Objectives 1. Recognize the social and cultural factors that - PDF document

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Removing Barriers that Prevent Older Adults from Being Safe, Healthy and Independent Barbara Nichols, DNSc (h), MS, RN, FAAN Chair, United Way’s Self -Reliance & Independence Community Solutions Team Toya W. Johnson, MBA Community Impact Director, Self-Reliance & Independence United Way of Dane County MetaStar's Health Care Quality Symposium November 8, 2017 Objectives 1. Recognize the social and cultural factors that influence the health of older adults 2. Identify several major barriers that prevent older adults from achieving optimal health 3. Evaluate several community exemplars for keeping older adults safe, healthy and independent 1

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Objective 1: Recognize the social and cultural factors that influence the health of older adults  International (Global)  National (United States)  Local (State of Wisconsin) Globally Without Precedence the World is Growing Older  It is estimated that 524 million people are ages 65 and older (8 percent of the world’s population)  By 2050, older adult population expected to triple to 1.5 billion representing 16 percent of the world’s population  Aging phenomenon is being driven by declines in fertility, improvements in longevity and a shift in the leading causes of death * Source: World Health Organization 2

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Globally Without Precedence the World is Growing Older  Many problems of older adults are rooted in early life experiences and living conditions, thus social and cultural factors impact the health of older adults  Ensuring good child health can yield benefits for adults as they age  Preventative Care vs Reactive Care * Source: World Health Organization Unprecedented Growth of Older Adults in the United States  47.8 million people are ages 65 and older in the U.S.  98.2 million is the projected population of 65 and older in 2060  Of the 98.2 million, 19.7 million people will be ages 85 and older * Source: U.S. Census Bureau 3

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Unprecedented Growth of Older Adults in the United States  In the U.S., multiple concurrent chronic conditions with degenerative diseases impact older adults  According to the American Community Survey, older adults ages 65 and older identify: 1. Ambulatory difficulty such as: -Walking and climbing stairs - Reaching - Lifting or Carrying 2. Cognitive difficulty such as: - Remembering and concentration - Making decisions - Hearing Difficulty The Tremendous Impact of Local Rapid Growth of Aging Population  In 2010, the population of older adults age 65 and older in Wisconsin was 777,500 (13.7 percent of total population) and increased rapidly, nearly doubling in 30 years so that in 2040, the population is projected to be 1,575,000 or 23.7 percent of the total population  Dane County has fastest growing population in the state with over 64,000 residents age 65 and older representing 12.3 percent of the total population and is projected to be 121,470 by 2040  Similar to Global and National trends, Dane County residents 85+ are the fastest growing segment 4

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 The Tremendous Impact of Local Rapid Growth of Aging Population  Due to chronic health conditions, older adults consume increased medications, which puts them at risk for negative drug reactions and falls  Falls are the leading cause of injury-related deaths in both the state of Wisconsin and in Dane County  21.9 percent of Wisconsinites ages 65+ reported that their health was fair or poor in 2014 Objective 2: Identify several major barriers that prevent older adults from achieving optimal health Key Barriers that arise across all areas are: 1. The impact of aging on health care and social cost 2. Infrastructure requirements needed to be in place to sustain well-being among older adults 3. Cultural and racial differences based on socio-economic class 4. Impact of evolving technology and globalizing economies 5

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Objective 3: Evaluate several community exemplars for keeping older adults safe, healthy and independent Recommended Strategies to reduce the rate and percentage of Adverse Drug Events (ADEs) and Falls by 20 percent by 2022 Improve Coordination of Care between Physicians and Pharmacists Provide Caregivers Access to Resources Expand Reach of Nutritional Supports Foster a Greater Sense of to Rural Communities and Purpose and Communities of Color Contribution to Society Our Strategies Keep Older Adults Out of Hospitals and Institutions Comprehensive Medication Review Evidence-Based Falls Prevention Classes In-Home Safety Assessments (SAFE Program ) 6

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 What is a Comprehensive Medication Review?  Trained pharmacist – Wisconsin Pharmacy Quality Collaborative (WPQC) use evidence-based comprehensive screening tools to help detect the risk of adverse drug events for low-income older adults  All-inclusive review of a person’s medications, including prescription and over-the counter medications, herbal therapies, and dietary supplements United Way of Dane County/Wisconsin Pharmacy Quality Collaborative Comprehensive Medication Review Event Process Community Model:  1 day event with 2 pharmacists: 12 patients  1 hour long appointments  Student: intake and medication history  Pharmacist/student: comprehensive medication review  Geriatric syndromes focus (Aprexis-guided)  Follow-up  Recommendations to prescriber/med list  Three follow-ups annually with the older adult (via phone/in person) United Way of Dane County/Wisconsin Pharmacy Quality Collaborative 7

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 POTENTIALLY INAPPROPRIATE MEDICATIONS (PIMS) FOUND ON THE BEERS LIST (PIMs) recommended for discontinuation  Lorazepam (Ativan)  Citalopram (Celexa)  Diphenhydramine (Benadryl, Tylenol PM)  Oxybutynin (Ditropan)  Terazosin (Hytrin)  Naproxen (Aleve)  Gabapentin (Neurontin ) United Way of Dane County/Wisconsin Pharmacy Quality Collaborative Established in 2011, supports United Way’s Safe and Healthy Aging Initiative to reduce the rate of ADE and Falls by 20 percent by 2022  In-home safety assessments coordinated by our Safe at Home Coordinator and follow up administered by a masters-prepared medical social worker with extensive experience in older adults  Trained volunteers go into homes of older adults to do environmental scans  Target Population: Low-income seniors ages 60+ at risk for adverse drug events and falls in their home  Average Age: 83 Home Health United-S.A.F.E. at Home/United Way of Dane County 8

MetaStar Health Care Quality Symposium: Overcoming Obstacles for the Health of Patients, Providers and Communities Glacier Canyon Lodge Conference Center at the Wilderness November 8, 2017 Assessments Include:  Written Recommendations  Comprehensive Medication Review  Safety Aids (pillbox, nightlight)  Community Resource List  Detailed List of Exercises/Balance/Tai-Chi classes Home Health United-S.A.F.E at Home/United Way of Dane County Falls Prevention Classes  Evidence-based falls prevention classes that are offered throughout Dane County include:  Stepping On – partnership with Safe Communities- offered at locations throughout Dane County https://safercommunity.net/falls-prevention/prevention-programs/  Tai Chi and Gentle Balancing Exercise offered at Goodman Community Center  Latino Falls Prevention Exercise Class & Chair Based Exercise Class at North/Eastside Senior Coalition 9