Can Age-Friendly Care Delivery Improve Outcomes for Seniors?

The CMO of Northwell Health is developing a specific care strategy for the fastest growing segment of the nation's population.

With seniors comprising the fastest growing segment of the American population, Northwell Health is developing an "age-friendly" strategy aimed at improving clinical outcomes.

According to the Population Reference Bureau, the number of Americans who are 65 or older is expected to rise 47% over the next three decades, increasing from 58 million in 2022 to 82 million by 2050. During this period, the share of the total population of Americans who are 65 or older is expected to increase from 17% to 23%.

Healthcare providers need to step up efforts to serve that population, says Jill Kalman, MD, CMO, deputy physician-in-chief and executive vice president at Northwell Health.

"They are complex with multiple chronic conditions," Kalman says. "We need to take care of this growing part of our population. Both the 65-and-older and 80-and-older patient populations are growing."

Northwell has joined 29 other health systems in launching the Institute for Healthcare Improvement's Age-Friendly System-Wide Spread Collaborative. The collaborative is designed to accelerate and spread evidence-based care for older adults. A primary goal of the collaborative is to push adoption of four evidence-based elements of high-quality care, known as the 4Ms: medication, mobility, mentation, and what matters most to older patients and their families.

Kalman says Northwell has embraced the 4Ms at the health system's 21 hospitals and 900 ambulatory practices:

• For medication, Northwell is focused on how an older adult metabolizes certain medications, which can be significantly different with younger patients, especially if there is kidney disease, liver disease, or heart disease. Clinicians take great care with medications that can be harmful for older adults such as benzodiazepines and opioids. Those medications are used when necessary, but doses are adjusted and clinicians are intentional about the medications they choose.
   
• Mobility is of the utmost importance in the inpatient and outpatient setting.  For example, clinicians need to be aware of a patient's mobility for risk of falls. In the outpatient setting, Northwell is encouraging physical therapy and mobility activities that can be specifically tailored to an older patient's co-morbidities.
   
• Mentation and cognition may decline naturally over time, and there are diseases that impact mentation such as Alzheimer's. Northwell is focusing on how patients can improve their mentation with specific activities such as games or social interactions.
   
• Northwell is focusing intently on what matters most to the health system's older adult patients and their families. For example, patients are asked about what matters to them as they advance in an illness and about their goals in care.

Age-friendly care delivery and CMOs

Kalman says CMOs have an obligation to address quality of care, and the delivery of age-friendly care is part of that mission.

"It is important to deliver on quality metrics for older patients," she says. "I am focused on making sure evidence-based forms of care are used and making sure we are minimizing harm in everything that we do. I understand that older adults often have multiple chronic conditions that need to come into play when we are looking at the complexity of care for these patients."

The primary quality metrics in the care of older adults include the 4Ms, length of stay, and hospital readmissions, Kalman says.

"I monitor dashboards for our age-friendly health system that look at multiple metrics across our hospitals and ambulatory practices, so we can continue to understand how well we are doing in the evidence-based delivery of care," she says.

A CMO must recognize that older adult patients also have different needs and risks when it comes to surgery, Kalman says.

"Someone coming into a hospital for an appendectomy at the age of 80 is going to have different needs than someone coming in for an appendectomy at the age of 25," Kalman says. "It can be extremely different. Even the least complex surgery can be complex in an older adult, particularly in the recovery phase."

CMOs who are committed to age-friendly care delivery should make sure their health systems pay attention to medication management, delirium screening, and the goals of care, Kalman says.

"These factors need to be put together to drive the best outcomes," she says. "If we can drive the best outcomes in the outpatient and inpatient settings, we also work toward preventing some of the frailty in the older adult [and supporting] a better health span. We can also reduce length of stay and reduce hospital readmissions."

Value of age-friendly care delivery

The benefits of age-friendly care delivery are considerable, Kalman says.

"It is all about the quality of life and quantity of life, if that is what the older patient desires," she says. "The combination of health span and life span is extremely important. The benefits of age-friendly care include driving good clinical outcomes."

"The drawbacks of not providing age-friendly care delivery are poorer outcomes," Kalman says. "For health systems, there are financial drawbacks from not providing age-friendly care delivery. If you provide the best care and achieve the best outcomes, it will drive the financial health of your organization as well."