Creating an Age-Friendly Health System Dr Kathleen Brasher

A world in which everyone can live a long and healthy life

Aligned to the needs of older people Part of an age-friendly environment

Why do we need an age-friendly health system?

Health in later life is complex Multiple long-term health conditions Physical changes with growing old Individual effects of long-lived life

Health in later life is complex Health is connected to wellbeing - Impact of age discrimination Loss of social contacts can lead to loneliness Housing and transport

Health services Designed to cure Patients treated by single disease state Multiple points of care

Health services Older people are: Hospitalised unnecessarily Have higher lengths of stay & rates of readmission Significant decline in their own abilities More likely to experience hospital-related harm

To ensure the positive contribution of older people

Remain in the workforce

Provide care to family and neighbours

Provide social services as volunteers

Continue to develop their own lives

What is an Age-Friendly Health System?

An Age-Friendly Health System Is one that will measurably improve the quality of care for older adults, and optimise value for the health system. IHI, 2016

In an Age-Friendly Health System Older adults get the best care possible; Healthcare-related harms to older adults are dramatically reduced and approaching zero; Older adults are satisfied with their care; and Value is optimised for all — patients, families, caregivers, health care providers and health systems

Creating an Age-Friendly health system Physical environment Social environment Providing clinical care Health system

Creating an Age-Friendly health system WHO Integrated care for older people 2017 WHO World report on ageing and health 2015 WHO Age-friendly Primary Health Care Centres Toolkit 2008 Goodwin N, Sonola L, Thiel V, Kodner D. Co-ordinate care for people with complex chronic conditions The Kings Fund ; London; 2013 Institute for Healthcare Improvement http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

1. Physical Environment Buildings and services are accessible Transport and parking are close by Access audits are undertaken regularly

1. Physical Environment Signposting is clear Buildings and services are easy to navigate or a support person is available to assist

1. Physical Environment There is adequate seating, heating or cooling Toilets are accessible and clean

2. Social Environment Older patients are respected Designated care coordinator Regularly consulted by health services

Communication Face to face Separate activity from conversation Allow more time in general the older/frailer the person Include family or carer if possible

Communication Listen first Start with the knowledge, ideas, questions of the older person Use humour (with care)

2. Social Environment Appointments are at times convenient for older people Services needed are integrated and coordinated

2. Social Environment When providing information Use clear simple language Avoid jargon Start from specific to general Be culturally sensitive

2. Social Environment When providing information Single point of contact if possible Match written information with verbal Follow up within a week Involve family or carers

3. Providing clinical care The 4 Ms What matters Mobility Medication Mentation

What Matters Know what matters - What are their health goals? What are their care preferences - now and in the future? Do they have an end-of-life plan?

Are you able to act on what matters for your patients? What gets in the way?

Mobility Implement an individualise mobility plan Create an environment that enables mobility

Medication Implement a standard process for medication reconciliation De-prescribe and adjust medication to be age-friendly

Mentation Ensure adequate hydration, nutrition, sleep and comfort Engage and orient to maximise independence Identify, treat and manage dementia, delirium and depression

4. Health System Staff education and training includes Communication with older people Normal ageing The 4Ms

Staff have core competencies for working with older people 4. Health System Indicators and data in place to monitor health status, quality of life, and hospital outcomes for older people Financial mechanisms in place to ensure older people can afford medicines, safe housing and adequate nutrition Staff have core competencies for working with older people

How will we know if we have an Age-Friendly health system?

An Age-Friendly Health System Provides the care and treatments best suited to older people Provides integrated care Lowers costs through preventable health care

An Age-Friendly Health System Respects and values older people for who they are