If we had to pick a theme for 2012, it might be Measuring Quality of Care Year. Our annual report discussed the lack of quality mental health care for older adults, recently illustrated by the callous dismissal of annual report writer Lynne Christensen’s mother’s post-surgical depression as “to be expected.” Our April poll, “How Does It Feel? The Older Adult Health Care Experience,” also concentrated on this theme. The poll showed that although the vast majority of older adults are satisfied with their care, that care lags badly behind recommended care for older adults on numerous measures.
While the poll was a new experience for us, writing about the sorry state of care for older adults isn’t. To help you better understand this important and frustrating issue, we’ve gathered a collection of Health AGEnda posts that address some of the problems—and solutions—we’ve identified.
Supporting the results of our poll was “The Good, the Bad, and the Ugly,” in which I discussed how far we need to go to improve care for older adults. Although there are some good programs improving geriatrics training for physicians, not all of them are producing robust results. For example, raising falls screening from a dismal 11 percent to a still-mediocre 34 percent is nowhere near good enough, and I believe there needs to be a greater sense of urgency in solving the problem.
In “Quality of Geriatric Care,” I share some recent presentations by top geriatrics scholars that make me wonder if “there really is something special about caring for people with geriatric conditions that is different from caring for people who have only general medical issues.” Somehow, while each additional general medical issue (a simple disease) predicts BETTER quality of care, each additional geriatric condition seems to disrupt the care process and predicts lower quality of care.
One geriatric condition that particularly makes care difficult is dementia. Even the best primary care systems lack strategies for best managing these patients—who are only going to increase, and who rarely suffer only from dementia.
Thankfully, as Marcus Escobedo writes in “Making the ACA’s Quality Measurements Work for Older Adults,” the Affordable Care Act includes a number of pilot programs that include quality measurements, particularly for accountable care organizations (ACOs). There’s a great potential for helping older adults, but only if the measurements of care that the government chooses incorporate advice from geriatrics experts. I think we know a few people who might be able to help.