Navigating Adults Through the Health Care System

Presented by: Rita Ghatak, PhD
Director, Stanford Aging Adult Services
Stanford University Medical Center
October 29, 2009

Lecture Overview:

• Factors that affect a person’s health outcome include social vulnerability, aging, acute illness, and chronic disease.
• People are most vulnerable during care transitions, as they change doctors, settings, and treatments, or are discharged from a hospital.
• Stay mentally active and set up a support system to help coordinate care before the need arises.
• Learn how to maneuver through the health care system and take steps to engage in preventive health practices.

Although many seniors are still playing golf, traveling, and staying involved in community and cultural events well into their 90s, the truth is, most of us will require hospital services at some point as we age. With a growing population of older adults, society is already facing enormous growth in indirect and direct demands on the health care system. And while the field of geriatrics is growing to address this need, research is still woefully underinvested and many questions about maintaining optimal health for older adults still remain.

That makes it even more imperative to learn how to maneuver through the system-and to take steps to avoid it, according to Rita Ghatak, PhD, director of Stanford’s Aging Adult Services, who spoke at a presentation sponsored by Stanford Hospital Health Library.”

Aging does not mean illness,” she said. “Normal aging does involve changes to your vision, hearing, and reflexes, so it’s important to understand why you feel the way you do. When you start having problems, or start to feel different, that’s where screening comes in.”

There are several interconnected factors that affect a person’s health outcome, including social vulnerability, aging, acute illness, and chronic disease. Problems often arise where these areas overlap, said Ghatak. People are most vulnerable during care transitions, as they change doctors, settings, and treatments during the course of a chronic or acute illness.

About 30 percent of older adults use five prescription medications or more, which can lead to an adverse drug event, one of the most common reasons for a trip to the emergency room. Ghatak and her team follow up every geriatric ER visit with tracking calls and home visits to make sure patients understand how to use their medications and to encourage them to check in with their primary care physicians.”

Lack of follow-up care is the biggest problem,” she said. “Long-term communication is critical and that’s where setting up an advocate comes in. Patients require a support system-someone to follow them and help coordinate their care.”

That’s why it’s essential to have a plan in place before facing a health emergency. Ghatak suggests talking in advance to set up an advocate for your care and follow-up services. It’s an asset to have a positive attitude about health, to plan ahead, and to develop a network of community and caregiver support.

Ghatak also stressed the importance of staying mentally active to sustain cognitive vitality. Practice mental gymnastics that combine the senses or break routines. “Improving your organization will improve your cognition. Use visual cues, practice stress reduction, and pay attention to detail,” she said.

She also pointed out the difference between delirium, depression, and dementia, and that these very different conditions sometimes have similar symptoms. For example, eight of 10 older patients experience postoperative delirium after surgery from anesthesia or medication. They appear confused and lose track of time, and can appear to be suffering from Alzheimer’s. Episodes can last several hours or even days, and the condition has been associated with increased complications and medical costs since patients stay bedridden longer. Aging Adult Services  has a delirium protocol in place, Ghatak said, so nurses know to call someone to help with the condition.”

The bottom line is that you need to be your own advocate to establish a support system for your health,” she said. “And take care of your legal and financial paperwork sooner than later for your own sense of well-being.”

About the Speaker
Rita Ghatak, PhD, is a clinical psychologist specializing in gerontology and director of Aging Adult Services at Stanford University Medical Center. The program offers consultations and assessments, assistance with appointments, physician referrals, coordination of services, access to community resources, and educational workshops. Most of these services are free to community members. The program has helped more than 4,000 geriatric patients since it launched in 2004.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

Stanford Aging Adult Services
http://www.stanfordhospital.com/forPatients/patientServices/geriatricHealth

Stanford Partners in Caring
http://stanfordhospital.org/forPatients/patientServices/partnersInCaring.html

Senior Health (National Institutes of Health)
http://nihseniorhealth.gov/

Healthy Aging (Centers for Disease Control)
http://www.cdc.gov/aging/