university lectures for health and hygienes ppt.pptx

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1. AGEING POPULATION: Health Systems for Elderly

2. At the end of the session, you will be able to: Understand the health system for ageing population; Discuss challenges and opportunities to provide health care for ageing population; Develop a plan of action responding to the disease burden of ageing population.

3. Introduction Changing causes of death and morbidity . WHO estimated, in 1990 about 50% of the burden of disease in developing countries was attributable to communicable diseases, around 40% to NCDs. By 2030 NCDs are expected to be over three-quarters of the disease burden in developing countries.

4. Con… Population ageing will bring challenges to health care, policy makers. The changing pattern of disease , disappear in future; but at the same time, NCDs will increase in both prevalence and cause of death.

5. Align health systems Place older people at the centre of health care Shift the care focus from managing diseases to optimizing what people can do Develop the health workforce https://www.who.int/ageing/pub lications/icope-framework/en/ htt p s:/ / w w w .une s ca p .org/

6. Age-friendly Health Systems What Matters Know and align care with each older adult’s specific health outcome goals and care preferences across settings of care Medication If medication is necessary, use age- friendly medication that does not interfere with other M’s Mentation Prevent, identify, treat, and manage Mental health & psychological issues Mobility Ensure that each older adult moves safely every day to maintain function and do What Matters

7. What is different in 4Ms Health System? 4Ms Framework: Not a Program, but a shift in care Current health system probably practices at least a few of the 4Ms in some places, at some times. The 4Ms are implemented together (i.e., all 4Ms as a set of evidence-based elements of high- quality care for older adults). The 4Ms are practiced reliably and consistently (i.e., for all older adults, in all settings and across settings, in every interaction).

8. Two Key Drivers of Age-Friendly Health Systems Age-Friendly Health System: 4Ms Assess: Know about the 4Ms for each elderly people in your care Act On: Incorporate 4Ms in the Plan of Action

9. Common Social Issues to Aging Loneliness Dependency Economic burden Isolation Abuse Neglect Generation Gap

10. Putting the 4Ms into Practice Integrating the 4Ms into Care Using the PDSA Cycle Provide care Study your performance (M&E, CBA, CEA etc) Understand your current state Describe care consistent with 4Ms Design or adapt your health workforce Improve and sustain care Act P l an Do Study

11. Putting the 4Ms into Practice: 6 Steps Step 1: Understand the Current State Know the Older Adults in Your Health System Know the 4Ms in Your Health System Select a Care Setting to Begin Testing Set Up a Team Step 2: Describe Care Consistent with the 4Ms – Questions to consider: How does your current state compare to the actions outlined in the 4Ms Care Description Worksheet? Which of the 4Ms do you already incorporate? How reliably are they practiced? Where are there gaps in 4Ms? What ideas do you have to fill the gaps?

12. Assessment of elderly people in hospital The holistic assessment of older people. The MDT members include doctors, nurses, physiotherapist (PT), occupational therapist (OT), dietician, clinical pharmacist, social worker (SW), specialist nurses (e.g. tissue viability nurse and Parkinson’s disease nurse specialist), hospital discharge liaison team and care givers. Input from a clinical psychologist or old age psychiatrist may be needed depending on individual patients’ needs. All members engage with patients and care givers to complete their assessments and intervention, followed by multidisciplinary meeting (MDM) to formulate ongoing care plan and follow-up.

13. Medical Assessment (1) Common medical conditions seen in older people Alzheimer’s disease Normal pressure hydrocephalus Temporal arteritis (giant cell arteritis) Diastolic heart failure Inclusion body myositis Atrophic urethritis and vaginitis Shingles (herpes zoster) Benign prostatic hyperplasia Aortic aneurysm Polymyalgia rheumatic arthritis.

14. Medical Assessment (2) Common medical conditions in older age group Degenerative osteoarthritis Overactive bladder with urinary incontinence Diabetic hyperosmolar non-ketotic coma Falls and fragility hip fracture Osteoporosis Parkinsonism Accidental hypothermia Pressure ulcers Prostate cancer Stroke Glaucoma and cataract

15. Putting the 4Ms into Practice: 6 Steps Step 3. Design or Adapt Your Workflow Current workforce – numbers and skills What you need? Step 4. Provide Care Apply your draft standard procedure and workflow first with one patient. Can your team follow the procedure in your work environment? If necessary, modify your procedure Step 5. Study Your Performance – M&E, CBA, CEA etc. Step 6. Improve and Sustain Care – 4 steps Engage all; Choose a pilot with the organization Build the changes into the standard, well-defined work processes Use early wins to build momentum, motivate and carry-on.

16. Assessment and Management of elderly people Multiple co-morbidities, physical limitations, increased functional dependence and complex psychosocial issues are common health problem of elderly people. The elderly people are more vulnerable and could easily decompensate with minor stressors, resulting in increased frailty. To improve outcomes for frail older people with multiple co- morbidities, admission should be to an Emergency Frailty Unit (EFU) having Acute Medical Unit (AMU) for elderly. The physical illness or adverse effects of drugs are more pronounced in atypical presentation among elderly people and cognitive decline, delirium or inability to manage routine activities of daily living (ADLs) are common.

17. Ask the older adult What Matters most, document it, and share What Matters across the care team Align the care plan with ‘What Matters’ most Review for high-risk medication use and document it Avoid high-risk medications, and document and communicate changes Ensure sufficient oral hydration Orient to time, place, and situation Ensure older adults have their personal adaptive equipment Support non-pharmacological sleep 4Ms in an Age-Friendly Health System Hospital & Practice

18. Screen for delirium at least every 12 hours and document results Screen for dementia/cognitive impairment and document the results Screen for depression and document the results Consider further evaluation and manage manifestations of dementia, educate older adults and caregivers, and/or refer out Identify and manage factors contributing to depression and/or refer out Screen for mobility limitations and document the results Ensure early, frequent, and safe mobility. 4Ms in an Age-Friendly Health System Hospital & Practice

19. Challenges & Opportunities for 4Ms Lack of a framework for the technological ecosystem Wide variety of country socio-economic-cultural contexts Need to engage all! Need political commitment and champions Put it within the existing health system – no parallel Need evaluation/assessment – resources, framework Appropriate regulatory approaches Affordability! (Inequities are increasing) Multiple morbidities; need for integrated action