WHAT WE'RE LEARNING

Dear Colleagues—

We are approaching the end of 2020—a challenging year on all fronts. We are seeing COVID-19 rates soar across our country, and around the world, with contagion far from under control. Thankfully, the first vaccines are starting to be distributed to stem the tide of this rampant virus, but we have many weeks and months before widespread immunity can begin to get us to a new normal.

As infections and hospitalizations surge, health systems must act on hard-learned lessons from the last nine months as we care for the populations most at-risk. No group has been more disproportionally harmed than older adults. The Age-Friendly Health Systems movement, an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, provides an evidenced-based framework for caring for older people during the most vexing and tragic public health crisis of the 21st century. The 4Ms of age-friendly care—What Matters, Medication, Mentation, and Mobility—are the backbone of the approach. More than 1,000 care settings have adopted the 4Ms, which can improve COVID-19 care for older adults across the care continuum, including in nursing homes and in the home.

Examples from an Age-Friendly Health Systems pioneer

Providence St. Joseph Health is among the first of the Age-Friendly Health Systems participants and is using the 4Ms during COVID-19. Providence admitted the first COVID-19 positive person in the United States in January and quickly found that the virus triggered serious decline in older adults, and especially those in hospitals and nursing homes. Older adults in isolation were more likely to experience cognitive decline, increased falls, and decreased mobility. Visitor restrictions precipitated a crisis for older adults and their family caregivers who experienced emotional and moral distress from what felt like abandonment of their loved ones, as well of the staff they had come to know.

These challenges reinforced the importance of the 4Ms and underscored their necessity. At Providence, conversations with patients about “what matters” were prioritized—including advanced directives that inform care should the person’s condition worsen. Adherence to the 4Ms reinforced the need to conduct routine delirium checks for patients in the ICU whose mentation was altered, and mobility checks on all patients over the age of 65. Like many other health systems, Providence saw the opportunity to expand its telehealth services so people could stay safe at home and out of the hospital, while getting the necessary care to manage their conditions.

COVID-19 as an opportunity to accelerate and innovate with Age-Friendly Care

From the example of Providence, and so many other Age-Friendly Health Systems participants, we’re learning that health care organizations of all sizes are not intractable institutions but can move rapidly to improve care for older adults.

Yes, COVID-19 poses an existential threat to the nation and the systems that we count on to keep us healthy, but we’re learning that it also presents an opportunity to enact much needed change. In fact, with COVID-19 as the impetus, Providence better aligned ambulatory, community and long-term care, acute care, and telehealth. This resulted in improved communication among providers to ensure people received needed medications, were living in safe environments that minimized the risk of falls, maintained their mentation, and were still able to do the things they wanted to do within public health guidelines.

Providence showed us that telehealth visits with a person in the home provided a better chance to do a comprehensive medication check during a routine visit, since people are likely to have all of their drugs at hand. It also afforded a much deeper look into the person’s home to see if there are any mobility hazards.

Mentation can also be assessed during a telehealth visit, to monitor the effects of social distancing, including depression, diminished motivation to do activities, or feelings of anxiety. Over the last nine months, we’ve heard about creative ways all of the Age-Friendly Health Systems sites are working with older patients at-risk of the harms from isolation and loneliness. For example, providers are working with older adults and their family caregivers to help them become accustomed to Zoom, Facetime and other technology platforms they may not have taken advantage of prior to social distancing.

An important lesson to keep in mind, however, is that not all older adults have access to a computer or internet and may be limited in their understanding of technology. Providence reported that alternatives, like COVID-safe house calls, are another important way to provide age-friendly care and reduce isolation.

Where do we go from here?

Inoculation of all older adults will take time and we’re facing a long winter in which social distancing and isolation will be the norm. Health systems must learn from their experiences with COVID-19 thus far, prioritize age-friendly care and support champions of this movement in all departments, not just COVID-19 hot spots like the ICU.

By focusing on older patients’ mentation, medication, mobility, and what matters to them during and after the pandemic, systems will ensure optimal patient outcomes, improve productivity of providers and focus on high-value interventions that materially improve the lives of patients.

Sincerely,

Terry Fulmer, PhD, RN, FAAN
President, The John A. Hartford Foundation

You can learn more from Providence St. Joseph Health and other Age-Friendly Health Systems partners on this Modern Healthcare webinar.

Sign up for the next Age-Friendly Health Systems Action Community at ihi.org/agefriendly.