As is widely known, the risk of falling increases with age for a number of reasons, such as decrease in bone density and failure to exercise regularly resulting in decreased strength. But another reason, which is not as debated, is all the medication that elderly are prescribed, especially antidepressants that are commonly used when elderly are starting to worry about the future. As falls are the leading cause of death from injury among people 65 or over and the fact that the majority of the lifetime cost of injury for people 65 or over can be attributed to falls, this is an important area of study.
Prior research indicates that there is a connection between medication with anti-depressive drugs and the risk of falling. This inspired scientists at Erasmus University in Rotterdam to investigate whether the connection between antidepressants and injurious falls is dose-dependent. A study involving 248 patients with dementia at a nursing home was conducted. Drug prescription and injurious falls were analysed during a period of two years and the results show a significant higher risk of falling for patients using SSRI, Selective Serotonin Reuptake Inhibitors, (a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders and some personality disorders). The higher the dose, the higher the risk of falling. A low dose (25% of the Defined Daily Dose) resulted in 31% higher risk of falling and a higher dose (100% of the Defined Daily Dose) tripled the risk of falling.
This study, published in the British Journal of Clinical Pharmacology, is the first one to quantify the contribution of SSRI to the risk of falling. The results indicate that even low doses of SSRI are associated with an increased risk of falling for patients suffering from dementia. This leads the scientist to suggest that new treatment protocols should be assumed.
Image source: http://www.arabstoday.net/en/2012011980618
Can’t help but returning to the theme of life’s second chances in my writing. I guess it might be related to being a person with a little too many interests to be able to realize all of them as career choices in one life time (and put to that a general dislike for making choices) and my fascination for seeing people that reinvent themselves at the age of 80 suddenly becomes quite evident.
Next up is the career of a dancer. A profession I hold dearly, since I, myself, earlier pursued a dance career before changing lanes over to the engineering guild.
I don’t know if there are any communities that are as judging when it comes to age as that of the dancing community. If you didn’t start at five, it’s over, if being a prima ballerina is what makes your heart beat. At least that’s what they tell you.
BUT, what if it isn’t true?
Obviously there are a lot of pros with starting early if you want to become a principal or first soloist of the Kirov (Mariinksy) Ballet of St Petersburg, but as a Guardian Theatre Blog post recently pointed out, there is a lot to the stories told in ballets or dance performances that having a little life experience can make more interesting.
And the best part is that there are quite a lot of good examples. Apart from the obvious dance icons of Martha Graham, Merce Cunningham and ballet icon Frederic Franklin, who all continued to give popular performances up in their 70s (90s(!) for Franklin), just adapting movements to the new restrictions of the body, there are also examples of people having started to dance way later than in their 10s or 20s. Such as e.g. Cambridge pensioner John Lowe, who started dancing ballet at the age of 79 and recently at the age of 88 performed on stage in his first ballet at a regional theatre. Specific routines and stretches supported with ropes help him keep up with his arabesques.
So I say, if you want it – just go and get it. Be it a career of dance, music, writing, acting, photography, archeology or whatever you’ve always wanted, but never taken the time to do, or thought you’d have become too old to pursue. Sure, age does affect the body. But apparently less in some cases than our mind makes us believe.
More to come on this very interesting topic…
PS. This post also makes me think about my old ballet teacher. He always used to say that students that had once trained for him didn’t get injured, because they learnt the techniques right from the start. Another one of those prejudices. That ballet will destroy your body. It doesn’t need to, if you are just careful when approaching it. Another important hint for all you senior to be-dancers out there. DS.
In my search for innovative systems promoting patient-centred integrated care, I recently came across the company myVitali, which is designed to facilitate for people approaching what Jane Fonda calls “Life’s Third Act”. MyVitali is a system integrated into the own home, consisting of emergency call, vital monitoring, control, information and supply services offering the security of total care. The system is designed to motivate the user to actively and effectively take care of his health. The company has aimed to create an intuitive interaction concept rather thought of as a lifestyle product than a device for telehealth.
The project was born out of a brainstorming session between the developers at Massive Art Multimedia in Austria and CoSi Elektronik in Germany where they produced the idea of bringing together several aspects of the modern computing world and applying them specifically to senior citizens. As Massive Art Multimedia’s Tom Ulmer explains, “The introduction of computing power into the lives of the elderly can offer reminders to take medicines, dietary advice, immediate access to medical professionals and much more. It also reduces the need for visits to a local doctor. Users can take important measurements such as their blood pressure, weight and body fat and have that information directly uploaded to the system. Any healthcare professional they deal with can therefore have immediate access to their recent health records.”
The system is designed assuming very little computer knowledge of their users, without compromising on the inclusion of advanced technology, such as wireless, webcams and touch pads. Users with sight and hearing problems are also taken into consideration. All the information that is gathered belongs to the user and he can limit access at any time. The data is safeguarded using the same technology that banks use for mobile devices.
For a better understanding of how myVitaly works, have a look at the below video which is posted under “Our Goals” on the company’s webpage.
A new tool to help doctors and patients discuss life expectancy.
From my posts, I hope my bias for my home institution is not too burdensome. Unfortunately, I cannot help it if the Geriatrics faculty at the University of California at San Francisco churn out an innovation a week. This week? A major advance in how we can prognosticate for our patients.
Prognosis is an inherently difficult process for doctors. How do we, as a medical community, really know how long a patient has to live? What should we tell her about what we do know? It is often difficult to determine a person’s prognosis if she does not have one specific disease that can guide us. It would be helpful to always be able to say something specific; for example, “We know that women with your stage of lung disease generally live another 6 to 8 months with the treatments we can offer you.”
The difficult place for doctors to prognosticate accurately is when a patient has many diseases, none so severe that one overshadows the others. And sadly, many doctors do not, as a result, discuss life expectancy with their older patients who often have multiple diseases. Despite this, we increasingly have evidence that patients and their families want to know what the future holds so they can plan and make medical decisions accordingly. And that doctors should start these conversations. Drs. Alex Smith, Brie Williams and Bernard Lo made this case quite convincingly in a recent New England Journal of Medicine article.
Now we have a tool to help us and patients discuss prognosis and overall life expectancy. And it’s publically available!
Uniting different research done on larger populations and tools developed from this research, eProgosis.org, is a platform for using 16 different estimators of life expectancy for older adults in different settings—nursing homes, hospital, the community—and it leads you through each calculator. In the end, you get an estimated life expectancy. And anyone can use it.
The media buzz around this tool (see articles listed below) has emphasized what should be understood well by anyone using it—this is not a crystal ball. These are tools based on studies of groups of people, and therefore cannot be exact with an individual. Also, because certain populations are used in the studies to derive the tools, it may not apply to everyone who plugs in his or her information. It is unclear, for example, how this extends to international populations, which were not studied. Therefore, the results should always be discussed with a doctor.
Regardless, ePrognosis is a remarkable leap forward. It is an accessible and useable tool that uses the best information on how to predict life expectancy in complicated older adults. It creates a way for patients and doctors to begin these critical conversations with real information. Explore it, and see what you think!
ePrognosis website: http://www.eprognosis.org/
Blogs and articles mentioning ePrognosis:
3) NY Times, New Old Age Blog: http://newoldage.blogs.nytimes.com/2012/01/10/how-long-until-the-end/?scp=2&sq=eprognosis&st=cse
4) NY Times article on JAMA paper: http://www.nytimes.com/2012/01/11/health/using-interactive-tools-to-assess-the-likelihood-of-death.html?scp=1&sq=eprognosis&st=cse
Recent academic articles on prognostic indices:
1) Yourman LC, Prognostic Indices for Older Adults. Journal of the American Medical Association (JAMA), 2012;307(2):182-192, http://jama.ama-assn.org/content/307/2/182.short
2) Smith AK, Williams BA, Lo B. Discussing Overall Prognosis with the Very Elderly. New England Journal of Medicine (N Engl J Med), 2011; 365: 2149-2151. http://www.nejm.org/doi/full/10.1056/NEJMp1109990
Think AT&T and cellular devices such as iPhones as well as Blackberries would spring to mind.
These days however, the American telecommunications giant is also venturing into telehealth devices and a communication network that could potentially expand its wireless business. A slew of prototype connected health products have already been developed by AT&T’s scientists who are seeking to make everyday household items “part of the network cloud.”
One particular innovation that is still under clinical trials aims to reduce fall rates among the elderly. Statistically in the US, about one third of the elderly over 65 fall each year and 10% of these cases result in serious injury or death. The “smart slippers” designed by AT&T’s scientists may be the solution to this growing problem. With built-in pressure sensors in their soles to record gait, stride, and pace measurements as elderly patients walk, these information will then be transmitted over AT&T’s network to healthcare providers. By noting changes in the elderly patient’s walking pattern, the device will notify a doctor via e-mail or text message of a problem before they take a tumble. This could reduce the chance of a fall and a costly trip to the hospital. In the UK, medical expenditure of fall injuries and deaths by the elderly are already amounting up to a staggering £6m daily and the government is looking to promote music-based exercises to build strength and reduce falls among the elderly.
In addition, the other pilot programme initiated by AT&T covers the aspect of diabetes management while its ‘telehealth solutions’ involve the use of high-definition video and audio conferencing technology to offer patients in underserved regions access to higher quality care. Vitality Glowcaps that run on AT&T’s wireless network is also an interesting feature to aid elderly patients with medication reminders.
With a swelling elderly population nationwide, AT&T is one of the few companies that are working on a technology solution that not only lower costs but enhance medical care at the same time. According to AT&T’s Xavier Williams, ”If we do what we think we’re capable of doing, we think we’re able to change healthcare the way ATMs changed banking.”
And with forward-looking innovations such as the “smart slippers,” they are certainly taking the right ‘step’ forward.
(Image source: Business Week)
(Video source: ATTBizSolutions)
Jane Fonda recently held a speech about what she calls “Life’s Third Act” which refers to the ages 60-90 and the fact that we on average today live 34 years longer than our great-grandparents did. Life’s Third Act is a whole second adult lifetime that has been added and Jane Fonda discusses how to make the most out of these years and how you can during this time free yourself from your past in order to become whole. As she approached her 60th birthday she did a life review where she studied the life she had lived in order to realize who she had really been. She also talks about the upward ascension of human spirit and how to avoid what she calls decrepitude.
This is a very inspiring speech by Jane Fonda who herself is more than a decade into her “third act” and has had three extraordinary careers as an Oscar-winning actress, an activist and a best-selling fitness guru. The speech was organized by TED, which holds conferences offering free knowledge and inspiration from the world’s most inspired thinkers.
What do you think about when I say grandparent?
Cinnamon roles, a warm smile, a friendly voice and some amazing stories told and songs sung before going to bed on a summer’s eve? A prankish friend with a childlike mind inventing new games, adventures and setting up family shows starring you as the main act anytime the family got together? A strict head of family, speaking slow and only when necessary, that sets all the rules and expects you to pay your respect and loyalty?
Whichever is your personal memory of a grandparent I’m sure it’s a special one, which is why I felt a particular warmth inside when I came across a particular news article when preparing for my latest blogpost on Active Ageing. The article was about a new research project on grand-parenting, reported by the European Union’s initiative of focusing the year of 2012 on the topic of Active Ageing and Solidarity Between Generations (the former part of that focus being one that I particularly feel about).
Launched in October 2011 by the organization Grandparents plus, the research project, or International Study of Grandparenting, set out to examine the role of grand-parenting across Europe, and answer the questions of how grand-parenting differs from family to family and from country to country and how family policy frameworks shape the role of grandparents.
One thing that the pre-study, launched in 2010, found is that grandparents’ role in family life is likely to become more important as populations age. Parents of tomorrow are both more likely to have parents that are alive, but also healthy and financially stable, and thus can take a bigger part in their grandchildren’s lives. Therefore it is also increasingly interesting to look at how legislation and social policies across different countries have dealt with the inclusion of grandparents in family life, where examples such as transferable parental leave in Germany, basic state pension credits for taking care of grandchildren in the UK or financial support for grandparents of teenage parents in Portugal are a couple of the forerunners.
While looking forward to the results of the newly launched research project maybe you have your own good grandparent story to share? What is your best grandparent memory? For me, my viking grandpa has provided me with a couple of good ones for sure. Maybe that could be the topic of another blog post?
Til then, Happy (soon) Grandparents Day Poland! (21st of January) (First country in the world to start celebrating the tradition of a National Grandparents Day.)
The weighty issue of preventive health in the elderly.
When someone says preventive health, many things might come to mind: eating right and exercising, screening for pre-cancerous lesions, and getting a yearly flu vaccine. Doctors also often address secondary prevention measures, which are the prevention of further complications of a disease such as preventing a second heart attack or stroke. A comprehensive approach to preventive health care in adults needs all these strategies. However, the holy grail of medicine is prevention that also improves mortality. That is, effectively extending life for people because they did not get the disease we prevented.
The straight line from preventive action to actually preventing disease may still exist in the elderly. Certainly, we can say that the influenza vaccine and the pneumococcal vaccine (against a bacteria that causes pneumonia) provide protection from these diseases or their complications. Figuring out what also prevents death is increasingly complex in the world of geriatric medicine since the most powerful predictor of death is age, not a specific disease. At a certain point, if you prevent one cause of death, people will die of another.
If this is the case, the important question is what should be the focus of preventive health in elderly? Cancer, heart disease, vaccine-preventable diseases are all uncontroversial as critical diseases the elderly. But increasingly the best approach is to ask, who is the patient? As with everything else in the elderly, the individual is the important guide to knowing how to proceed.
For example, in the field of cancer screening Dr. Louise Walter of University of California, San Francisco has shown that not everyone of all ages is created equal. For those adults in the healthiest bracket for their age that have at least 10 more years to live, it would be reasonable to offer them colorectal screening that takes at least that long to have any benefit. But for a frail older woman in the nursing home, she may not need such screening as it will be unlikely to impact her life or life expectancy. And furthermore, colorectal screening – which includes a colonoscopy and medications she would need to go through the procedure—might cause her more harm than good. Lastly, the patient’s preferences should be considered, not just the guidelines. Does she want to know if she has a tumor in her colon even if it is unlikely to cause her death, or not? Increasingly, preventive health guidelines with strict age cutoffs are meaningless as the diversity of people at different ages is more powerful than age alone. Life expectancy should be a far more practical guide for a physician and patient to making decisions about what screening to do.
What can we say is universal? For everyone, young and old, being as functional and independent for as long as possible is generally a goal. To that end, the obvious applies: counseling older adults to remain as physically, mentally and socially active as possible. Physical activity helps with mood and depression, weight control, falls and all those pesky diseases that are so prevalent in the elderly—bone disease, heart disease, stroke, diabetes and cancer. Being mentally and socially active also helps maintain cognitive function. Checking hearing and vision and making sure any deficits are corrected is key to preventing falls, social isolation, depression and cognitive decline. Quitting smoking at any age is hands down the best thing you could do for your health, and this applies still in older age (though I have one patient who is 98 who understandably wants to enjoy his pipe a few times a day without me constantly nagging him to stop). Watching how much you drink as you get older is also highly advised as alcohol can affect cognition and falls. Getting an annual flu vaccine and other recommended vaccines are just as important as when people are younger, if not more important. Disease and cancer-specific prevention requires an individual approach, especially in the oldest old. Life expectancy and weighing harms and benefits with our patients should be our guide there.
1) Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly. Am J Gastroenterol 2011; 106:1197–1206
2) Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750-2756.
Hospital stays pose additional hazards for the elderly and one of which is hospital delirium. This is a type of brain dysfunction characterized by sudden confusion and inattention and is considered as one of the most common complications of hospitalization for the elderly. Despite its seriousness, doctors and nurses are still not able to recognize and prevent it as effectively as it can be.
American Society of Geriatrics estimates that one third of hospitalized patients over 70 years old suffer from hospital delirium. The prevalence is even much higher for patients requiring intensive care and surgery. Its exact cause is unknown. However, primary contributing factors include a long list of sedatives, narcotic medicines, allergy and blood pressure drugs and procedures like catheterization. Sleep interruptions, changing rooms or being without eyeglasses and dentures may trigger anxiety consequently delirium. Also, Day et al.(2012) found out that isolation of patients where they are twice more likely to suffer from delirium.
Most doctors think that hospital delirium is acceptable because of the decline in the cognitive functions of the elderly. This should not be allowed since premature death often occurs among 35- 40 percent of those with delirium each year. Elderly patients who suffer from delirium also has longer hospitalization by six days and more likely to be placed in nursing homes after discharge.
The good news is that 40% of delirium is preventable. And as part of the family, we can help how to prevent or limit the occurrence of this complication by orienting the elderly to the environment, people, place and time; conducting stimulating activities such as crossword puzzles, card games etc.; making their environment familiar by taking few family photos and their favorite objects; staying close to them during the hospitalization and make them feel not isolated, insist on their use of sensory aids and simply prevent unavoidable hospitalizations.
Hannah R. Day, Eli N. Perencevich, Anthony D. Harris, Ann L. Gruber-Baldini, Seth S. Himelhoch, Clayton H. Brown, Emily Dotter, and Daniel J. Morgan, “The Association between Contact Precautions and Delirium at a Tertiary Care Center.” Infection Control and Hospital Epidemiology 33:1 (January 2012)
Swedish paper conglomerate SCA recently announced an investment in the Chinese elderly care market. SCA produces a wide array of products including a large range of incontinence products under the brand Tena, SCA is in part motivated by the fast growth that the incontinence product market is expected to have in China: estimated at 20% annually compared to the overall market growth rate of 4%. But the incontinence market is not the only market experiencing rapid growth in China, the General Secretary of the Standing Committee of the NPC Li Jianguo recently announced that another 3.4 million beds in eldercare facilities will need to be added in the next five years.
SCA is partnering with Singaporean company ECON Healthcare Group to start the care company Jiahu, and aim to have 1000 nurses in Shanghai within a couple of years and then expand to the rest of Asia. Today ECON operates eight nursing homes and a hospital in Singapore as well as a maternity hospital ward in Malaysia.
However, the Swedish and Singaporean companies are not the first foreign companies to enter the promising Chinese market. Last year American Cascade Healthcare announced plans to build a eldercare facility in Shanghai. Other international companies have entered joint ventures with Chinese healthcare providers in an attempt to bypass some of the difficulties that come with entering a country where cultural traditions suggest that care for elders stays within the family.
http://di.se/ “Svenska Skogsjätten startar hemtjänst i Kina”
Several weeks ago, I had a bathroom mishap where my smartphone was in the thick of the action. Seemingly beyond my control, the Nokia E72 tempted fate and took a nosedive straight into the toilet bowl. Why it was so keen to pick up swimming at that particular moment, I will never know. But one thing for certain was that an iPhone beckons as the ‘little swimmer’ was pronounced dead on the spot. In the meantime, I was now in the market for a short-term mobile replacement.
Some serious pondering later, I made a decision and bought myself a senior-friendly phone.
Interestingly, there are a variety of names attached to this mobile. In the Americas and Europe, it is called the Just5 phone. Over to the east, Russians are also dubbing it as the ‘Babushka’ (grandmother) phone while in Singapore, it is commonly known as the iNO CP09 phone. To avoid confusion however, we will simply call it the Just5 phone.
Quite frankly, the Just5 phone is simplicity at its best. It takes the shape of a candybar and has elderly friendly features such as large keypad buttons, SOS button, torchlight and build-in speakerphone specifically designed for elderly mobile users to have a better experience. The FM radio function comes as a surprise as it does not require an earpiece to be plugged in in order to use it. Conveniently, the keypad can also be unlocked via a single button while the torchlight can be activated through a slide switch by the side. And if you are sharp enough, you would notice a woman and man icon at the bottom left (*) and right (#) keys. These are speed-dialling keys and they supposedly represent the daughter and son of the elderly to allow easy recognition and convenient access to their loved ones. For myself however, these two icons could represent my wife and boss in the near future.
From an adolescent point of view, the Just5 phone is also practical in a couple of scenarios;
What if I am surrounded by a bunch of thugs along a deserted alley?
By pressing the SOS button, a sharp siren pierces the air and wails in a desperate plea for help. At the same time, all the 4 emergency numbers that I have configured receive an emergency SMS text. The siren continues as each of the emergency contact numbers are being dialled in cycles until someone picks up. The wailing ceases and the Just5 phone goes into hands-free talk mode.
What if I have a bad sore throat and a lady asks for my number over the phone?
I simply select the ‘human voice’ tone for my keypad. Then by pressing the digits of my number, the ‘human voice’ reads out the corresponding digits.
On top of being elderly-friendly, the Just5 phone is brilliantly simple for seniors to use. Indeed, it has fulfilled its purpose as a basic phone with practical functions. Yet, the future elderly will be different. In Singapore for instance, we have identified that they will possess plenty of energy and experience, as well as varying needs and aspirations. They may not only be socially active but also technologically savvy. Thus, it is important that the next generation of Just5 phones take into account these factors and tailor their products to suit the varying demands of the future elderly.
(Video source: Just5)
It was yet another mundane night to pass for the folks in a little diner when the door slowly creaked open. All eyes were curiously locked onto a towering beefcake as the man trudges forward expressionlessly. What was astonishing about him was the lack of clothes from head to toes. The man advances in the buff across the diner, approaching the billiard table where he sizes up another man. The movie screen brilliantly switches to a transparent red visual ‘dashboard-like’ display with multiple rows of flickering alphabets and figures by the side. The diagnosed result showed high relevance in terms of ‘similarity.’ What will ensue in this popular eighties action film is the delivery of an old-fashioned beat down by “The Terminator” before he obtain his clothes, boots and motorcycle.
Despite the date of the film release however, it has hinted slightly as to how futuristic technology will shape out to be over the years. In fact, the transparent red visual ‘dashboard-like’ illustration featured in the blockbuster is what we now call a “head-up display.” (HUD) It enables users to view data in their line of vision. Several auto makers such as BMW, Toyota and Lexus have already adopted this concept into their range of products. Many contemporary systems are able to display data from the speedometer and tachometer onto the windshields.
General Motors (GM) on the other hand has set their sights on developing a new generation of HUDs on their windshields. These windshields will combine the use of cameras, sensors and ultraviolet lasers to enhance the driving experience of an elderly. They will highlight objects in the roads and paint the road edges to aid elderly drivers in poor visibility conditions. Another function also involves tracking the driver’s position in order to align the images to be displayed on the windshields.
As the silver tsunami sweeps across the globe, there will be a surge in the number of elderly drivers and auto makers must start catering to this swelling group of consumers worldwide. In addition, ageing deficiencies will pose as an obstacle to elderly drivers (as I have mentioned a couple of months back) and there will be emerging issues concerning with the safety and independence of the seniors that must be addressed.
(Source: NY Daily News)
(Image source: Switched)
(Video source: Network World)
Sleep may be the next frontier for aged care. Research has revealed how better sleep can help the elderly live healthier, happier lives.
Over a third of people over the age of 65 have trouble sleeping at night. This is partially because of changing body clock – inside the brain there is a cluster of cells that help tell the body when to sleep and when to be awake. It’s this cluster that regulates our circadian rhythm. Unfortunately, as we age, this cluster becomes less and less active.
This lack of activity might be caused by a lack of light. Our circadian rhythms are normally regulated by how much light we see – the more light, the more awake we are. That’s why it’s difficult to sleep if you look at something bright just before you go to bed. As we age, our eyes start to work less well. The lens of the eye begins to get thicker, and the pupil gets smaller, meaning we get less light inside our eyes. This is particularly true in people with Alzheimer’s disease.
Alzheimer’s disease patients are well known for having particularly disturbed sleeping patterns. They sleep in short spurts, seldom longer than 15 minutes. This leads to both irritation and depression.
Recent research by Dr Eus Van Someren, of the Netherlands Institute for Neuroscience, has found exciting evidence that these coincidences might be connected. Many elderly care centres are poorly lit, meaning that the people inside are only rarely exposed to bright light. Dr Van Someren changed this by increasing the light levels over three times in nursing homes. He then studied the effect of this change over a number of years. The results were remarkable. The patients had less depression, improved memory, and their ability to perform everyday tasks declined far less than would be expected. A simple thing like increasing the amount of light in the room gave similar effects to the drugs currently used to treat dementia, without the side effects.
Even if the lights in their house are dim, there’s still an easy fix for many elderly people. If they simply go outside or stay near an open window for the brightest parts of the day (wearing sun protection, of course!), they may find themselves rewarded with longer, better sleep.
As we enter into the year of 2012 there are lots of exciting things going on on the scene of demographic ageing and the ‘silver evolution’. As it seems, more and more people, organizations and governments are becoming aware of the enormous potential in the growing 65+ generation and keeping them actively involved in society. In this blog post I set out to outline five things, all related to the topic of Active Ageing, that I believe to become important during the year of 2012.
But first a quick break for terminology: What is actually meant by Active Ageing? According to the European Union it’s defined as:
“Giving the baby boom generation and tomorrow’s older adults the opportunity to:
- stay in the workforce and share their experience
- keep playing an active role in society
- live as healthy and fulfilling lives as possible.”
Or as the World Health Organization (WHO) put it: “Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.”
1. One initiative along those lines is that of the European Union (EU) who has designated the year of 2012 as the European Year for Active Ageing and Solidarity between Generations. The European Union has a tradition since 1983 of dedicating every year to a specific cause important for society. On the 14th of September 2011 the European Parliament decided that the turn had come to the cause of Active Ageing and Solidarity Between Generations. In practice, this means that since that day a number of organizations, both public and private, have been invited to take part in or lead initiatives with tangible, measureable results to be followed up upon during 2012 related to those two topics. This includes everything from research projects on Information and Communication Technologies (ICT) for ageing, and making use of participative web 2.0 tools in caregiving for frail older people, to facilitating the creation of new business opportunities for products and services related to the ageing challenge, promoting better inclusion of elders in the labour market and showing photo exhibitions picturing the intergenerational dialogue within Europe, to mention a few initiatives. In other words a very interesting agenda, that we are all looking forward to be following.
2. Meanwhile, at the other side of the Atlantic, Harvard Business Review Blogger and MIT Sloan School research fellow Michael Schrage, recently pointed out the business opportunity of adapting apps, devices and tablets to the growing senior customer base as one of six ‘Innovative Ideas to Watch in 2012′. All as the silver generation grows and becomes more active and technologically savvy.
3. And as one multilateral organization prepares for its year of Active Ageing another one under the United Nations (UN) umbrella, namely WHO, enjoys an increased awareness around their related programme of creating age-friendly cities. After arranging the programme’s first international age-friendly cities conference in late September 2011, now WHO’s intitiative is an integrated part of the EU’s year of Active Ageing, encouraging more European cities to apply to the network.
4. For 2012, the UN is also looking forward to get on with the the second quinquennial review of the outcome of the Second UN World Assembly on Ageing that took place in Madrid in 2002, also known as The Madrid International Plan of Action on Ageing (MIPAA), a document that marked a sort of turning point in how the world has seen the challenge of population ageing. This was the conference where the WHO presented their well-known Active Ageing Policy Framework that has served as a basis for the definition ever since.
5. Last but not least, as one of the pioneer organizations in advocating the rights of older people, also the International Federation on Ageing (IFA) will make their important contribution to the active ageing discourse next year. One way that they’ll be doing this is through their 11th bi-annual Global Conference on Ageing, which this year goes under the theme of ‘Ageing Connects’ – covering topics from work and the access to knowledge/education to advancing health and well-being and the possibilities within innovative products and connected technologies such as twitter, blogs and social networks.
In other words – a lot to look forward to during the coming year. So while we wait eagerly for all the good blog post material that the above mentioned happenings will generate, let us take the opportunity to wish you all:
A Happy New Year of Active Ageing!
Improving care after hospitalizations
In the US, one of the most dangerous times for an older person is being discharged from a hospital. After even a brief stay in a hospital, often many things have changed: important medications, disease-specific care plans (for example diet or activity), or follow-up plans with doctors. And a bad discharge can mean readmission to the hospital in less than a month for as many as 20% of patients.
Assimilating new and critical information at discharge can be difficult. For one thing, an elder may have reversible cognitive dysfunction, which is memory and thinking difficulty during an acute illness that improves over the course of weeks to months. This is not to mention those elders that we know already have cognitive problems, eg. dementia.
However, a known and likely more potent contributor is how badly discharges are done—hastily, without communicating to the patient’s outpatient doctors, and sometimes without caregivers there to help process information. I cannot say how many times I have seen a patient in clinic who was recently discharged from the hospital and I have no record of the hospitalization, medications changes made and what, if anything, I was supposed to follow-up on.
This needs to change. In 2013, US health care reform will mean that for certain conditions hospitals and their affiliated systems (clinics, medical centers) will be penalized for “unnecessary readmissions”.
This is an added push to innovators to work now on the issue of transitions. One approach is the Support from Hospital to Home for Elders (SHHE) Project at the San Francisco General Hospital where they have a nurse visit the patient before discharge to make an individualized plan and follow-up with them afterward for several weeks. Another is to standardize how the discharge is done through a checklist, one way that Better Outcomes for Older adults through Safe Transitions (BOOST) in Atlanta tackles the problem. Further still, some programs focus on providing a new team of providers—doctors, nurses, social workers—who will take over care of the patient during the critical transition time and do all that is needed to make it a success, for example by doing more home visits. This is the model that GeriTraCCC has started in San Francisco for heart failure patients.
There is no right way to improve hospital transitions in all systems and for all patients, but more innovations surely will follow as we feel the pressure to change over the next year.
1) General information on innovations in health care to improve quality: http://innovations.ahrq.gov/innovations_qualitytools.aspx
3) GeriTraCCC: http://geriatrics.medicine.ucsf.edu/care/geritraccc.html
Lola Techie was phenomenal in the Philippines in the late 2009. She is the fictional technology- savvy sextagenarian created by a local exchange carrier to market their broadband services.
The first Lola Techie advertisement that was released depicts an old woman berating her grandson JR, because he only comes to her to ask how to operate the computer and how he would not even “poke” her in Facebook. This was followed closely by her second video where she announced on her “Twitter” that JR is no longer her favorite grandchild. Meanwhile, another video featured how she is too engrossed playing in an online game and getting too temperamental and disappointed with her younger team members.
“Lola Techie” became the talk of the town as she is the epitome of how the elderly should welcome change brought about by technology. Generally in the Philippines and probably the rest of the world, the elderly do not know how to use the computer or afraid to even try so. Majority also have limited access to computers and technology gadgets and do not care to learn because they do not find it beneficial.
This phenomenon not only debunked the stereotype that technology and golden years do not always go together but showed how technology could be used as a means of socialization. It also reminds us how we should not take the temperament of an elderly too lightly.
Here is one of Lola Techie’s video. Enjoy!