In a report from the Centers for Disease Control and Prevention (CDC), one in five Americans will be a senior citizen by 2030, nearly double the 12 percent in 2000. Not only are there more seniors, but they are also living longer and experiencing multiple chronic conditions.
By 2050, the U.S. population of those aged 65 years and older is expected to comprise 20 percent of the population, of which approximately 19 million will be people aged 85 years or older. Of these older Americans, it is estimated that 30 percent will require care for their multiple comorbidities.
As the population of older Americans expands and baby boomers turn 65, a growing number of older Americans expect to live healthy lives well into their seventies, eighties, and nineties. This growing number of older adults, and the families who care for them, will need emotional, educational, and financial resources that are not currently available.
The simple, most expeditious way to identify the needs of your aging patient population is to engage the patient and family in their care in both the ambulatory and inpatient settings and assess their individual needs. Whom do they live with? Do they understand their medications? What language barriers do they experience? Do they have a family support base? Have they been hospitalized recently as a result of noncompliance with medications or medical treatment advice?
Asking these simple questions may reveal clues to perceived issues of compliance, disengagement, or misunderstanding and communication errors. The best way to deal with these areas of concern, in the ambulatory setting, is to encourage patient preparation and engagement for each appointment. The Agency for Healthcare Research and Quality (AHRQ) provides some tools to assist patients and their families become more fully engaged in their medical appointments. The tools encourage patients to prepare for their appointment, to speak up and ask questions, and to take notes.
Aging patients quite frequently are confused or unsure about their medications, especially when new medications are added or after changes due to hospitalization. Many medical malpractice lawsuits include allegations of medication errors or lack of informed consent, alleging errors due to lack of communication. Therefore, an accurate medication list, fully discussed, is an important tool to prevent medication errors. AHRQ provides a sample medication list and a patient reminder tool to engage patients and caregivers to create a complete and accurate medication list using the brown bag method. Additionally, patient and family engagement is also a priority at the time of hospital discharge. Hospitalists are encouraged to:
- Provide the patient and/or family with clear and specific discharge instructions.
- Furnish a complete and correct list of medications, administration instructions, and side effects.
- Instruct the patient on scheduling a follow-up appointment with their PCP.
- Provide information about which provider to contact for questions, concerns, or problems.
- Transmit a comprehensive written discharge summary to the outpatient healthcare provider.
Ambulatory care providers also should establish discharge systems:
- Designate an office staff member to field calls from newly discharged patients.
- Create a system that notifies office staff when patients are discharged.
- Patients should never be discharged without adequate instruction and education.
- Actively perform a medication reconciliation at the first visit.
We are in the midst of an important and potentially transformative shift related to patients’ roles in healthcare. Active patient and family engagement in their health and will strengthen decision making, improve health, reduce liability, and is key to error and injury prevention.
Ann Whitehead is Vice President Risk Management and Patient Safety for CAP. Questions or comments related to this article should be directed to awhitehead@CAPphysicians.com. The information in this publication should not be considered legal or medical advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.