Archive | December 2014

The Mobile Emergency Team for the Elderly

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The office of the Mobile Emergency Team for the Elderly. Here, a nurse and a physician prepare to start the day by checking emails for updates on any of their patients.

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Pia, one of the team nurses, leaves for a patient visit. She brings all the equipment she needs to treat patients at home.

Last week, I traveled to Uppsala from Stockholm to meet the team of the Mobile Emergency Team for the Elderly (Mobile Team). I am in the process of writing an in depth case study of the Mobile Team. This case study is part of our larger effort to identify good practice in integrated eldercare in a number of countries, including Sweden, Singapore, and the United States.

The Mobile Team is a leading example of integrated eldercare. Healthcare professionals can learn from the organization in general, and from its philosophy. As I build this case study, I will share with you some of my experiences with the process and what I am learning. In a series of blog posts, I will tell you about the Mobile Team and highlight different aspects of their work.

The Mobile Team started as a project in 2011, with financial support from the Swedish Association of Local Authorities and Regions. Today, the Mobile Team is financed by Uppsala Municipality and the Uppsala County Council. Uppsala County is located just north of Stockholm County. All members of the Mobile Team are employed by Uppsala County, which covers sixty percent of the total costs of the Mobile Team. Uppsala Municipality covers the remaining forty percent of the costs. Both the county and the municipality raises funds through taxation.

The Mobile Team becomes involved with patient care through several different avenues: Nurses who work in homecare organizations contact the Mobile Team when they need a second opinion on a patient. Employees at care homes for the elderly contact them for advice. And ambulatory personnel coordinate their efforts with the Mobile Team.

The Mobile Team centers on the needs of the patient. The objective of the Mobile Team is to offer urgent care at home to people over the age of sixty five. Many older patients visit emergency rooms at hospitals for urgent but non life threatening care that can be treated at home. Often, these patients must wait for hours at emergency rooms because their illnesses are not as pressing as the illnesses of other patients seeking emergency care.

The Mobile Team performs urgent care right in patients’ homes. The Mobile Team is able to measure glucose, take blood tests, test urine, and perform electrocardiograms in the home. The team can treat patients with a range of drugs at home. They measure blood flow in arteries to assess if the blood circulation provides enough blood to the legs and to the brain. Blood circulation to all tissue is necessary to avoid stroke, for example. The team also measures saturation, or oxygen levels in the blood.

They treat patients with pariboy, an inhaler, if patients experience difficulty breathing. The team also treats minor wounds. When a patient needs treatment at the hospital, the Mobile Team coordinates with the ambulatory service to arrange transport.

Many older patients need support at home from multiple caregivers. The Mobile Team coordinates care with these caregivers, including professional homecare providers. If a patient visits the emergency room for an illness that can be treated at home, a municipal nurse of the Mobile Team, who works at the hospital emergency room, informs the patient of the Mobile Team. If possible, the municipal nurse informs the patient caregivers of the treatment that the Mobile Team can offer at home. If a patient needs urgent care a second time, the caregivers and the patient know about the Mobile Team.

The Mobile Team includes a nurse from the municipality and a doctor from the county. Sometimes, the municipal nurse needs assistance from the doctor to treat patients at home. In turn, the doctor often relies on the expertise of the municipal nurse about the full care plan for a particular patient. For example, the municipal nurse coordinates the effort of the Mobile Team with the effort of homecare teams. The Mobile Team and homecare teams work together to ensure that patients obtain the support they need to stay at home and recover. Both the healthcare and the social care needs of the patient are assessed. Many times, doctors assess healthcare needs in isolation. Homecare teams assess social care needs. The Mobile Team can help provide for these needs by increasing communication between caregivers.

The quality of healthcare delivered to a patient depends to a large extent on the quality of communication between caregivers. This is particularly true for older patients with complex needs. The municipal nurse in the Mobile Team can update homecare providers on new treatment and new medications. Sometimes, the communication between doctors from the county and homecare providers can become delayed. Since the Mobile Team only recruits nurses with experience from municipal care organizations, the nurses in the Mobile Team are familiar with the channels of communication in the municipality. This familiarity speeds up communication and creates added value to patients that obtain care from different caregivers.

The Mobile Team is a critical link in the integrated healthcare chain in Uppsala Municipality. The neighboring municipalities are examining the possibility of establishing similar mobile teams.

The combination of the medical expertise of the doctor from the county and of the network and the experience of the municipal nurse renders the Mobile Team more effective than its constituent parts. Integrated care requires that different care providers collaborate. Different healthcare providers must acknowledge each other, and they must understand each others’ abilities and limitations.

Healthcare professionals cannot become experts in isolation. High quality healthcare at home and the timely transfer of information to homecare organizations improve patient experiences and patient outcomes. The best healthcare at home will not in itself prevent the patient from falling ill a second time. A patient may need help cooking or remembering to take her medication. If the homecare team is not informed or fails to help the patient take her medication, the patient may soon fall ill again. This is just one example of the interdependencies of integrated care models. Each care provider depends on other care providers. Patients depend on multiple care providers.

The Mobile Team collaborates with nursing homes, ambulatory nurses, the emergency service at Uppsala University Hospital, and various homecare organizations. Follow this blog for more information about how the Mobile Service works with other healthcare providers.

Nobel Week Dialogue

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This week is a special week in Stockholm. The Nobel Laureates of 2014 have come to Stockholm for a week full of events. Some of the events, like the Nobel Week Dialogue, are open to the public. This year, the topic of the dialogue was aging, so I could not stay away. I would like to share some of the impressions from the Nobel Week Dialogue.

I listened to the panel “Diseases of Aging.” For information on the panelists and to view the program of the Nobel Week Dialogue, please visit the Nobel Week Dialogue website.

The panelists and the audience discussed how the burden of disease changes as our population ages. More people suffer from stroke, from cancer, and from cardiovascular diseases. Many older people suffer from several diseases at the same time. One disease, such as obesity, is a risk factor for other diseases. Can we afford to treat these diseases in the future? Are there effective ways to prevent these diseases?

You can watch the panel discussion here. The discussion yielded some useful insights: We have not slowed the development of age related diseases like dementia. We have postponed the onset of age related diseases. We do not age more slowly. We age later in life.

When we stay physically active, we help our bodies and our minds to stay young. When we remain socially connected, we slow down the aging processes. When we learn, we activate parts of the brain that prevent us from aging. We ought to remain students throughout our lives.

Some age related diseases have common causes. If we can identify the common causes, we can prevent or delay several diseases at the same time. Once a person develops diseases, we must treat each disease separately. Professor Miia Kivipelto, a geriatric epidemiologist at the Karolinska Institute, argued that prevention is partly a political issue. We must make it easier for people to lead healthy lifestyles. Linda Partridge, Director of the University College London Institute of Health Aging, disagreed. She argued that raising taxes on unhealthy food would not prevent people from consuming sugary and fatty foods. We must persuade people to lead healthy lifestyles. We must educate people.

Professor Ingmar Skoog of the University of Gothenburgh highlighted another important point. He talked about early diagnosis. Most studies of dementia follow patients for a period of twenty years. What if the early signs of dementia are visible earlier than twenty years prior to the development of dementia? What if prevention as we see it today, such as exercise and cognitive training, are retarders of the disease? What if what we call prevention is not prevention? Perhaps we must understand the fundamental mechanics of the disease better. Perhaps we must learn how to diagnose dementia earlier than twenty years before the onset of the disease. Perhaps we must rethink prevention.

Sweden spends below five percent of healthcare costs on prevention, according to a recent report from the Forum for Welfare (Forum för välfärd). It is costly to screen people for diseases. We may need to screen one hundred thousand individuals to find the disease in one person who can benefit from an early treatment. The panelists and the audience talked about the importance of preventing diseases. What I missed from the lecture today was a discussion on cost effective prevention. The gains of prevention seem to be large. If we can reduce the costs of prevention, we could lower healthcare costs. We could offer early treatment.

The moderator, Göran Hansson, Professor at Karolinska Institutet asked the panelists if they believe we could repeat the success story of the reduction in smoking. Can we reduce obesity like we reduced smoking? Nobel Laureate Eric Kandel offered a positive view. We made it trendy not to smoke. Many people stopped smoking because it was no longer trendy to smoke. But Ms. Partridge countered with a pessimistic view. We were never made to smoke, but we were made to eat. Historically, the more we ate, the greater our chance of survival was. Evolution has equipped us with few tools to resist fatty foods. We have lived in abundance for a short period of time. Repeating the success story of smoking will be a challenge. Are you an optimist or a pessimist when it comes to reducing obesity in the world?

The discussions stimulated my curiosity. I want to learn about common causes of diseases related to old age. I want to know more about prevention of diabetes and early detection of dementia. The topics at Nobel Week Dialogue were relevant because the panelists discussed diseases that affect large groups of people. In Sweden, one hundred and fifty thousand individuals suffer from dementia, and two thirds of these people also suffer from Alzheimer´s Disease, according to the Swedish Dementia Register. There are over four hundred thousand individuals who suffer from diabetes in Sweden. And almost four hundred million people in the world suffer from diabetes, according to the International Diabetes Federation. These figures are growing.

I was happy to note that many young people attended the Nobel Week Dialogue. I am also grateful that Nobel Week Dialogue chose to focus on aging this year. ACCESS Health works actively to support young entrepreneurs who are interested in aging. Entrepreneurs in different countries participate in ACCESS Health incubator programs.

As previous authors of this blog have described, Modern Aging is an ACCESS Health project designed to encourage entrepreneurs to create new businesses to serve the needs of the elderly and the chronically ill. The Modern Aging project was first conceived and implemented in Sweden. Young entrepreneurs were selected to participate in a fourteen week educational program. The winner received money to start a company. ACCESS Health plans to replicate and expand the Modern Aging project in Europe, the United States, and Asia. Check out www.accessh.org for updates on the program and the Modern Aging Innovation Laboratory.

Warm greetings from Sweden!

Sofia

Introduction

Hello everyone,

My name is Sofia Widén. I am the new coordinator of this blog. I joined ACCESS Health International earlier this month as a program manager. I am studying integrated elder care and healthcare. I will identify global examples of good practice in integrated elder care, together with other members of the ACCESS Health team working on elder and long term care. Some of the ACCESS Health team members will be blogging with me here. We have projects in countries as diverse as India, mainland China, Hong Kong, Singapore, and Sweden. We will tell you about our work on this blog.

Right now, I am based in Sweden, and I plan on working in the United States next year. I graduated from the University of Edinburgh in June 2014, where I studied economics, politics, and languages. In my role at ACCESS Health, I will be blogging about my research, about articles that I read, and about topics such as elder care and healthcare. From time to time, I will write about related topics. I love writing and I love reading. I will tell you about inspiring people that I meet. I will tell you about the exiting things that I learn through my research. Please send me comments and interact with me. Please follow me on Twitter @SofiaWiden, and check out our website www.accessh.org.

I wish you all the best and I hope that you will enjoy our blog!