OHA Presentation November 23, 1999 Geriatrics Introduction to Specialized Geriatric Services and RGPs: Definitions and

1. OHA PresentationNovember 23, 1999GeriatricsIntroduction to Specialized Geriatric Services and RGPs: Definitions and Scope Dr. W.B. Dalziel Chief, Ottawa-Carleton Regional Geriatric Assessment Program President, Canadian Geriatrics Society Associate Professor, Division of Geriatric Medicine, University of Ottawa

2. HSRC

3.  Potential Benefits of SGS To Acute Care Hospitals

4.  Models For SGS

5. Interdependencies

6. Historical How Did Geriatrics Start? 1940�s England 1970�s Canada 1982 Geriatric Specialist Exams 1985 Ottawa Starts RGAP (1st in Ontario) 1986 Timmins Program 1980/90�s ? Medical Schools ? Family Medicine ? Internal Medicine Early 1990�s Large Urban Academic Geriatrics

7. A Vision for Specialized Geriatric Services Independence through partnership, clinical excellence, and compassionate care. Older people with complex needs can expect to optimize their independence and quality of life, through timely access to specialized geriatric services when required. These innovative services are fully integrated as a fundamental component of the health system of Ottawa-Carleton and surrounding areas.

8. A Vision for Specialized Geriatric Services (Continued) The acute, primary and continuing care sectors are predominantly responsible for providing care and treatment for the elderly in need. Specialized geriatric services will therefore work in partnership with primary care physicians and other providers in an accountable, responsive, and coordinated system of care. This system will be characterized by simplified access and continuity of care. Available resources will be optimized by offering care at the point most likely to offer the greatest benefit.

9. When to Consider Referral To Specialized Geriatric Services(Regional Geriatric Assessment Program) 1. Assessment and Evaluation of �Geriatric Giants� These are common final pathway problems often with multiple causes of critical importance in that they have a major impact on function and quality of life. ? Acute or chronic change in cognitive status ? Decrease in overall function/independence ? Falls/poor balance ? Decreased mobility

10. When to Consider Referral To Specialized Geriatric Services(Regional Geriatric Assessment Program) Continued 1. Assessment and Evaluation of �Geriatric Giants� Possible depression Possible iatrogenesis/polypharmacy More urgent referrals should be considered if the problems are recent or acute in onset more likely to find reversible cause(s) if there is not a clear underlying cause, of if there are significant management difficulties.

11. Still Behind the Demographic Wave Human Resource Shortages Inadequate Support Spotty Service Development

12. When to Consider Referral To Specialized Geriatric Services 2. The Frail and Failing (�Vulnerable�) ? Frailty is usually defined as those who are already suffering dependence in the activities of daily living (ADLs), or those who are at high risk of losing functional status. Failing usually refers to a frail elderly person who has suffered a recent further decline over the past several weeks - months. ? The multiple underlying causes can often be improved with appropriate assessment and intervention including rehabilitation.

13. When to Consider Referral To Specialized Geriatric Services(Continued) 2. The Frail and Falling (�Vulnerable�) Continued Not eating well ? Significant weight loss ? Increasing concern about the individual�s ability to remain in the current living situation (consideration of institutional placement) ? Coping marginally for yet undetermined reasons (�dwindles�) ? Persons considered �high risk� for poor outcomes (hospital admission, community crisis, institutional placement).

14. When to Consider Referral To Specialized Geriatric Services(Continued) 3. Increasing Use/Demand on Services Increased use of services or caregiver burden and stress are a marker of underlying health or functional problems which are potentially reversible with appropriate intervention. ? Increasing Family Physician visits/phone calls ? Repeated hospital admissions or emerg room visits ? Increased family caregiver burden or caregiver burnout ? Increased need for CCAC (Home Care), community services

15. When to Consider Referral To Specialized Geriatric Services(Continued) 4. Multiple and Complex Medical/Functional Problems Often those elderly with multiple health problems, particularly when impacting on functional status and independence can benefit from comprehensive geriatric assessment and intervention with access to multidisciplinary team (OT, SW, PT etc.) resources.

16. Do Geriatric Programs Decrease Long-Term Use of Acute Care Beds? BRIEF REPORT Christopher D. Brymer, MD, FRCPC; Catherine A. Kohm, RN, BA; Gary Naglie, MD, FRCPC; Lorie Shekter-Wolfson, MSW; Marissa L. Zorzitto, MD, MSc, FRCPC; Keith O�Rourke, MBA; James L. Kirkland, MD, MSc, Ph.D., FRCPC Journal American Geriatric Society 43:885-9, 1995

17. Absolutely Necessary Without Which Failure Is Guaranteed Fundamentals For Success In Developing SGS

18. 1. A Plan with Consensus buy-in, (MAP, Blue Print) 2. Presence of support by ALL the key players (local champions) even in the face of competing priorities. 3. Strong Geriatric Leadership 4. Add-on Protected $ Resources 5. A Regional Advisory Committee Representing all Interests

19. 6. A Part for all Players - Acute Care - Long Term Care - Community Care And recognition of interdependencies 7. 10 Times the Communication you Thought was Necessary 8. Evaluation 9. Education 10. Impatience

20. What Comes 1st - The Chicken or the Egg 1. Geriatric Assessment Unit 2. Geriatric Consultation Service 3. Geriatric Rehabilitation Unit 4. Geriatric Outpatient Clinic 5. Geriatric Day Hospital 6. Geriatric Outreach Services

21. ROLE Specialized geriatric services attempt to optimize the health, independence, and quality of life of seniors. The majority of care and treatment for the elderly is, and will continue to be provided by the primary, acute, and continuing care sectors.

22. ROLE (Continued) Specialized geriatric services are intended to serve as a resource to family physicians and other providers in meeting the needs of seniors with more complex or multiple needs.

23. ROLE (Continued) As a result, specialized geriatric services are best used as a consultative service, providing comprehensive assessment and treatments on a time-limited basis.

24. Major Trends Economic Restraints Population Aging 75+ 85+ 1997 37,158 1997 8,373 2001 43,747 (+8%) 2001 10,653 (+28%) 2003 46,543 (+25%) 2003 11,626 (+40%)

25. Major TrendsHealth System Restructuring Increased service integration Increased accountability Decreased hospital inpatient services Increased community based care/caregiver burden Increased long-term facility care? Restructured mental health system