According to the National Council of Aging, approximately 92% of seniors have at least one chronic disease, and 77% have at least two. As a rapidly growing demographic, experts say seniors require particularly high-quality care and attention in areas such as independence, medication use, fall and dementia risk, and co-occurrence of disease conditions.
UC San Diego Health is at the forefront of addressing the complex needs of seniors, recently becoming the first health care system in San Diego to join the Age-Friendly Health Systems initiative and be recognized as Committed to Care Excellence by the Institute for Healthcare Improvement (IHI). The designation acknowledges UC San Diego Health's implementation of a set of evidence-based interventions designed to improve care for older adults.
UC San Diego Health joins more than 100 health systems across the nation that are part of the initiative. The goal of IHI is for 20% of hospitals and health systems in the United States to be recognized as age-friendly by 2020.
"We look forward to both sharing our best practices and learning what's working at other health care systems," said Alison Moore, MD, MPH, chief of the Division of Geriatrics and Gerontology at UC San Diego Health. "Through raising awareness, education, and collaborations, we can make a profound shift in how we define the future of care for a large and incredibly valuable portion of our society. We are dedicated to meeting our senior patients where they are in life."
The initiative is based on a series of practices known as the four Ms, which focus on addressing essential elements of care for senior patients:
What Matters: Knowing and aligning care with each older adult's specific health outcome goals and care preferences across all settings of care.
- Medication: Prescribing appropriate medications in doses that do not interfere with quality of life.
- Mentation (Cognitive Function): Preventing, identifying, treating and managing dementia, depression and delirium.
- Mobility: Ensuring older adults are able to move safely every day, both to maintain normal, healthy functions and to prevent injury.
"The initiative provides health care systems with the tools needed and creates new standards of care to ensure conditions, such as delirium and depression, are identified while falls and adverse effects of medications are prevented in older patients," said Khai Nguyen, MD, clinical services chief of senior medicine at UC San Diego Health.
Both cognitive function and mobility can decline significantly for older adults during hospitalization. In an Age-Friendly Health System, evidence-based protocols, such as physical exercises and daily cognitive stimulation, are used to prevent decline and may reduce the length of a person's hospital stay, plus increase the likelihood that an individual can return home versus transferring to a skilled nursing facility.
"Our care team is not only concerned with figuring out 'what's the matter with you,' but also figuring out 'what matters to you,'" said Lindsey Yourman, MD, primary care physician at UC San Diego Health.
Hospitals and health care practices recognized by the IHI as being Committed to Care Excellence have shown exemplary alignment with the elements of the four Ms over at least a three-month time period. UC San Diego Health has spearheaded the four Ms at the Medicine for Seniors clinic in La Jolla and Senior Behavioral Health program in Hillcrest, with the goal of implementing the four Ms care approach in other areas of the system.
"We are building a framework of care that can one day be rolled out across our hospitals and clinics," said Nguyen. "We are fortunate to be early adopters in this national movement. These efforts are historic in the care of seniors in our country."