Academic journal article Annual Review of Gerontology & Geriatrics

The Older Person in Transition: Implications for Pathways of Transitions of Care

Academic journal article Annual Review of Gerontology & Geriatrics

The Older Person in Transition: Implications for Pathways of Transitions of Care

Article excerpt

ABSTRACT

Older adults face many care transitions and often have difficulty navigating a complex, fragmented health care system. Health care providers, older adults, and their caregivers face challenges in communicating effectively during care transitions. Suboptimal care during transitions can lead to poor patient satisfaction, clinical deterioration, and unplanned use of health services such as return to the acute care setting shortly after discharge from the hospital. This chapter highlights characteristics older adults bring to the health care experience, with special attention given to those characteristics that make them more vulnerable to transitions of care problems in contrast to other age groups. This chapter also discusses issues that lead to care fragmentation and increased numbers of care transitions among older adults. Lastly, this chapter makes recommendations to address and reduce the fragmentation in care delivery for older adults. Ultimately, the implications for pathways of transitions of care are addressed in this chapter.

INTRODUCTION

Older adults face many care transitions and often have difficulty navigating a complex, fragmented health care system. Health care providers, older persons, and their caregivers face challenges in communicating effectively during care transitions. Ensuring optimal care during transitions involves making logistical arrangements for the services needed after the transition, providing education to older adults and their caregiver(s) on self-management of their conditions and about what to expect at the next site of care, and ensuring coordination among the health professionals involved in the sending and receiving ends of the care transition. Suboptimal care during transitions can lead to poor patient satisfaction, clinical deterioration, and unplanned use of health services such as early emergency department visits and rehospitalizations (Arbaje et al., 2008; Coleman, Boult & American Geriatrics Society Health Care Systems Committee, 2003). Because older adults are among the highest users of health care services and account for the largest amount of government health spending (Anderson & Steinberg, 1984, 1985; Federal Interagency Forum on Aging- Related Statistics [FIFoA-R], 2010; Thorpe & Howard, 2006), care transitions, especially between hospital and home, are viewed as attractive targets for improving health care quality and reducing medical expenditures.

The purpose of this chapter is to provide an overview of the characteristics of older adults that influence and shape the pathways of their transitions of care, discuss the challenges they face in a fragmented system of care transitions, and discuss ways we can address this fragmentation. The first section of this chapter highlights characteristics older adults bring to the health care experience, with special attention given to those characteristics that make them more vulnerable to transitions of care problems in contrast to other age groups. The second section discusses issues that lead to care fragmentation and increased numbers of care transitions among older adults. The third section describes ways to address and improve the fragmentation in care transitions for older adults. Lastly, this chapter comments on the implications for pathways of transitions of care for older adults.

OLDER ADULTS AND CARE TRANSITIONS

Demographic Trends and Older Adults

Over the next several decades, the population at risk for suboptimal care transitions is expected to grow markedly because of the growing proportion of older adults in the United States. Adults 65 years of age and older number more than 40 million persons nationwide, which is 12.8% of the U. S. population, and adults older than the age of 85 years are the fastest growing segment of the population. The highest percentages of older adults reside in rural areas of the central and western part of the United States, some areas of the eastern states, and in Florida. …

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