Homecare, Elder Abuse, and Hypertension Top Talks at AGS

Fran Lowry

April 24, 2018

ORLANDO — How to provide the best care for the increasing population of house-bound older adults in the United States will be highlighted at the upcoming American Geriatrics Society (AGS) 2018 Annual Scientific Meeting.

This vulnerable population of "older, frail folks who are often at home, or home-limited," will have implications for the development of health systems in the twenty-first century, said Bruce Leff, MD, from the Center for Transformative Geriatric Research at Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

New entities entering the healthcare marketplace "focus on care in the home, which I think is a really good signal for our patients in many ways," he added.

Leff, who has been a driving force behind the delivery of care in the home, will address, during the Henderson State-of-the-Art Lecture, the array of home-based medical care services and innovative models designed to care for people as they age.

"There is still tremendous confusion, even among geriatricians, on what the spectrum of home-based care actually is," he told Medscape Medical News.

It is important to provide good care, but also cost-effective care, because many more people are home-bound than is commonly understood, Leff said. Home-based primary care is a model for doing that, but not the only one.

"Hospital at Home is medical care in various forms, and the work I've been doing for almost 25 years has centered on developing a model of acute hospital-level care in the home," he explained.

Tackling Elder Abuse

"There is a sliding definition of what is an 'older' adult," said Thuan Ong, MD, from the University of Washington in Seattle, who is program chair for the meeting.

Thuan Ong

"We now understand that older may mean much more than just chronological age. There are robust people who are over the age of 65, but there are also frail individuals at age 65," Ong told Medscape Medical News. And "there is a greater perception of how certain illnesses, conditions, and issues, such as elder abuse, affect seniors."

A session on elder abuse should be of particular interest to clinicians, he said. "The physical, financial, and emotional abuse of older adults in the community" will be addressed, and services available discussed.

"Often, elder abuse is not perceived as hard science, such as hypertension," Ong pointed out. However, "it is a serious issue for adults as they age and become increasingly dependent on others for some of their care needs," he explained.

The management of hypertension will also be examined at the meeting.

High Blood Pressure

"Hypertension is such a timely topic," said Ong. "You would think that simple, mundane things like hypertension would have been solved by now, but there are so many nuances to it, especially as we grow older; there's so much heterogenicity within our older adult population."

A discussion of new clinical guidelines, how to use them in clinical practice, who they apply to, and how to discuss the topic with patients will be "clinically useful," he said.

There will also be talks on the management of chronic pain in older adults in the era of the opioid crisis and the prevention of delirium in hospitalized elderly patients.

Oral sessions, poster sessions, and case reports will be "where we generate a lot of enthusiasm for the future of geriatrics," said Ong. "Many students, residents, and fellows will be presenting posters that revolve around the work they've done."

Taking care of geriatric patients is complicated, he added. "There is no single algorithm. It's very much patient-centered care, and that's why I think many of us chose this specialty. Another reason is the interdisciplinary approach to the practice."

"As physicians, we are merely one of a team of many who are providing care. For example, the physical therapist might play the key role in one scenario, or perhaps the social worker, or the speech therapist, and the physician might be part of the ancillary support to that team," he explained.

"In this way, geriatric medicine is very different than other specialties, where the physician is the lead. Plus, we are serving an underserved and often overlooked population, he added.

"I often get asked what drew me to geriatric medicine, and I believe that many people in geriatrics get asked the same thing," Ong told Medscape Medical News.

"Our responses are probably limited, meaning we have very similar backgrounds, with amazing mentors who showed us how geriatric care can be very impactful and how it presents a great opportunity to learn from our patients. I know I am constantly learning from mine," he said.

Ong and Leff have disclosed no relevant financial relationships.

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