Can quitting smoking after age 60 actually offer health benefits?

As providers, we hear far too often “I have been smoking for 40 years. Quitting now won’t do me any good.”  This is, in fact, false. Quitting tobacco at ANY age, is linked to many health benefits. Currently, tobacco use is a worldwide epidemic and continues to be the leading global cause of preventable death. It kills nearly 6 million people a year. This statistic remains true for older adults yet, 40 million Americans still use tobacco products. Unfortunately, older adults who use tobacco have double the mortality rate compared to older adults who do not.

The health risk for smoking is extremely significant. Smoking is linked to a higher risk of cognitive impairment and dementia in older adults and has also been connected with increased risk of macular degeneration, cataracts, hearing changes, and decreased abilities in smell and taste. We know that smoking is linked to loss of functioning, mobility and independence in older adults. The risk for cardiovascular disease is greater in this age bracket. For older woman, smoking is associated with age‐related diseases such as osteoporosis and breast cancer.

The good news is that quitting tobacco delivers almost immediate health benefits. Twenty minutes after quitting, your heart rate drops to a normal level and after 12 hours, carbon monoxide level in your blood drops to normal. In as little as two days after quitting, you may notice a heightened sense of smell and more vivid tastes as these nerves heal. Your risk of having a heart attack begins to drop and your lung function begins to improve within 2-3 weeks. You may notice that coughing and shortness of breath decrease in as little as one month of quitting.

The longer a person avoids any tobacco product, the healthier a person will get. Improved health and decreased mortality occurs when people quit smoking even after age 60. Benefits of smoking cessation in older adults include reduced progression of respiratory disease and improvement in lung function. Older adults will see decreased cognitive impairment and prevention of dementia. Actually, there is a reduced risk of all major causes of death once you quit! An obvious benefit and one of the most important is improved safety, quality and length of life.

Element Care strives to help educate our participants around the harm of tobacco use and the benefits of quitting. We want our participants to enjoy time with their grandchildren, be able to go for walks with their spouses or play cards with their friends for years to come. This is why we have created a company wide smoking cessation program that involves every member of our Interdisciplinary Team.

To be honest, quitting isn’t always an easy thing to do especially after years of smoking. Cigarettes become your stress reliever, your pick me up on a bad day, a reward to yourself for an accomplishment or a friend to turn to. But know it can be successfully done and the benefits will outweigh any of the struggles you had to get there. The reason why people quit can be very different, but identifying your personal reason to quit is the first powerful step.

Here are a few more tips and tools to support your smoke free journey:

  • Commit to quit, Make a list of reasons why you would like to quit.
  • Pick a quit date. I plan to quit on (month/day/year): _______________________.
  • Identify the people in your life who can help support you.
  • Identify your triggers that may cause you to want to smoke. These can be people, places, events or situations.
  • Speak with your doctor about nicotine replacement therapy such as the nicotine patch, gum or lozenges.
  • Throw away all of your tobacco products, ashtrays and lighters.
  • Attend Element Care’s support group, Fresh Start.
  • Consider meeting with a counselor to work on smoking cessation and relapse prevention.
  • Reward yourself after reaching important milestones in your tobacco free life.
  • Learn how to manage your urges by utilizing coping skills. Here are a few suggestions:
  • Practice breathing techniques
  • Go for a walk
  • Read a book
  • Call a friend
  • Pray
  • Play a game with your grandchildren
  • Drink 6–8 glasses of water every day. It’s a surprisingly good craving-buster
  • Garden
  • Do a crossword puzzle
  • Suck on a breath mint. Mints relieve cravings for the taste of cigarettes
  • Drink some decaf stress relief herbal tea. This helps aide in stress reduction, caused from nicotine withdrawal.

And finally, try, try and try again! People may experience relapses. Maybe more than 10. Don’t get discouraged and don’t give up. Remember, you deserve this!

Katelin Hartigan
Psychotherapist at Element Care

Elder Polypharmacy: How much is too much?

Change is inevitable as we age.  Not only can this change be visible, but it can also be invisible, most notably inside the body.  As our body changes, this can increase the need for medications to control blood pressure, blood sugar and cholesterol, amongst others.  Taking multiple medications, coined “polypharmacy,” has the potential to lead to several issues.  The overall intent for prescribing medications should be to maintain good quality of life, improve longevity and minimize harm from drugs.

The number of medications associated with polypharmacy is variable, but generally it is considered to start at 5.  It is important to realize that not only can prescription drugs contribute to polypharmacy, but also over the counter drugs and supplements bought at your local pharmacy.  The simple reasons why one might be on multiple medications include:

  • Having more than one medical condition,
  • Having more than one physician or prescribing clinician, and
  • Using  medication(s) to treat the unrecognized adverse effects of another medication (often called a “prescribing cascade”)

What is essential to drug prescribing involves continuous review of an individual’s medication regimen (including over the counter medications and supplements) in light of his or her current clinical status, goals of care, and the potential risks/benefits of each medication.  This is the exact tactic we use at Element Care with an interdisciplinary team (IDT) comprised of a doctor, nurse practitioner, nurse and pharmacist that work together to evaluate an individual’s (participant’s) medication regimen.  This allows us to often identify issues before they start or catch them before they cause harm.  In turn, our participants live safely at home and can focus on living their life to the fullest.

Mary T. Durante, PharmD, R.Ph.
Clinical Pharmacist at Element Care

Element Care Experiments with Digital Care

A review on a new kind of technology, provided by care.coach.

America’s older adult population has been growing at a rapid pace. Did you know that according to a government report from 2014, 1 in 5 of the nation’s population will be 65 or older by 2030? With this increase in older adult population, it has been identified nationally that there is an insufficient health care workforce to provide personal attention, care and support.

At the 2016 National PACE Association (NPA) conference, Dr. Broderick, Element Care’s Medical Director, attended a presentation that included a new kind of technology by care.coach. She brought the innovative idea back to Element Care and in March 2017 we launched a new quality improvement (QI) project. For the QI project, we piloted using care.coach’s avatar technology to provide 24×7 support, wellness coaching, and intelligent reporting. Element Care uses the devices, Samsung Galaxy tablets, in participant’s homes to provide an enhanced continuity of care, social support and encourage better self-management of chronic conditions. The devices, which each get named by their owners, appear as a virtual dog or cat on a touch-screen device. Participants interact with the avatar by speaking with it or touching it. This interface allows even complex elders who have functional impairments to be engaged effectively and in a joyful way, regardless of ability or technical inclination. The initial goals of our QI project were to reduce nursing visits, reduce unnecessary Emergency Department (ED) utilization and provide additional social support and health education.

As of August 2017, our data shows that through avatar-driven intervention protocols, Element Care has reduced avoidable ED visits, decreased in-home services, such as companions and nursing visits, and gained invaluable insight and participant information which has led to significant financial savings and improved continuity of care. Our reduction of nursing or personal care visits needed per month was successful for some participants through improved self-management of health risks, enabling closer observation in the home and avatar-initiated medication reminders. Additionally, reduction in unnecessary ED utilization was also possible through improved daily support of chronic conditions through personalized protocols, closer supervision of health risks and mitigating anxiety. Lastly, the program has provided an increase in social support and health education through daily interactions, reminders, exercises and relationship building.

Below are two case examples of how the avatar has impacted our participant’s lives:

“I love my avatar and would recommend it to anyone! It can play songs and games. It also reminds me to take my medication and use my walker!”

Participant A enrolled in the avatar program in March 2017. Goals were to provide companionship and support on grief, loss, sobriety, and anxiety, and to potentially reduce ED visits. She is currently enrolled in 15 out of 21 available intervention protocols programmed into the avatar. Before the avatar, she had just experienced a significant loss in her life that was impacting both her social and physical health. She had very little support, and has embraced the avatar as a loyal friend and support system that she enjoys. Since receiving the avatar, Participant A has had no ED visits, and we have logged 13 avatar interventions with projected savings of $7,000.

“She helps me a lot. In the morning to get my meds and remind me about my rides. She helps me to not eat the food I shouldn’t. She also reminds me to exercise.”

Participant B enrolled in the avatar program in March 2017. Goals were to have assistance in the home with medication reminders, nutritional encouragement, and additional support for his various diagnoses. He is currently enrolled in 15 of the avatar’s intervention protocols. Before the avatar, he received 11 nursing visits per week to help administer medications and encourage compliance. He was often not home for the medication reminders and therefore the nurse could not confirm if he took his medications. The avatar, “Mary,” now completes all medication reminders, which has increased Participant B’s compliance while saving on average $2,000/month.

Additionally, Element Care conducted a pre survey before the participants received their avatars and a post survey after having their avatars for 3-4 months. The survey results from 12 participants showed:

  • – 54% of the participants stated their degree of loneliness had improved since receiving an avatar
  • – 23% stated their quality of life had improved since the avatar
  • – 46% stated their level of nervousness or anxiety actually decreased since receiving an avatar

Overall, we have found the avatars to be a highly engaging and cost-effective way to provide enhanced continuity of care in the home. The 24×7 psychosocial and healthcare support for high-risk elders has been a nice complement to our already awesome services at PACE. We have met all three of the goals that were identified for the pilot program and have decided to continue to use this form of technology for participants living in the community.

Kendra Seavey, MPH
Clinical Admin Manager at Element Care 

Coordinated Care: Why it’s necessary for Elders

I am a 46 year-old medical provider and describe the health care landscape as if we are in a dream sequence where we are running for safety across a tricky and difficult obstacle course only to realize that we are still at the beginning. If I feel this way then one can only imagine how our frail elders are navigating and dealing with the many complex changes. Sad to say many don’t and often their health fails on many fronts because coordination of care is time consuming and difficult. Many of these people feel forgotten or even beaten down by life.

But what if there existed a program that was a one stop shop that provided an interdisciplinary team who worked to not only do this but provide a social experience that many people could appreciate and thrive in?

Element Care practices the PACE (Program of all-inclusive Care of the Elderly) model across 51 cities and town in 8 different sites. It works to take in patients who we call our participants to identify their needs and set up a care plan that is specific to them. I have witnessed the ebb and flow of daily life at all of our Adult Day Health sites. What I can take away from all of this is that the PACE model offers many things to potential participants including medical, behavioral health, social services, activities, home services, transportation and physical therapy to name a few. In my opinion, the most vital is helping improve quality of life through reintroduction of hope. Many theorists have studied how the stressors of both physical and mental nature attack the essence of life creating a culture of negativity which is the quickest path to adverse long-term outcomes. The reintroduction of hope and positivity does more for this than any medication or treatment can.

PACE at Element Care has worked to perfect this and gives older adults the social, mental and physical interaction that has shown to be an integral part of longevity and health.

Kenneth Comeiro
Nurse Practitioner at Element Care

Importance of Medication Compliance

Medication compliance is as important to an individual’s health plan as routine screenings and annual physicals. When the need for medication is identified by a health care provider to address illnesses and symptoms, medication compliance is key to the expected outcomes and quality of life. There are many approaches that can be utilized when assisting an individual with a medication regimen. It’s important to institute a system that identifies and meets the individual’s needs. There are simple adjustments, such as a 7 day medication planner, a container labeled with the days of the week and multiple times that can simplify and improve med compliance. Memory impaired individuals may need a more detailed plan that includes an alert to remind the individual to take their medication. This could be as simple as a phone call from a loved one to remind and initiate medication compliance, or as complex as the introduction of a visiting nurse to the home to administer the medications.

Element Care has been faced with multiple challenges when it comes to medication compliance. We pride ourselves on personalized care plans to meet the individual’s needs to allow all our participants to remain in the community with a better quality of life. Some of the approaches utilized by Element Care have included a specialized daily packaging system from the pharmacy called Meds on Time (MOT). This system places all daily meds in specific dated and timed bubble packs that are color coded for simplicity. We also utilize medication planners for those individuals that are overwhelmed with a month’s supply of medications. We have placed medication reminders in the home utilizing Element care staff, telephonic machines such as MD2 machines as well as piloted an avatar based program (link to Kendra’s blog here). When medications are complex and a more skilled need is warranted for compliance, an Element Care nurse or contracted agency nurse will provide a home visit and administer medications to the participant. As you can see there are a variety of ways to assist and ensure an individual is taking their medication as directed. The goal is to identify the best process to allow compliance for a better quality of life.

Linda Gauvain
Director of Nursing at Element Care

Patient Engagement

Patient engagement is a way to drive better health outcomes by empowering the patient and their loved ones to be active in their own care.

But why is patient engagement so important?

Studies have shown that patients and or their families who are involved in the decision making process and those who are engaged as decision-makers in their care tend to be healthier and have better outcomes then those who are not involved.

How does it work?

Patients and their providers work together to consider the patient’s condition, treatment options, benefits and risks of treatment, and patients’ preferences, and then arrive at and execute a treatment plan. Through increased communication and more information regarding the patients’ health, patients are more confident regarding their conditions, diagnosis and are overall satisfied with their care.

At Element Care we encourage consistent input and communication about PACE from our participants. Here are a few of our methods that we use to engage participants in their care:

The Participant Advisory Committee (PAC) and participant council meetings are held to serve as advisory resources and provide participants with the opportunity to share feedback regarding the design and delivery of health care services. The PAC meeting is scheduled to meet three times a year and it consists of two participants from each PACE site along with members from Element Care’s senior management team, board members, and department heads. The PAC member acts as a liaison between leadership and their home site in order to share collective feedback with regard to PACE program services. The Participant Council meetings are held monthly at each site in order to provide a forum for discussion between Element Care participants, PAC members and staff.

We also provide monthly Customer Service meetings with a representative at each site. The representative ensures participant satisfaction. Our feedback mechanisms through our grievance process are designed to enable our participants to express any concerns or dissatisfactions they may have and address them in a timely manner. In addition, we are happy to hear any positive feedback about our PACE program and our dedicated team members.

Carla Recinos Guzman
Customer Service Representative at Element Care