Best Practices for Improving Patient Outcomes in Older Patient Population - Episode 8
Stephanie Chow, MD, MPH: Again, what matters the most to our patients is, is this going to really affect their quality of life? I find, as a geriatrician, working in the community of New York—and this is probably true in most places—many of our older individuals want to stay in the community as long as possible. They want to be independent, they want to live their lives, they want to function as they did previously as much as they’re able to in society. For us to allow our older patients, who are very deserving, to have this highest quality of life, as geriatricians and as primary care supports and all those who take care of older individuals—which basically is everyone—we need to reorganize the whole social structure, the financial piece, the working piece.
Basically, every aspect of society needs to flex a little to maintain this because this is something that is not going away. We have more individuals who are getting older. We need to build on this momentum and keep it going. Quality of life can be physical, but it can also be very much mental. So the idea of aging as a negative, which is often the connotation—we need to move away from that. We need to promote aging as a process that everybody experiences, and this is something we need to be creative about in our society and come up with ways to help with our older individuals. Keep them at home.
If they need to go out and need transportation because they can no longer drive, we get them transportation services. Some of you may or may not know that many of these transportation services are starting to use, for example, robocalling to call the individual and let them know their car has arrived. If you can imagine technology also being a barrier, learning how to use or respond to an automated call can be challenging. That’s 1 example, but coming up with ways to help with navigating community, for example, in terms of transportation, getting nutrition into the home if they’re unable to go outside, having supports, having pharmacies to support them in terms of medication. These are things that can help maintain the highest quality of life in that particular social aspect.
Regarding caregivers at home, this is another aspect that lacks in the United States. Previously, the most common demographic, the type of caregiver was a woman between the ages of 25 and 45 who would stay at home and help take care of this older individual. Nowadays, in this country, women of this age group are actually doing other things. There are more opportunities for women to do other things, therefore leave this caregiver gap. Who is stepping in to take over this gap? And so caregivers may be outside of this demographic—so not women, not ages 25 to 45—who are trying to fill this role, and they may not be prepared. They may not have thought that they were going to do this. They may feel resentment. They may feel guilt. And they’re just ill prepared to take this on. To maintain a high quality of life for our older patients who might need caregivers, we need to also reinforce this caregiver workforce and help meet this demand—this very necessary demand for our older population.
There are a lot of new technologies that exist to help monitor individuals. It is tricky to figure out which ones are the best comparing them. Because there are so many that come in and out, it’s hard as a geriatrician to keep track of all these things that come out. It really is a good discussion to have with your patient in front of you, seeing how much access they have to other people. If they need to have this monitoring, perhaps a device on their wrist or some kind of emergency call button would be the best. If they have both, or if they feel comfortable, they know how to use these kinds of technologies, this could be an extra asset. Some may feel that this is too much, so it’s really something you would have as part of your advance care discussion or the advance care planning. But this can be part of helping our older individuals maintain their independence for longer in the community, which could be what matters the most to them.
Transcript edited for clarity.