TOPIC: GERIATRIC HEALTHCARE TEAM • Gerontologists- perform a support function in

educating and understanding aging, while

Health Care Settings • Geriatricians- deal with the care of these older
adults.
Care may be delivered in the following settings:
The difference in approaches between gerontology and
• Physician's office: The most common reasons for
geriatrics is a matter of scope.
visits are routine diagnosis andmanagement of acute
and chronic problems, health promotion and disease • Gerontology- uses a multidisciplinary approach to
prevention, and pre-surgical or postsurgical study the problems that the elderly face and seek out
evaluation. Medicare pays for a yearly wellness visit big-picture solutions. Geriatricians deal with the
for older adults enrolled in Medicare Part B for issues that their patients may be facing today.
longer than 12 months (see Medicare Coverage for • A gerontology nurse- is a nursing specialist who
limits and exceptions). The annual visit focuses on works directly with older adults to provide them with
identifying areas of risk, prevention of disease and specialized care and a high quality of life.
disability, screening for cognitive impairment, and • A geriatric nurse- is a specialist who will help
creating a prevention plan. elderly patients recover from illness or injury by
• Patient’s home: Home care is most commonly used providing practical care and developing patient care
after hospital discharge, but hospitalization is not a plans. They may also help with rehabilitation and
prerequisite. Also, a small but growing number of conduct check-ups in skilled care facilities or hospice
health care practitioners deliver care for acute and facilities. While many specialists in this field
chronic problems and sometimes end-of-life care in a administer medication and assist with pain
patient's home. One model called Independence at management, they are also trained to focus on
Home Demonstration provides care to people who preventative care so that their patients are able to
have significant functional limitations and multiple avoid injuries and common medical conditions that
chronic illnesses. Care is provided by teams develop most commonly later in life.
consisting of physicians, nurse practitioners, • An occupational therapist- is a healthcare provider
pharmacists, and social workers. This model has who helps you improve your ability to perform daily
shown significant savings in the Medicare program tasks. They’ll help you learn how to stand, sit, move
and has high patient and provider satisfaction. or use different tools to participate in your activities
• Long-term care facilities: These facilities include safely.
assisted-living facilities, board-and-care facilities, • A physical therapist (PT)- is a health specialist who
skilled nursing facilities, and life-care communities. evaluates and treats human body disorders. Physical
Whether patients require care in a long-term care therapists help people of all ages and at different life
facility depends partly on the patient’s wishes and stages. Some people visit a physical therapist for
needs and on the family’s ability to meet the patient’s advice on becoming healthier and how to prevent
needs. Because of the trend toward shorter hospital future problems from occurring.
stays, some long-term care facilities are now also • Speech-language pathologists-, also called “speech
providing post-acute care (eg, rehabilitation and high- therapists,” work with patients on a broad range of
level skilled nursing services) previously done during physical and cognitive communication disorders:
hospitalization. issues with articulation, stuttering, word finding,
• Day care facilities: These facilities provide medical, semantics, syntax, phonics, vocalization, and
rehabilitative, cognitive, and social services several swallowing. These disorders have a variety of causes,
hours a day for several days a week. such as autism, stroke, brain injury, hearing loss,
• Hospitals: Only seriously ill older patients should be developmental delay, a cleft palate, and psychological
hospitalized. Hospitalization itself poses risks to issues, among others.
older patients because of confinement, immobility, • A nurse case manager- develops, implements, and
diagnostic testing, and exposure to infectious reviews healthcare plans for patients that are
organisms. Some hospitals have developed programs geriatric, recovering from serious injuries, or dealing
that provide hospital-level services in the home with chronic illnesses. Case managers work both
environment. These programs are particularly useful within and outside of a hospital or medical facility.
for patients that require long-term therapies that need
to be administered by licensed nurses and may reduce
risk of hospital-acquired conditions, such as delirium
Geriatric Interdisciplinary Teams
and some infections.
• Long-term care hospitals: These facilities provide
extended hospital-level recovery and rehabilitative
care to patients with severe injuries and clinically • Geriatric interdisciplinary teams consist of
complex conditions (eg, severe stroke, severe trauma, practitioners from different disciplines who provide
multiple acute and chronic problems). These facilities coordinated, integrated care with collectively set
are for patients who are expected to improve and goals and shared resources and responsibilities.
return home but who need a longer period of time. • Interdisciplinary teams aim to ensure the following:
• Hospice: Hospices provide care for the dying. The ➢ That patients move safely and easily from one care
goal is to alleviate symptoms and keep people setting to another and from one practitioner to
comfortable rather than to cure a disorder. Hospice another
care can be provided in the home, a nursing home, or ➢ That the most qualified practitioner provides care for
an inpatient facility. each problem
➢ That care is not duplicated
Health Care Team ➢ That care is comprehensive
• While geriatrics deals with the care of the elderly and
their needs, gerontology is the study of aging and its
impacts on the population.
 • To create, monitor, or revise the care plan, • Practitioner team members must treat patients and
interdisciplinary teams must communicate openly, caregivers as active members of the team—eg, in the
freely, and regularly. Core team members must following ways:
collaborate, with trust and respect for the ➢ Patients and caregivers should be included in team
contributions of others, and coordinate the care plan meetings when appropriate.
(eg, by delegating, sharing accountability, jointly ➢ Patients should be asked about their preferences and
implementing it). Team members may work together goals of care and to take a lead in helping the team
at the same site, making communication informal and set goals (eg, advance directives, end-of-life care,
expeditious. However, with the increased use of level of pain).
technology (ie, cell phones, computers, internet, ➢ Patients and caregivers should be included in
telehealth), it is not unusual for team members to discussions of drug treatment, rehabilitation, dietary
work at different sites and use various technologies to plans, and other therapies, and these treatments and
enhance communication. plans should align with patient preferences.
• A team typically includes physicians, nurses, nurse ➢ Practitioner teams should respect the patients' and
practitioners, physician assistants, pharmacists, social caregivers' ideas and preferences (eg, if patients will
workers, psychologists, and sometimes a dentist, not take a particular drug or change certain dietary
dietitian, physical and occupational therapists, an habits, care can be modified accordingly)
ethicist, or a palliative care or hospice physician. • Patients and practitioners must communicate honestly
Team members should have knowledge of geriatric to prevent patients from suppressing an opinion and
medicine, familiarity with the patient, dedication to agreeing to every suggestion. Cognitively impaired
the team process, and good communication skills. patients should be included in decision making
• To function effectively, teams need a formal provided that practitioners adjust their
structure. Teams should develop a shared vision of communication to a level that patients can
care, identify patient-centered objectives and set understand. Capacity to make health care decisions is
deadlines for reaching their goals, have regular specific to each particular decision; patients who are
meetings (to discuss team structure, process, and not capable of making decisions about complex
communication), and continuously monitor their issues may still be able to make decisions about less
progress (using quality improvement measures). complicated issues.
• In general, team leadership should rotate, depending • Caregivers, including family members, can help by
on the needs of the patient; the key provider of care identifying realistic and unrealistic expectations
reports on the patient’s progress. For example, if the based on the patient’s habits and lifestyle. Caregivers
main concern is the patient’s medical condition, a should also indicate what kind of support they can
physician, nurse practitioner, or physician assistant provide.
leads the meeting and introduces the team to the
patient and family members. The physician, nurse
practitioner, and physician assistant often work Topic: Research Agenda on Ageing
together and determine what medical conditions a
patient has, inform the team (including differential INTERNATIONAL: UN PROGRAM ON AGING
diagnoses), and explain how these conditions affect
care. If the patient and family members need help in
coordinating care, the social worker might be most What is WHO's role in the UN Decade of Healthy Ageing?
knowledgeable and therefore assume team leadership.
Similarly, if there are medication issues, the • The United Nations Decade of Healthy Ageing
pharmacist might be the best person to lead the team. (2021–2030) is a global collaboration, aligned with
Alternatively, if the main concern is related to nursing the last ten years of the Sustainable Development
care, such as wound care, then the nurse should take Goals, to improve the lives of older people, their
the lead. families, and the communities in which they live. The
• The team’s input is incorporated into medical orders. World Health Organization was asked to lead the
The physician or one of the provider team members implementation of the Decade in collaboration with
must write medical orders agreed on through the team the other UN organizations and serves as the Decade
process and discusses team decisions with the patient, Secretariat. Governments, international and regional
family members, and caregivers. organizations, civil society, the private sector,
• If a formally structured interdisciplinary team is not academia and the media are encouraged to actively
available or practical, a virtual team can be used. contribute to achieving the Decade’s goals through
Such teams are usually led by the primary care direct action, partnering with others, and by
physician but can be organized and managed by an participating in the Healthy Ageing Collaborative.
advanced practice nurse or physician assistant, a care WHO's work on the Decade action areas
coordinator, or a case manager. The virtual team uses
information technologies (eg, handheld devices, • To foster healthy ageing and improve the lives of
email, video conferencing, teleconferencing) to older people, their families, and communities,
communicate and collaborate with team members in fundamental shifts will be required not only in the
the community or within a health care system. actions we take but in how we think about age and
ageing.

The Decade will address four areas for action:

Patient, family member, and caregiver participation
1. Age friendly environments
Recent evidence has pointed to the importance of providing
2. Combatting Ageism
person-centered care, which means that providers are highly
3. Integrated Care
focused on patient preferences, needs, and values. The key
4. Long-term Care
principles of patient-centered care include respecting patient
preferences; coordinating care; providing information and
education to the patient and family members; involving family
and friends; and providing both physical comfort and
emotional support.
Age-friendly Environments → • Given there is no typical older person it is important
to hear voices of older people in all their diversity
• Age-friendly environments are better places in which and to reach those in situations of greatest
to grow, live, work, play, and age. We can create them vulnerability, exclusion and invisibility—leaving no
by addressing the social determinants of healthy one behind. Authentic voices emerge through a
ageing and enabling all people, irrespective of their meaningful engagement process where older people
level of physical or mental capacity, to continue to do influence discussions on health and well-being.
the things they value and live dignified lives.
• Within this action area, WHO works with its Member • WHO is enabling voice and meaningful engagement
States at national and local levels to develop age- under the UN Decade of Healthy Ageing by:
friendly cities and communities, including through
supporting the Global Network for Age-friendly ➢ Testing and using methodologies to meaningfully
Cities and Communities. engage older people, their families and local
Combatting Ageism → communities and amplify their voices
➢ Enabling these voices to be heard by decision-makers
• Ageism is stereotyping (how we think), prejudice and influence activities implemented during the UN
(how we feel) and discrimination (how we act) Decade of Healthy Ageing and
towards people on the basis of their age. It affects ➢ Supporting others to use and integrate processes that
people of all ages but has particularly negative effects enable meaningful engagement by providing
on the health and well-being of older people. guidance, toolkits, and other resources
• Within this action area, WHO is working to change
Building leadership and capacity for the UN Decade of
how we think, feel, and act towards age and ageing
Healthy Ageing (2021-2030)
by generating evidence on ageism, building a global
coalition to combat ageism, and developing tools and • 2021-2030 is the United Nations (UN) Decade of
resources that can be used by others to take action. Healthy Ageing: a global collaboration led by WHO
Integrated Care → that brings together governments, civil society,
international agencies, professionals, academia, the
• Older people require a comprehensive set of services media, and the private sector to improve the lives of
to prevent, slow, or reverse declines in their physical older people, their families, and the communities in
and mental capacities. These services need to be which they live.
delivered to meet the person’s needs (person- • To generate meaningful and lasting change during the
centred), coordinated between different health and UN Decade of Healthy Ageing, leaders are needed to
social care providers, and avoid causing the user generate commitment for healthy ageing and drive
financial hardship. coordinated actions across sectors and stakeholders to
• Within this action area, WHO supports its Member ensure older people are not left behind. Development
States to understand, design, and implement a person- or updating of national strategies on healthy ageing
centred, integrated model of care by producing that promote intersectoral approaches including but
evidence, guidance, and resource packages. going beyond health (e.g. labor, community
development, education) are needed to enable people
Long-term Care → to live long and healthy lives.
• Many older people experience declines in their • Stakeholders across all levels and areas of society
physical and mental capacity which means they can also need to be equipped with the relevant skills,
no longer care for themselves without support and competencies and knowledge to foster healthy ageing
assistance. Access to good-quality long-term care is and enable older people to be and do what they value
essential for these people to maintain their functional for as long as possible.
ability, enjoy basic human rights and live with • Recognizing the role of leadership and capacity
dignity. building as key enablers of the UN Decade of
• Within this action area, WHO works to provide Healthy Ageing, Member States have requested
technical support to countries for conducting national WHO to work together with partners to develop
situation analyses of long-term care towards learning opportunities, mentorship programmes, and
implementing a minimum package of long-term care other tools that can help create a global community of
as part of universal health coverage. change agents working to create a world where all
people can live long, healthy lives.
Enabling diverse voices and meaningful engagement of
older people

• With the adoption of the UN Decade of Healthy

Ageing (2021-2030) by the UN General Assembly in
2020, Member States committed to 10 years of
concerted and collaborative action to improve the
lives of the older people, their families, and
communities. The Decade’s action plan recognizes
older people as rights holders and calls for them to be
at the centre of the Decade’s work.
• Older people around the world are a diverse group in
terms of their mental and physical capacities,
experiences, interests, needs and available resources.
Older people make considerable contributions to their
communities as agents of change, consumers,
employees, employers, givers and receivers of care,
volunteers and so much more.
New Evidence in Sleep's Role in Aging and Chronic
Disease

• Sleep may be as important to health in old age as diet

and exercise. Numerous studies have shown that
sleeping too much or too little is associated with
mortality among older adults.

• A growing body of research indicates that not getting

enough sleep may also increase the risk of several
conditions and chronic diseases including diabetes,
cardiovascular disease, obesity, and depression.

• This issue of PRB’s Today’s Research on Aging

(Issue 38) explores National Institute on Aging-
supported research on sleep and aging, reviewing
new evidence indicating that poor sleep may be both
a sign of ill health and a trigger for processes related
to disease and biological aging.

• While sleep often tends to become more challenging

for older people, insomnia—trouble falling asleep
and staying asleep—is not a given with old age. The
research examined here underscores the importance
of screening for poor sleep and interventions that
improve the sleep of older people.

Poor Sleep Linked to Biological Aging

• Investigators are looking more deeply into the role of

sleep in chronic disease and the aging process. Most
studies on the relationship between sleep duration
and health have been based on self-reported time
spent asleep. These studies provide evidence of a U-
shaped relationship between sleep duration and
mortality: Regularly sleeping less than five hours
daily or more than nine hours raises the risk of death.

• However, analysis of electronic sleep assessment

data—gathered over multiple nights using wrist
bands (actigraphy)—offers a more nuanced view.
Diane Lauderdale of the University of Chicago and
colleagues find sleeping less than six hours per night
is associated with poor or fair health among older
people but sleeping longer than average is not linked
to any negative health consequences.

• Specifically, disturbed sleep and too much sleep are

associated with the inflammation markers C-reactive
protein (CRP) and interleukin-6 (IL-6). These
markers tend to be related to chronic conditions such
as diabetes and cardiovascular disease. Previous
research shows that treating insomnia can reduce
inflammation. The researchers argue that sleep
disturbance and long sleep duration should be viewed
as additional risk factors for inflammation that can be
modified, like high-fat diets and sedentary lifestyles.
For example, several studies show that insomnia
treatments can reduce inflammation markers, offering
evidence that sleep problems can be a cause of
inflammation.
Sleep Problems Are Often Related to Depression modifiable, offering preventative and therapeutic
treatment potential.”
• Poor sleep is also related to depression in old age,
according to several studies A University of Michigan • Dementia-related brain changes may be linked to
team finds disturbed sleep is associated with regularly sleeping less than six hours per night and
depression, regardless of the number of chronic may begin in middle age, researchers based in
medical conditions a participant has. The study California, Pennsylvania, Alabama, Maryland, and
tracked more than 3,500 older adults participating in Illinois find. More than 600 black and white adults
the nationally representative Americans’ Changing (mean age 45) in the Coronary Artery Risk
Lives Study, which surveyed participants five times Development in Young Adults (CARDIA) study
over 25 years. reported their typical sleep duration and then had
• The researchers show that older adults diagnosed brain MRIs five years later. Compared with those
with a higher number of chronic medical conditions– who slept between six and eight hours per night, the
such as high blood pressure, diabetes, chronic lung brains of short sleepers had a greater concentration of
disease, heart attack or other heart trouble, stroke, white matter hyperintensities (a hardening of arteries
cancer, and arthritis—have higher levels of in the brain), which have been linked to stroke and
depressive symptoms. People sleeping poorly who vascular dementia.
also have heart trouble face a particularly high risk of
having depressive symptoms.

• In the researchers’ view, detecting sleep problems

early and intervening with medications or behavioral
change is crucial, and can have long-term benefits for
physical and mental health. They point out that
people with depression tend to use more health care
services than average, and given high medical costs,
early screening and treatment of disturbed sleep may
reduce costs and have “enduring public health
benefits.”

Severely Disturbed Sleep May Signal Impending Dementia

• Severely disturbed sleep may be an early signal of

impending dementia, a team of Canadian researchers
show. Otherwise healthy older people may experience
disturbed sleep, including severe insomnia and
daytime sleepiness, prior to displaying other
dementia-related symptoms, such as memory loss.
For the study, the researchers examined the survey
responses of more than 28,000 adults ages 50 and
older collected through the Survey of Health, Ageing,
and Retirement (SHARE) in 12 European countries.

• Using data for participants with no symptoms of

Alzheimer’s disease or dementia at the beginning of
the study, researchers created a sleep disturbance
index (based on measures of sleep problems, fatigue,
use of sleep medication, trouble sleeping, and
changes in sleep patterns). Analysis shows that each
separate sleep measure is independently associated
with a greater risk of Alzheimer’s disease, dementia,
or death within four years. After accounting for
overall health, high scores on the sleep disturbance
index remain associated with a greater risk of
developing dementia.

• Dementia is known to profoundly disrupt the sleep-

wake cycle of people with the disease and leave them
highly active at night, creating a burden for their
family caregivers. The researchers recommend that
health care providers screen for sleep problems in
older people, in order to detect dementia earlier and
initiate interventions to potentially prevent or delay
institutionalization.

• Similarly, researchers at the University of California,

Berkeley show that disrupted sleep related to
Alzheimer’s disease may be different from or
significantly more severe than typical age-related
sleep impairment. Evaluating older people for sleep
changes linked to Alzheimer’s, such as declines in
non-rapid eye movement sleep, could be a potentially
non-invasive way to identify individuals at risk for
Alzheimer’s disease. They suggest that sleep
impairment is both “a consequence and cause of the
progression of Alzheimer’s disease; one that is