Update on Research in Geriatrics Presentation March 6-7 2009

1. Cutting Edge: Update on Research Advances in Geriatrics Janet E. McElhaney, MD, FRCPC, FACP Professor of Medicine Allan M. McGavin Chair, Geriatrics Research UBC, PHC and VGH Division Head, Geriatric Medicine

3. Seniors’ Health: Adding Life To Years 60 70 80 90 Age 2000’s 1990’s 1980’s

4. Chronic diseases increase risk for catastrophic disability Successful Aging Usual Aging Frail Seniors Seniors in LTC

5. Risks Associated with Hospitalization 65+ population are hospitalized 3X more often than younger adults; 36% of hospitalizations and 50% of hospital expenditures At discharge, 33% are more disabled 5% die in hospital, 20-30% die in the year after hospitalization Elixhauser A et al; AHRQ Pub. No. 00-0031, HCUP Fact Book No. 1, 2000 Covinksy KE et al; J Am Geriatr Soc; 51:451, 2003 Transforming Seniors Care – what’s not hot but should be

8. Demand savings from Seniors Transformation ALC ELOS LOS Acute days that exceed ELOS Prevent 20% of cases from becoming ALC Remove 50% of acute days that exceed ELOS Acute Reduction of acute days by 16,556 per year Total Savings Possible for “Target Group” Includes: CMGs grouped by guideline Seniors aged 70+ VCH residents only Excludes: COPD (CMG 139) & Stroke

11. One presentation of dynamic frailty Picture an 82 year old woman who presents in the ED with a cough and increasing SOB while walking with her 3 K-a-day Club on the Sea Wall.

12. Dynamic frailty can be a mask that limits our view of possible outcomes Picture an 82 year old woman who presents in the ED with confusion and a cough. She was walking with her 3 K-a-day Club on the Sea Wall 2 days ago .

13. Learn to look behind the mask …

14. Catastrophic Disability Ferrucci et al. JAMA 277:728, 1997

15. Acute Illness: Prevent or Minimize Disability 80 80 80 80 80 Age Cardiovascular Disease Diabetes Osteoporosis Chronic Lung Disease Cognitive Impairment Dynamic Frailty Usual Aging IADL Frailty ADL Frailty

16. We’re all in the same boat!

18. Collaborative Practice : Care that integrates best available research evidence with professional judgment and patient values First, think of collaboration as a continuum … Then, see the continuum from the patient’s perspective

19. Accommodate: Multidisciplinary professionals intervene on an autonomous, parallel basis.

20. Cooperate then Coordinate: Interdisciplinary team members cooperate then coordinate assessments and care plans.

21. Collaborate: Professionals have a narrower margin of autonomy but the team as a whole is more autonomous and its members better integrated