When Leila Colmen became unable to care for herself, her family grappled with the best course of action. Living more than 3,000 miles away, it would be difficult for family members to assist Leila with her transition into supported living. Rita Ghatak, PhD, Director of the Aging Adult Services (AAS) program at Stanford Hospital & Clinics, was there to meet with Leila and her doctors, reporting back to the family on phone and e-mail to reassure them that Leila was in good hands. "Rita was our surrogate, trusted advocate and friend. She was able to provide objective feedback about our aunt's care and condition," explained a grateful niece. "It set my mind at rest knowing that Rita was following up and helping us deal with a very sensitive situation."
In the health care setting, older adults often require assistance with health evaluations, physician referrals and polypharmacy awareness. After discharge, they need preventive health and safety advice, along with linkages to services enabling them to live safely at home. Despite these needs, few hospitals have a clinical geriatric department to assist older adults. Stanford Hospital's AAS program offers older adults in Palo Alto the range of support that they, and their loved ones, need to take on the challenges that come with growing older.
A continuum of care for older adults
As medical breakthroughs help people to live longer, the systems that provide support to older adults are increasing in number and sophistication. But while new approaches to dealing with some of the unique needs of older age are being considered, creating a holistic approach that both prevents and treats illness and injury remains the ultimate goal.
"Modern medicine has come a long way, and older adults are certainly reaping the benefits," says Ghatak, a clinical psychologist specializing in gerontology. "But medicine is only one part of the picture. As people get older, we need to look at a whole host of solutions that can keep them healthier and happier for their entire lives."
Stanford Hospital & Clinics recognized that older adults were often coming to the emergency department to receive care for injuries or illnesses that may have been avoided if simple measures, such as a review of medications, were in place. Established in 2004 and housed in the Guest Services department, the AAS program was created to meet the needs of patients 65 years and older. A team of skilled professionals assist outpatient older adults and work with them and their families to develop appropriate transition plans. The AAS program also works across medical disciplines, connecting patients with medical services that ensure older patients are not just living longer, but also living well.
Picking you up when you fall
Farewell to Falls, a program of the Trauma Center at Stanford Hospital, is working with older adults to help reduce falls. More than 1 million older adults in California fall each year, with 200,000 of those falls resulting in injury. And nearly 188 Californians, age 55 and over, are hospitalized every day from slips, trips and falls. Research shows that exercising regularly, reviewing medications and making modifications to the home can prevent falls and help older adults maintain independence. But that relatively simple message doesn't always reach older adults. Stigma, the fear of a loss of independence and denial can all play a role. The Farewell to Falls program tries to overcome all of these issues.
"I didn't think there was anything wrong with me," recalls Diane Finch, a 75-year-old Menlo Park resident. "I slipped on a piece of ice in the kitchen, and was a mess for a while. I thought it was the stroke, but that wasn't it, the stroke was in my face. It had nothing to do with my loss of mobility."
Diane agreed to try out the Farewell to Falls program after having a second fall at her home. An occupational therapist at Stanford Hospital went to Diane's home to perform an assessment. "She sat there with me for an hour. She showed me exercises, showed me what I didn't do right. I couldn't stand on one foot; I was stunned," says Diane.
Lending a hand
The program focuses on those aspects of falls that can be prevented. Each participant receives two home assessments. An occupational therapist travels to the home and lets the participant know about potential problems, like the need for a grab bar for getting in and out of the shower, that can reduce the chance of falling. A video is given to each participant to help them improve strength and balance. The Stanford representative also creates a list of all of the medications the patient is taking and has it reviewed by a pharmacist to ensure that all of the prescriptions are appropriate. If there is a problem, it is flagged so that the patient can speak with his or her primary physician.
"I have allergies, and I was taking a medication that impairs my physical gait. Nobody had picked up on that, including my doctor," says Diane. "It was a lifesaver."
In addition to the home visits, older adults in the program also receive periodic phone calls from volunteers to check in with how they're doing. "The phone call, just reminding them helps out," explains Barbara Gordon, an 83-year-old volunteer who checked in on Diane for a year after her fall. "It helps them be more conscientious. They think 'hey, I'd better be more careful'".
"It still comes down to teaching people to be their own advocate," agrees Ellen Corman, the Farewell to Falls program director. "We're telling them, look, your falls are preventable. We're here to help you."