Newswise — LOS ANGELES (July 7, 2020) - Shortly after COVID-19 was declared a pandemic, more than 450 older adults learned their weekly exercise classes offered through the Cedars-Sinai Geriatrics Program were on hold. But under the quick-thinking direction of geriatrician Allison Moser Mays, MD, the program pivoted, creating a way for seniors to access live classes from the comfort of their homes.
Supported by a three-year grant from the AARP Foundation, Leveraging Exercise to Age in Place (LEAP) classes bring older adults together for group workouts as part of a study that aims to help prevent falls and physical inactivity while fighting social isolation.
Now offered over Zoom, participants can take one of three courses: Tai Chi for Arthritis, Arthritis Exercise and a Heathier Living workshop. The online format has proved especially popular.
"This is one example of how we have continued to pivot and adapt to best support our older adult patients," said Mays, who leads LEAP. "All of our programs aim to better understand what types of programming improve social connectedness for older adults and decrease their risk of falling. The transition to virtual programs allows us a unique opportunity to compare the benefits of our in-person classes to those offered virtually."
Such efforts that are tailored to the needs of older adults are why Cedars-Sinai recently earned the distinction of an Age-Friendly Health System Committed to Care Excellence. The distinction is part of a national initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.
"This important recognition signals that we are part of the national movement to help ensure that we're taking the best possible care of older people," said Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai.
It comes at a critical time. The surge in the number of Americans age 65 and older-projected to exceed 70 million in 2030, up from about 40 million in 2010-has fueled the trend. In fact, people age 80 and older account for 19% of patients at Cedars-Sinai- more than any major academic hospital. Cedars-Sinai Geriatrics is ranked No.12 in the nation and has a distinguished comprehensive outpatient geriatric program to care for patients 65 and over.
Still, "We can’t ever have enough geriatricians to care for all of the growing number of older persons," said Rosen. "We have to work with all of our different disciplines across the health system to collaborate and implement geriatric models of care with non-geriatricians. That is the direction geriatrics has taken across the country."
A leading example of that approach is the Geriatric Fracture Program, a pioneering effort that helped Cedars-Sinai earn its Age-Friendly designation. Led by Cedars-Sinai Orthopaedics and in close collaboration with geriatrics and hospitalist services, this program specifically targets older patients who have been hospitalized with fractures, which often lead to complications-and even death-among seniors. Delirium often occurs with such injuries, and one of the changes under the program is that patients now are regularly assessed for the issue.
"The problem is that once somebody has prolonged delirium, their cognition, their ability to function in the world, is not the same anymore. And when they’re elderly and have any kind of cognitive impairment to begin with it, it exacerbates that," said Kathleen Breda, MSN, a lead nurse practitioner in the orthopaedics department and the program’s manager.
By several measures, the program has paid off dramatically. Time to surgery for hip and other serious fractures-meaning the time from arrival in the emergency room until entering the operating room-has declined by 41%.
Because the hip is the biggest bone in the body, a fracture can have dire consequences, Breda said. "If you can get medically stable patients to surgery faster to fix that fracture, they will actually do a lot better."
Length of stay in the hospital was cut 11%, down to four-and-a-half days. In addition, the program saved Cedars-Sinai $330,000 in direct costs its first year, when it served 153 patients. Now that it is being expanded and expected to cover about 300 patients a year. Annual savings of about $1 million are projected.
The approach, implemented under the direction of Cedars-Sinai Orthopaedics chair Mark Vrahas, MD, embodies what the national Age-Friendly initiative calls the 4Ms Framework:
- What Matters-the patient's health outcome goals and care preferences
- Mobility-ensuring that patients move safely every day
- Mentation-preventing or responding to dementia, depression and delirium
- Medication-using only those medicines that don't interfere with the other goals
Read more on the Cedars-Sinai Blog: How to Support Elderly Friends and Family During COVID-19