Abstract
Portugal currently registers 182 elderly (+65 years) for every 100 young people (- 14 years), becoming the fastest aging country in EU. In the 30 years, the elderly population tripled.
The elder’s access to quality health services is essential to maintain their functional ability, to ensure the access to a basic human right and to live a life with dignity.
HÁ+ VELHOS is a co-construction project focusing on a person-centred response to the elder population. The model is the culture sensitive adaptation of the 4M Methodology based on: Motivation (adjusting care to the result expected); Medication (adapting medication to the patient`s condition and expectations), Mental State (preventing, identifying, and treating the 3 D's) and Mobility (encouraging mobility and functionality). The project pursued strategic objectives of intersectoral coordination, promoting the convergence of wills, resources, and actions with local partners, fostering organizational innovation.
Goals:
- Promotion of the integration of care through the alignment of relevant local actors
- Alignment of care to the patient’s Motivation: encouraging visits; case management; preparatory home visits; permission of visitation of significant animals; removing physical and social barriers and converting spaces (automatic doors, changing decoration and use of colour), Informal care giver courses, involving the support network and encouraging visits, participation of patients in preparing information, Proximity exams @Primary care units and 3rd sector institutions, Collaboration with schools, proactive communication with patients.
-Assessment of the need to use Medication: systematic, multidisciplinary therapeutic reconciliation program; deprescribing; application of SAG BEERS criteria for potentially inappropriate medication.
-Management the Mental State: psychological scales; NBPC for detection and treatment of 3D's (dementia, depression, and delusion); collaboration with a Psychiatry, “Yoga for all”; measurement of water intake to prevent dehydration, promotion, and measurement of water intake to prevent dehydration, project “From wishful thinking to WISH FULFILLING”
-Promotion of Mobility: MYMOP and EQ-5D; promotion of mobility; Fall Prevention Program - systematic methodology for risk assessment, identification, and signalling; “no pyjamas” policy and daily rehabilitation gym session.
- Improvement patient´s experience : Drawing a citizen-oriented clinical pathway model to improve patient satisfaction.
- Communication strategy to combat ageism: use of social media to convey a positive image of ageing through digital storytelling of people as role models, to generate engagement from the deconstruction of stereotypes.
Results:
-Barthel Index: 94% of the patients improved on this index, and the rest of them keep the punctuation. The level of the IB raised 22% on global.
-Functional Independence Measure – 86% got better results.
-Mini Mental State Examination – 63% got better results.
-Increasing efficiency: No funding increase but more clinical activity (20-23)
-PREM: Satisfaction inquiry rated 3,8| max.4
It is necessary to change the paradigm towards an integrated model, proactive, that privileges continuity, quality, efficiency, and safety, to obtain real health gains and an efficient use of resources with courage to innovate to achieve sustainability, referring a top-down vision and bottom-up approach.
Age friendly institutions are not an option, they are inevitable! At HAJC we faced it as a choice.