Elder Health Interventions
The focus of treatment planning with the frail elderly patient is always the provision of comfort and the maintenance of independent functioning. Independence is usually the shared goal of patient and clinician. To achieve this in the face of aging and progressive disease, treatment planning must include utilization of community care resources, skillful medical management, and rehabilitation therapies.
Elder Screening Tools:
Mini Mental Status Examination
Geriatric Depression Scale
Functional Assessment Screening In The Elderly
Fall Prevention Training
Multifactorial interventions:
Appropriate use of assistive devices; Exercise programs with balance and gait training; Safety modification of environment; Review of medications; Education on long-term planning; treatment of cardiovascular & postural hypotension. (Gonzales & Kutner, 2008, Current Practice Guidelines in Primary Care) Social Issues & Barriers To Care.
Social Issues & Barriers to Care
The growing number of older adults will present unique challenges to their health care providers and caregivers because of the vulnerabilities that often accompany aging in America . Factors that increase the vulnerability of the elderly may include: Medical chronic illness; economic insecurity; mental health issues including substance abuse; cultural and educational diversity; frailty and dependency including the risk of elder abuse. Despite the financial gains achieved by older Americans in the last century, many still face financial insecurity. It remains to be seen if Medicare reforms will substantially improve the economic well-being and health of elders. In order to meet the needs of the elderly population who live in poverty, health care providers will need to be aware of the multidisciplinary resources that exist in their communities.
Key Elder Care Concepts:
Use a patient-friendly approach; Focus on function and on goals; involve caregivers; Ask about geriatric syndromes (e.g., falls, memory problems, depression; Use assessment tools; Use life expectancy to guide; Prevention efforts; Get health care team help; Connect patients with community resources. (Talmadge & Wheeler, 2007, Medical Management of Vulnerable and Underserved Patients)
National & Local Resources
American Association of Retired Persons
NIH Senior health information
RxAssist Volunteers in Health Care
Alzheimer's Association 800-660-1993
Caregiver Resource Centers 800-445-8106
Elder Abuse - 800-962-2873
ElderCare of Alachua County 352-265-9040
Comfort Keepers- 352-379-6103
ATC (MV) Transport 352-384-9774
United Way I & R- 352-332-4636
Social Security Administration 800-772-1213
ACCESS program 866-762-2237
Alachua County Social Services 352-264-6750
Caregiver Resources Online
by Susie Lyons, MSW, LSCW
Administration on Aging
Alzeimer's Disease Training
American Academy of Home Care Physicians
American Institute of Stress
Caregiver Newsletter
Department of Elder Affairs
Elder Law, Aging, and Other Internet Resources for Seniors
Health Care Financing Agency
Institute of Gerontology
Mid-Florida Area Agency on Aging
National Aging Information Center
Seniornet
Social Security
Veterans Administration
Most Dependent to Least Dependent Resource Guide
by Susie Lyons, MSW, LCSW
End of Life Care :
- Palliative Care GVAMC – End of Life (2 weeks or less OR symptom management while receiving chemotherapy or radiation treatment).
- Inpatient Hospice Care LCVAMC Hospice Unit (last few months of life).
- In-home Hospice from a local Hospice (when prognosis is less than 6 months) 24/7 phone access.
Long Term Care in Facility :
• Funding Sources: Private pay/Medicare/Long Term Health Insurance/Medicaid
• Community NH (apply for Medicaid with period of spend down. Primary residence, are, some savings not counted as assets
• Private Pay: Assisted Living Facility (ALF)
• VA Community Residential Care homes
Short-Term Rehab :
• VA Geriatric Evaluation and Management (GEM) Intensive Rehab, 3-4 weeks (inpatient)
• VA Extended Care/Rehab in LC VA NHCU (up to 90 days) less intensive rehab (~$97 co-pay after first 21 days from some people)
Home Based Interventions to Maximize Independence :
• Advance Illness/Palliative Care Home monitoring with technology
• Home Based Primary Care (HBPC at home instead of coming out of house to Geri-Firm Primary Care)
• Lower ADL monitoring Program (LAMP)
• Home safety evaluation and recommend and procure grab bars, equipment, and access to Home Improvement and Structural Adaptation (HISA Grant), remote monitoring, etc
• Aid & Attendance claim application thru Vet Service Officer in County where veteran resides.
Special Group of Resources for People Caring for Veteran's with Dementia
(mid-advanced stages) :
• Home Health Aid/Homemaker (through Home Health Agency)
• Either form of Respite:
• In-patient respite at Lake City VA NHCU twice yearly 13 days each time.
• In-home respite though VA (2x/mo ~4 hours)
• In-home respite through Elder Care, Catholic Charities (when available)
• Adult Day Health Care (Altrusa House open 6:30am – 5:30pm, 2002 NW 36th Avenue, Gainesville, FL 352-377-7708 and (Blessed Trinity 5 SE 17 th St. Bldg L, Ocala, FL 352-671-2823).
Living at Home Alone :
Lifeline 1-800-543-3546 ext 3050 (several companies who offer this service) ~ $38-$40/mo. (free activation coupons available Security Alert through VA that dials 911 immediately. Veteran had to have h/o falls, failed Gait & Balance program.
11/18/08 Susie Lyons, MSW, LC SW
Geriatrics Health Facts
In 1990 4% of the U.S. population was 65 years of age or older; that segment is now more than 13% and it is projected to be over 20% by 2030 - the most rapidly growing age group within the population. {Source: Kyle, L: A Concept Analysis of Healthy Aging. Nurs Forum 2005; 40:45}.
In 2000, 41.6% of adults aged 65+ did not have a high school degree. {North Carolina Study Commission on Aging (2004). Report to the Governor and the 2004}.
More than half (55%) of those ages 55 and older have been diagnosed with arthritis/joint problems. Of those with arthritis, 28% reported that arthritis adverely affected their usual activities and/or the nature and amount of work that they perform (2003). {N.C. Department of Health and Human Resources, Division of Public Health. (2003). The Health of North Carolinians: A Profile, Raleigh, NC).
The average daily cost for a private room in a nursing home is $213, or $77,745 annually.
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