Complexities of care: Common components of models of care in geriatrics

Matthew K McNabney, Ariel R Green, Meg Burke, Stephanie T Le, Dawn Butler, Audrey K Chun, David P Elliott, Ana Tuya Fulton, Kathryn Hyer, Belinda Setters, Joseph W Shega, Matthew K McNabney, Ariel R Green, Meg Burke, Stephanie T Le, Dawn Butler, Audrey K Chun, David P Elliott, Ana Tuya Fulton, Kathryn Hyer, Belinda Setters, Joseph W Shega

Abstract

As people age, they are more likely to have an increasing number of medical diagnoses and medications, as well as healthcare providers who care for those conditions. Health professionals caring for older adults understand that medical issues are not the sole factors in the phenomenon of this "care complexity." Socioeconomic, cognitive, functional, and organizational factors play a significant role. Care complexity also affects family caregivers, providers, and healthcare systems and therefore society at large. The American Geriatrics Society (AGS) created a work group to review care to identify the most common components of existing healthcare models that address care complexity in older adults. This article, a product of that work group, defines care complexity in older adults, reviews healthcare models and those most common components within them and identifies potential gaps that require attention to reduce the burden of care complexity in older adults.

Keywords: care complexity; complexity of care; geriatrics; models of care; older adults.

Conflict of interest statement

The authors have no conflicts of interest to report.

© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

Figures

FIGURE 1
FIGURE 1
Frequency of components of care in 18 geriatrics models of care. GOC/ACP, goals of care/advance care planning; IDT, interdisciplinary team; LTSS, long‐term services and support
FIGURE 2
FIGURE 2
Number of components of care in geriatrics models of care. ACE, Acute Care for the Elderly; BOOST, Better Outcomes for Older Adults Through Safe Transitions; CTI, Caregiver Training Initiative; GRACE, Geriatric Resources for Assessment and Care of Elders; HELP, Hospital Elder Life Program; TCM, Transition Care Model

References

    1. Kelley AS. Defining “serious illness”. J Palliative Med. 2014;17(9):985. doi:10.1089/jpm.2014.0164
    1. Institute for Healthcare Improvement . Age‐Friendly Health Systems: Guide to Using the 4 Ms in the Care of Older Adults; July 2020. Accessed February 8, 2022.
    1. The Geriatric Emergency Department Collaborative (GEDC). Accessed February 8, 2022.
    1. American Geriatrics Society CoCare®: Ortho. Accessed February 8, 2022.
    1. American Geriatrics Society CoCare®: HELP (Hospital Elder Life Program). Accessed February 8, 2022.
    1. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity . Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012;60(10):e1‐e25. doi:10.1111/j.1532-5415.2012.04188.x
    1. The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel . The 2019 American Geriatrics Society beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674‐694. doi:10.1111/jgs.15767
    1. Choosing Wisely®: Ten Things Physicians and Patients Should Question . American Geriatrics Society; 2015. Accessed February 8, 2022.
    1. American Geriatrics Society Ethnogeriatrics Committee . Achieving high‐quality multicultural geriatric care. J Am Geriatr Soc. 2016;64(2):255‐260. doi:10.1111/jgs.13924
    1. American Geriatrics Society Ethics Committee . American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement. J Am Geriatr Soc. 2015;63(3):423‐426. doi:10.1111/jgs.13297
    1. Farrell TW, Ferrante LE, Brown T, et al. AGS position statement: resource allocation strategies and age‐related considerations in the COVID‐19 era and beyond. J Am Geriatr Soc. 2020;68(6):1136‐1142. doi:10.1111/jgs.16537
    1. Farrell TW, Francis L, Brown T, et al. Rationing limited healthcare resources in the COVID‐19 era and beyond: ethical considerations regarding older adults. J Am Geriatr Soc. 2020;68(6):1143‐1149. doi:10.1111/jgs.16539
    1. Leipzig RM, Sauvigné K, Granville LJ, et al. What is a geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs end‐of‐training entrustable professional activities for geriatric medicine. J Am Geriatr Soc. 2014;62(5):924‐929. doi:10.1111/jgs.12825
    1. Parks SM, Harper GM, Fernandez H, Sauvigne K, Leipzig RM. American Geriatrics Society/Association of Directors of Geriatric Academic Programs curricular milestones for graduating geriatric fellows. J Am Geriatr Soc. 2014;62(5):930‐935. doi:10.1111/jgs.12821
    1. Alzheimer's Association . 2021 Alzheimer's disease facts and figures. Alzheimers Dement. 2021;17(3):327‐406. 10.1002/alz.12328
    1. Malone ML, Capezuti EA, Palmer RM, eds. Geriatrics Models of Care: Bringing “Best Practice” to an Aging America. Springer International Publishing; 2015. doi:10.1007/978-3-319-16068-9
    1. Fox MT, Sidani S, Persaud M, et al. Acute care for elders components of acute geriatric unit care: systematic descriptive review. J Am Geriatr Soc. 2013;61(6):939‐946. doi:10.1111/jgs.12282
    1. Ahmed NN, Pearce SE. Acute care for the elderly: a literature review. Popul Health Manag. 2010;13(4):219‐225. doi:10.1089/pop.2009.0058
    1. Ahmed N, Taylor K, McDaniel Y, Dyer CB. The role of an acute care for the elderly unit in achieving hospital quality indicators while caring for frail hospitalized elders. Popul Health Manag. 2012;15(4):236‐240. doi:10.1089/pop.2011.0055
    1. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332(20):1338‐1344. doi:10.1056/nejm199505183322006
    1. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669‐676. doi:10.1056/nejm199903043400901
    1. Rubin FH, Neal K, Fenlon K, Hassan S, Inouye SK. Sustainability and scalability of the Hospital Elder Life Program at a community hospital. J Am Geriatr Soc. 2011;59(2):359‐365. doi:10.1111/j.1532-5415.2010.03243.x
    1. Strijbos MJ, Steunenberg B, van der Mast RC, Inouye SK, Schuurmans MJ. Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and cost‐effectiveness in Dutch health care. BMC Geriatr. 2013;13:78. doi:10.1186/1471-2318-13-78
    1. Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM. Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma. 2006;20(3):172‐180. doi:10.1097/01.bot.0000202220.88855.16
    1. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta‐analysis. J Orthop Trauma. 2014;28(3):e49‐e55. doi:10.1097/bot.0b013e3182a5a045
    1. Williams MV, Li J, Hansen LO, et al. Project BOOST implementation: lessons learned. South Med J. 2014;107(7):455‐465. 10.14423/smj.0000000000000140
    1. Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8(8):421‐427. doi:10.1002/jhm.2054
    1. Boutwell AE, Johnson MB, Watkins R. Analysis of a social work–based model of transitional care to reduce hospital readmissions: preliminary data. J Am Geriatr Soc. 2016;64(5):1104‐1107. doi:10.1111/jgs.14086
    1. Alvarez R, Ginsburg J, Grabowski J, Post S, Rosenberg W. The social work role in reducing 30‐day readmissions: the effectiveness of the Bridge model of transitional care. J Gerontol Soc Work. 2016;59(3):222‐227. doi:10.1080/01634372.2016.1195781
    1. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51(4):549‐555. doi:10.1046/j.1532-5415.2003.51185.x
    1. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822‐1828. doi:10.1001/archinte.166.17.1822
    1. Eghaneyan BH, Sanchez K, Mitschke DB. Implementation of a collaborative care model for the treatment of depression and anxiety in a community health center: results from a qualitative case study. J Multidiscip Healthc. 2014;4(7):503‐513. doi:10.2147/jmdh.s69821
    1. Thielke S, Vannoy S, Unützer J. Integrating mental health and primary care. Prim Care. 2007;34(3):571‐592. doi:10.1016/j.pop.2007.05.007
    1. Hornick TR, Rubenstein L. Outpatient geriatric evaluation and management. In: Malone ML, Capezuti EA, Palmer RM, eds. Geriatrics Models of Care: Bringing “Best Practice” to an Aging America. Springer International Publishing; 2015:183‐191. 10.1007/978-3-319-16068-9_16
    1. Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004;116(6):394‐401. doi:10.1016/j.amjmed.2003.10.031
    1. Totten A, Carson S, Peterson K, et al. Evidence brief: effect of geriatricians on outcomes of inpatient and outpatient care. VA Evidence‐Based Synthesis Program Evidence Briefs. VA Evidence‐Based Synthesis Program Reports. Department of Veterans Affairs (US); 2011. Accessed April 24, 2022.
    1. The Eden Alternative®. Accessed February 8, 2022.
    1. Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric resources for assessment and care of elders (GRACE): a new model of primary care for low‐income seniors. J Am Geriatr Soc. 2006;54(7):1136‐1141. doi:10.1111/j.1532-5415.2006.00791.x
    1. Counsell SR, Callahan CM, Clark DO, et al. Geriatric care management for low‐income seniors: a randomized controlled trial. JAMA. 2007;298(22):2623‐2633. doi:10.1001/jama.298.22.2623
    1. Counsell SR, Callahan CM, Tu W, Stump TE, Arling GW. Cost analysis of the geriatric resources for assessment and Care of Elders care management intervention. J Am Geriatr Soc. 2009;57(8):1420‐1426. doi:10.1111/j.1532-5415.2009.02383.x
    1. Boyd CM, Boult C, Shadmi E, et al. Guided care for multimorbid older adults. Gerontologist. 2007;47(5):697‐704. doi:10.1093/geront/47.5.697
    1. Boult C, Leff B, Boyd CM, et al. A matched‐pair cluster‐randomized trial of guided care for high‐risk older patients. J Gen Intern Med. 2013;28(5):612‐621. doi:10.1007/s11606-012-2287-y
    1. De Jonge KE, Jamshed N, Gilden D, et al. Effects of home‐based primary care on Medicare costs in high‐risk elders. J Am Geriatr Soc. 2014;62(10):1825‐1831. doi:10.1111/jgs.12974
    1. Edes T, Kinosian B, Vuckovic NH, Olivia Nichols L, Mary Becker M, Hossain M. Better access, quality, and cost for clinically complex veterans with home‐based primary care. J Am Geriatr Soc. 2014;62(10):1954‐1961. doi:10.1111/jgs.13030
    1. Meredith S, Feldman P, Frey D, et al. Improving medication use in newly admitted home healthcare patients: a randomized controlled trial. J Am Geriatr Soc. 2002;50(9):1484‐1491. doi:10.1046/j.1532-5415.2002.50402.x
    1. Leff B, Burton L, Guido S, Greenough WB, Steinwachs D, Burton JR. Home hospital program: a pilot study. J Am Geriatr Soc. 1999;47(6):697‐702. doi:10.1111/j.1532-5415.1999.tb01592.x
    1. Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital‐level care at home for acutely ill older patients. Ann Intern Med. 2005;143(11):798‐808. doi:10.7326/0003-4819-143-11-200512060-00008
    1. Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc. 1999;47(3):269‐276. doi:10.1111/j.1532-5415.1999.tb02988.x
    1. Boult C, Boult LB, Morishita L, Dowd B, Kane RL, Urdangarin CF. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc. 2001;49(4):351‐359. doi:10.1046/j.1532-5415.2001.49076.x
    1. Patel NK, Jaén CR, Stange KC, Miller WL, Crabtree BF, Nutting P. Patient centered medical home: a journey not a destination. In: Malone ML, Capezuti EA, Palmer RM, eds. Geriatrics Models of Care: Bringing “Best Practice” to an Aging America. Springer International Publishing; 2015:155‐162. doi:10.1007/978-3-319-16068-9_13
    1. Arend J, Tsang‐Quinn J, Levine C, Thomas D. The patient‐centered medical home: history, components, and review of the evidence. Mt Sinai J Med. 2012;79(4):433‐450. doi:10.1002/msj.21326
    1. Morishita L, Kunz EM. Program of all‐inclusive care (PACE) model. In: Malone ML, Capezuti EA, Palmer RM, eds. Geriatrics Models of Care: Bringing “Best Practice” to an Aging America. Springer International Publishing; 2015:259‐266. 10.1007/978-3-319-16068-9_24
    1. Friedman SM, Steinwachs DM, Rathouz PJ, Burton LC, Mukamel DB. Characteristics predicting nursing home admission in the Program of All‐Inclusive Care for elderly people. Gerontologist. 2005;45(2):157‐166. doi:10.1093/geront/45.2.157
    1. Nadash P. Two models of managed long‐term care: comparing PACE with a Medicaid‐only plan. Gerontologist. 2004;44(5):644‐654. doi:10.1093/geront/44.5.644
    1. Naylor MD, Brooten D, Jones R, et al. Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Ann Intern Med. 1994;120(12):999‐1006. doi:10.7326/0003-4819-120-12-199406150-00005
    1. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow‐up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613‐620. doi:10.1001/jama.281.7.613
    1. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675‐684. doi:10.1111/j.1532-5415.2004.52202.x
    1. Szanton SL, Leff B, Li Q, et al. CAPABLE program improves disability in multiple randomized trials. J Am Geriatr Soc. 2021;69(12):3631‐3640. doi:10.1111/jgs.17383
    1. LaMantia MA, Alder CA, Callahan CM, et al. The aging brain care medical home: preliminary data. J Am Geriatr Soc. 2015;63(6):1209‐1213. doi:10.1111/jgs.13447
    1. Popejoy LL, Vogelsmeier AA, Alexander GL, et al. Analyzing hospital transfers using INTERACT acute care transfer tools: lessons from MOQI. J Am Geriatr Soc. 2019;67(9):1953‐1959. doi:10.1111/jgs.15996
    1. Unroe KT, Caterino JM, Stump TE, et al. Long‐stay nursing facility resident transfers: who gets admitted to the hospital? J Am Geriatr Soc. 2020;68(9):2082‐2089. doi:10.1111/jgs.16633
    1. Hudon C, Chouinard MC, Diadiou F, Bouliane D, Lambert M, Hudon É. The Chronic Disease Self‐Management Program: the experience of frequent users of health care services and peer leaders. Fam Pract. 2016;33(2):167‐171. doi:10.1093/fampra/cmw007
    1. Hamel C, Hekmatjah N, Hakakian B, et al. Evidence‐based community fall prevention programs at senior centers near 10 US academic centers. J Am Geriatr Soc. 2019;67(7):1484‐1488. doi:10.1111/jgs.15961
    1. Reuben DB, Evertson LC, Wenger NS, et al. The University of California at Los Angeles Alzheimer's and Dementia Care Program for comprehensive, coordinated patient‐centered care: preliminary data. J Am Geriatr Soc. 2013;61(12):2214‐2218. doi:10.1111/jgs.12562
    1. Jennings LA, Hollands S, Keeler E, Wenger NS, Reuben DB. The effects of dementia care co‐management on acute care, hospice, and long‐term care utilization. J Am Geriatr Soc. 2020;68(11):2500‐2507. doi:10.1111/jgs.16667

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