But what about the Elderly? Part 2 of 3.

What Works and What Doesn’t?

A prominent topic in healthcare discussions these days is physician – patient engagement.  That is, encouraging physicians to reach out to their patients with reminders and health advice that inspires them to keep their appointments and engage in good health behaviors.  Multiple surveys show that younger patients give lip service to wanting a variety of medical apps or be engaged with their physician via text messages, automated voice messages, or e-mail.  The underlying assumption is that patients will change their health behavior and do what their doctor advises them to do.  But literature demonstrating that this type of remote “connection” translates into changing health behavior is glaringly absent.  There is no conclusive evidence in the literature that having an app on your iPhone or a computer that’s connected to the Internet 24 hours a day reduces your hemoglobin A1c, gets your blood pressure under better control, or makes it easier for you to breathe when your emphysema starts acting up.  This type of remote connection, although interesting, just hasn’t yet been shown to improve health.

Do you know what else doesn’t work?  Phone calls don’t work.  There are those who believe that trying to engage patients by calling them on the telephone and speaking with them about their health condition may cause them to be more compliant with health advice and therefore be healthier.  But this also DOESN’T WORK!  This was shown convincingly by Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment published by the Congressional Budget Office in 2012.  Patients acknowledged that they were called and given encouragement and health advice, but they still didn’t change their behavior.  This is ESPECIALLY true for the elderly, many of whom have at least some degree of hearing loss and find it difficult or even objectionable to assimilate instructions from a stranger over the telephone.

So what DOES work?  What IS effective in reaching elderly patients to help them remain as healthy and independent as possible for as long as possible? The answer lies in 3 parts:

  1. Visibility and Accessibility.  The elderly often neglect their healthcare because our medical system is so cumbersome and difficult for them to find and access.  If healthcare professionals are more visible, and physicians are more readily accessible, the elderly will get care – it’s as simple as that.
  2. Face-To-Face encounters.  Like it or not, the elderly won’t let you into their lives until you build a relationship with them.  And until then, you will usually have little influence over their health behavior until it’s too late (they fall and break a hip or get pneumonia or have a stroke from uncontrolled hypertension, etc.).  Face-To-Face encounters build relationships and therefore get results.  This has been proven conclusively in the field of Transitional Care Medicine which describes the care patients receive when they are recovering from an illness and transitioning from the hospital to home.  The common thread that is integral to all successful protocols that improve a patient’s health behavior and reduces hospital readmission rates is…Face-To-Face encounters.  In other words, RELATIONSHIPS.
  3. Technology.  New communications technology is making vast improvements in the way healthcare professionals interact with each other through Electronic Medical Records, through efficiencies in healthcare delivery, and in the coordination of patient care between hospitals and healthcare and residential facilities.  Younger patients are showing an increasing interest in engaging with their doctors using various modes of technology.   But when it comes to the elderly, meaningful and effective healthcare communication depends almost solely on Face-to-Face interactions and RELATIONSHIPS.

So these are 3 characteristics of healthcare delivery that get the best results with the elderly.  In Part 3 we discuss, “Where Do We Begin?”  If we have a disciplined, targeted, and focused approach in delivering healthcare to the elderly, we can and will make a difference.  And this is also where the fun begins, because to make a difference in this crazy and complex healthcare system, we need a simplified approach that is creative and innovative.  And the answer is found where the old merges with the new!

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