My patient Rose is very clear about what she needs when it comes to health care. She tells me that 15 minutes is too little time to cover what the doctor thinks is important, much less what she thinks they should be talking about. Her blood pressure, sugar, cholesterol, abnormal lab tests — does she need all these medications and tests? After all, she’s 85 years old — what benefit will she see and at what cost — emotional, physical and financial? She cares about health span, not lifespan, about function and not being a burden on others. In other words, she needs care that fits her stage of life — something that’s increasingly difficult to find for millions of older adults.
Exploring a solution to this problem is why the Academy’s Age-friendly NYC team, joined HealthFirst and the Icahn School of Medicine at Mt. Sinai to bring physicians, nurses, and other providers together for the symposium, Transforming Care for Older Adults [hyperlink added]. Throughout life, we acknowledge the different needs of men and women at different phases — childhood, adolescence, reproductive years, etc. Care providers are trained to treat us in these years, but this knowledge drops off dramatically once we pass ages 50 or 60. There’s an assumption that one-size-fits-all care is all that’s needed from middle age until the end of life, but that’s simply not the case.
Medicare at least partially ensures coverage for older adults, but not the most sufficient, effective and appropriate care. For this, we must all recognize the differences between 80 year olds and 50 year olds and use of one of the most valuable guidelines we have for caring for people in their 8th decade of life and beyond — the geriatric 5Ms:
l. Find out what Matters most to the patient.
2. Consider the patient’s state of mind Mind, mood, and mental health.
3. Assess their Mobility and ability to access care and do the things they need to support health and wellbeing.
4. Take Multi-morbidity into account, as they are likely living with several chronic disorders.
5. Carefully monitor their Medications to avoid over medication and ensure appropriate dosing).
As Rose and millions like her realize, primary care practitioners find it difficult to attend to the 5Ms, along with everything else the current guidelines require in the 15-minute visits medical insurers encourage. In addition, they often haven’t had sufficient training in geriatric medicine, despite caring for many older adults, to be fully aware just how critical the 5Ms are to providing the best possible care. Bringing providers together to improve training and increase awareness and the number of practitioners prepared to provide this more age-appropriate and age-friendly care is the Academy’s goal.
As important as primary care is, as providers, we must also remember that medical care is only one piece of what is needed for healthy aging. Accessing care: getting transportation to appointments, having to climb stairs to enter an office, patient instructions in small print, all these also impede care. The social determinants of health need to be addressed — such as where can women like Rose safely and cheaply get exercise, nutritious food, help to quit smoking, if needed? Who can help with keeping her rent-stabilized apartment, installing grab bars and other safety equipment? Or, help her address the social isolation, loneliness and depression that often occurs in older age and further impairs health and quality of life. Community organizations exist to help — but many older adults and their providers are ignorant of how to access this assistance.
For a healthy older age, one in which people have the best chance of doing and taking part in the things that bring them joy, it will take creative thinkers and doers looking at the big picture, envisioning age-friendly environments and health care systems that remove the obstacles to participation for older adults. It will take a village (to coin a phrase). The Transforming Care symposium is an opportunity to join with like-minded others in this most important endeavor. After all, we and our loved ones stand to really benefit from the results!
Rosanne Leipzig, MD, PhD, is the chair of the Academy Fellows Section on Healthy Aging and a professor of Geriatrics and Palliative Medicine at Mount Sinai Hospital.