting this illness if everybody were to get sick. So there are multiple reasons. It’s never an easy question. Go for the motivational interviewing, and see if you can find some root there.
Transcript edited for clarity.