Improving Healthcare Delivery For Older Adults

Simply put, “wear and tear” is what the aging process brings. Normal and expected physical and psychosocial changes arrive when we are fortunate to live into old age. While these changes are, in many respects, unwelcome, they also leave us with a deeper appreciation for what was. At different rates and to varying extents, older adults face these challenges. They may live within a supportive network of family and friends or they may live with minimal resources. They are a proud group of people and may or may not admit difficulty. What they hope to receive from healthcare and its many caregivers is to be treated with dignity, and with attention and concern reflective of that provision. They don’t want pity, and I assure you, they don’t want you to make broad assumptions about them just because they are of a certain age.   

According to the US Census Bureau https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html “Older Adults” will become the largest sector of our population in the United States by the year 2030, and will, for the first time in history, outnumber children. We shouldn’t wait until then to understand and address the reality that our existing delivery of healthcare to older adults has much to learn and improve upon as it relates to communicating with and caring for this special group of individuals. Here is a first look into what can be accomplished to improve the quality of person-centered care for older adults.

Recent research for my practicum heightened my awareness and sensitivity to the normal physiological and psychosocial changes that older adults are encountering during the aging process. Add to that, the influence of generational differences, and healthcare’s expectations for older adults to interact in ways that they either prefer not to or are simply unable.   
While many in healthcare are aware of, sensitive to, and responsive to the specific needs and concerns of this group, learning opportunities remain in abundance for healthcare entities and their personnel. As a nurse, I watch, listen, and can say, without hesitation, that our healthcare systems can and should do better by them.

Over the past year, I have been fortunate to help older friends navigate the healthcare system and it has greatly increased my appreciation for, and sensitivity to, the gaps in healthcare delivery. As expected, certain aspects of care are truly remarkable, and it was easy to recognize and show appreciation for the professionalism and the quality of care that was rendered in several settings. However, there were also less than favorable experiences. What we have witnessed may seem small in comparison to the larger landscape of healthcare, but I would argue that these experiences are but a microcosm of a much larger problem, as several others have shared similar stories with me.

Patient satisfaction is supposedly first and foremost in the minds of healthcare administrations looking to earn and maintain an esteemed reputation, ongoing accreditation status, and economic viability. As older adults enter the healthcare setting, it would be wise for staff to closely note the age of the person and begin the conversation with respect, caring concern, and specific inquiries. While this approach may appear self-evident, the examples given in this post are frequently not in practice. After receipt of the name and date of birth of the person/patient and a verification that their insurance is accepted by the facility/providers, I would encourage consideration and incorporation of the following recommendations when engaging with the older adult if you have not already done so.

• Begin by speaking to the patient/person directly, and not over them, by first posing questions and conversation to a younger family member who may be accompanying them. (Yes, allow and encourage family members to contribute, but not at the exclusion of the older adult)
• Assure them with “We want to make sure that you are comfortable and that your preferences, concerns, and needs are addressed.” (Note and communicate to other team members any evidence of possible hearing, speech, balance, mobility, cognition deficits)
• Ask “How do you prefer for us to address you while you are here?” (Unless they have specifically requested to be called “Sweetie” “Sweetheart” “Hon” or Honey, please refrain.)
• Inquire with “Do you have any special needs or concerns that you would like us to be aware of?”
• Explain the what and why of “We need you to fill out ______forms.” (Determine understanding)
• Offer “Would you like to have someone from our staff assist you in completing forms?” (Some of you may think this is elementary, but I assure you, it is necessary, as one of my older friends came to the office sufficiently early and was only then told that she was expected to fill out several forms, including the review of systems, on a TABLET. Later, she was given notice, as she neared the appointment time, that she would need to be rescheduled if she didn’t finish on time. This was unacceptable.)
• Understand that it is necessary to know “What is the best time of day and the best number to reach you?” and “Do you want us to leave you a message if you don’t answer?” and “What information can we leave on your voicemail?”
• Suggest with “We recommend that you also give us the name of someone we may contact in the event we cannot get a hold of you.” Also, “What health information may we share with them?”
• Consider including “Do you have a power of attorney for health decisions in the event you are unable to make these decisions for yourself?”
• “Do you have advanced directives?”

 
Quality of care across the continuum should include comprehensive training for all personnel, including the receipt of the appropriate knowledge, skills, and attitudes for professional communication. It is well known that difficult exchanges sometimes arise that have no relation to the quality of care in the healthcare setting. The goal should be to minimize any frustration and explore its cause. Older adults should be made to feel that they are listened to and that the staff is genuinely there to help them. If, for any reason, the staff is unable to handle a situation, managerial support needs to be immediately available to assist. It is vital that assumptions are avoided, and that staff attitudes do not contribute to further escalate an already tense exchange. As a previous practice manager, I remember distinctly an episode when a patient was repeatedly and verbally complaining to the staff. Once she was brought into the exam room, I was asked to visit with her, and came to quickly discover that she was dealing with a new diagnosis of breast cancer. This is a prime example of the necessity to examine the “why” of what is taking place and importance of avoiding a rush to judgment.    

Direct eye contact, a warm tone, and an expression of sincere interest in the welfare of older adults will go a long way to make them feel at ease and establish a relationship of trust. In a busy and fast paced environment, time is limited, and it becomes the responsibility of the healthcare personnel to be mindful that the quality of communication is achievable, and more significant than quantity.

​Thank you for allowing me to share my experience, reflections, and recommendations. I welcome your stories and thoughts. I hope you will return as I further explore person-centered care as it relates to older adults, and what that means relative to their unique preferences, needs, and concerns within the context and complexity of the today’s healthcare provisions.
 
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