In earlier blog post, I described my dream for a patient-centered, technology-driven healthcare system that I am hoping will become a reality in the not-too-distant future. In this second healthcare scenario, geriatric patient care is described during a biannual checkup.
In my future healthcare system, geriatric patient care is centered on meeting the mental and physical health needs of the total person using the most appropriate, cost-effective healthcare professionals and programs available. The primary goal of this holistic approach to geriatric patient care is to delay or prevent the onset of age-related conditions and disability that result in the need for costly medical interventions (hospital stays and nursing home care). This future healthcare system has recognized that the mere presence of a health condition does not necessarily mean high levels of dependency on costly health and care services if the right health and social services are made available and encouraged. In this future healthcare system, geriatric patient care places an emphasis on mental health and combating age-related frailty for huge savings in after sickness care. Education of the geriatric patient is key to success in this future healthcare system.
Let’s take a closer look at geriatric patient care in my future healthcare system during a biannual checkup.
Donna—A Geriatric Patient
My mom, Donna, an 80+ year old woman who lives independently alone, loves to garden, and is still able to handle all aspects of daily living. Even though she has type 2 diabetes, osteoarthritis, and high blood pressure, all of her conditions are well managed with oral medications. Donna has had problems with diverticular disease two times in the past and was hospitalized once with extensive rectal bleeding as a result. Apart from having open heart surgery many years ago (to open blocked arteries), Donna has had no additional heart-related problems since.
Donna sees her family doctor about three to four times per year and gets routine blood tests about twice a year. In addition, she gets an annual heart checkup with her cardiologist to renew hypertension and cholesterol drug prescriptions and for an annual EKG.
Checking In for a Biannual Geriatric Checkup
Donna’s son drives her to the community healthcare facility (open 24 hours a day/7 days a week) for her biannual geriatric checkup, which is scheduled so that educational, exercise, and mental health group sessions can be coordinated with her actual physical examination. While the presence of patient advocates is strongly encouraged, especially with elderly and very sick patients, Donna assures her son that she will be fine by herself.
Donna is greeted by a trained healthcare employee (Kelly), who is one of the facility’s “medical traffic cops”. This job is very important and requires good listening, observational, and “people” skills. Donna is greeted like a valuable member of the community who is respected and capable of contributing to her own health care. Donna is happy to see Kelly and responds warmly to her greeting.
Kelly scans Donna’s health identification card and confirms that she is scheduled for her biannual checkup and that the blood test results are ready for review. A computer algorithm defines the specific blood tests needed for Donna based on various parameters like age, sex, and history of diseases and conditions. Her son had received the blood test order on his smart phone and had taken Donna to the health center to have her blood drawn earlier.
Kelly and Donna review Donna’s list of current medications on the computer screen for verification. Donna has brought her current medications with her and Kelly helps her verify the list on record for accuracy. Kelly asks if any close family members have recently had any medical problems and if she would like to report any new health problems (symptoms) since her last visit. Donna tells Kelly that the weakness in her legs has improved since she has been attending the flexibility and strengthening exercise program next door. She also shares that she and a new friend at the exercise facility have a friendly competition to see who improves fastest. Kelly puts a note in the computer for the examining health professional to verify frailty improvements. My healthcare system of the future puts a high priority on minimizing falls among the elderly.
There is no need to verify health insurance coverage because everyone is covered under a single-payer universal healthcare system. Kelly sees on the computer that no copay is to be collected for today’s services (her income is below the level where copays start).
Donna’s weight, height, temperature, blood pressure, and pulse rate are taken by Judy, the healthcare technician, and the information is directly transferred into Donna’s Electronic Health Record (EHR) file. The computer displays Donna’s calculated Body Mass Index (BMI), a measure of obesity.
Mental Health Considerations in the Care of the Geriatric Patient
While waiting to be seen by the appropriate healthcare professional for her physical examination, Donna is placed before a computer screen to answer some questions aimed at assessing her mental health. Donna can handle this part of her health evaluation independently because of earlier help she had received from both her son and health center aides during earlier visits. She starts out by sharing information about herself like what she had for breakfast that day (is her diet healthy?), how is her garden progressing (does she get physical activity at home?) and who visited her in the past week (is she isolated socially?).
Donna answers the 10 question posed in the PHQ-9 test which indicates that Donna is not suffering from depression. Donna also answers questions geared at assessing the presence of dementia or Alzheimer’s disease. If the screening tests had revealed signs of poor mental health, Donna would have been set up to see one of the health facility’s mental health professionals for further evaluation and care.
In my future healthcare system, mental health aspects of geriatric patient care is recognized as extremely important for overall health and minimizing expensive hospitalizations and nursing home care. The community health centers coordinate with community centers to allow seniors to interact in groups (small and large) for support, educational health forums (including topics like end-of-life decision-making), and exchange of knowledge. Health service programs are geared to preserve dignity, promote feelings of independence, and minimize distress while coping with life changes.
At a previous biannual checkup, a mental health professional had observed that Donna was lonely at times, had a need to feel useful, and needed some group socialization. As a result, Donna now participates in two social programs at the community center next door: (1) she advises new mothers with practical parenting hints over tea and cookies (Donna brought some homemade cookies today to share with the young moms she advises) and (2) meets with other seniors for educational/social interactions. She has made new friends at both programs and feels she has a renewed purpose in life. Today Donna has signed up for a community center discussion on “Staying Independent as you Age”.
Seeing the “Doctor” in A Geriatric Patient Care Case
Donna is now ready for her physical examination. The health facility’s supercomputer evaluates all of Donna’s online health information and determines the most cost-effective healthcare professional that will meet Donna’s needs. Donna is seen by Anna, a non-physician healthcare professional. Donna is assigned female health workers because it has been determined that she feels more comfortable with females than with males. When Donna enters the examination room, Anna is already viewing Donna’s computer-generated summaries, blood test results, and vitals taken earlier as well as Donna’s most recent healthcare summaries of care, her allergies, and her pre-existing conditions.
Donna is greeted warmly and invited to sit down on a chair for a discussion of the blood test results. Anna explains the results Donna is happy to learn that all is well and that her medications are working well to control her diabetes, hypertension, and cholesterol. Anna listens to Donna’s heart, asks her to breath in and out deeply, looks in her ears and mouth, and checks for signs of diabetic foot problems. Anna congratulates Donna on losing five pounds since her last checkup.
To assess Donna’s strength, Anna watches as Donna is asked to stand and sit down three times. Anna records into the computer the ease with which Donna performs the task and notes that Donna needs to use her arm muscles to help lift her weight from the chair. The input from this test will be used to tailor her exercise program, to encourage her to be more physically active at home, and to include targeted online educations materials highlighting the importance of keeping muscles strong and flexible.
Before completing the physical examination (taking 15-20 minutes usually), Donna is asked if she has an questions about her health she wants to discuss. Donna says no and Anna reminds her that her health summary for today’s checkup will be available when she leaves or she can look at it online later. Her son usually prints out a copy for her of any documents in her Electronic Health Record. Donna is eager to go to her community center programs and bids Anna a final farewell.
As Donna checks out, she answers several questions about the care she received on an exit computer screen. The information is collected to assess the quality of care delivered by the various healthcare professionals she interacted with and to improve her care in the future. Donna can also access online educational games (identified for her particular health needs) if she chooses to play. One game helped Donna identify foods that are no-nos for people who have a history of diverticular disease. Since learning that her last bout with rectal bleeding was likely caused by the quart of strawberries she had eaten, Donna has learned to stay away from them.
Summary and Disclaimer–Geriatric Patient Care in the Future
The medical scenario described above is not to be taken as medical advice but rather as an example of how a patient-centered, technology-driven healthcare system of the future might function. The focus in geriatric patient care here is holistic in its approach where the complete physical, mental, and social well-being of the person is of central concern. It puts the well-being of the healthcare consumer above the financial interests of individual healthcare businesses. It uses healthcare resources to deliver maximum healthcare value and treats healthcare consumers as critical stakeholders in health care.
In our present healthcare system, Donna’s health care focuses around her general practitioner and not around her, the healthcare consumer. Presently, Donna’s health is reviewed in biannual checkups by her general practitioner, someone who is not the most cost-effective (or qualified) healthcare professional to meet most of her mental, social, and physical needs for independent functioning. Coordinated geriatric patient care using other non-medical healthcare services is not part of the equation in our present fragmented healthcare system.