Patient-centered medical homes help older adults take control of their well-being – Medical News Bulletin

Using wellness coaches and medical professionals, researchers were able to help older adults with chronic diseases to take control of their well-being.

“I don’t have the time.”  “It’s too much work.”  “I don’t have the money to pay someone to help.”  “There’s nothing I can do about it.”  “I have other responsibilities.”  “I don’t know how.”

There are many possible reasons and excuses for why elderly people may not take charge of their health and well-being while living with chronic diseases such as diabetes, arthritis, HIV, and cancer.  A previous study in The Gerontologist has listed three main reasons why a patient would delay self-care and the seeking of medical help:

  1. a) limited access to healthcare,
  2. b) lack of time/energy to go see a doctor, and
  3. c) negative feelings towards going to see a doctor.

Yet other studies have shown that self-management and taking charge of one’s health in the face of chronic disease is the key to managing and controlling the effects of that disease.  So how can we help overcome those barriers in order to allow older adults with chronic diseases to take control of their well-being and limit the damage these diseases can cause?

A research group has published the results of a recent study in the journal Innovation in Aging. The study looked at how using patient-centered medical homes (PCMH), self-management resource center small group programs (SMRCSGP), wellness coaching, social networking, and personal health records (PHR) can improve a patient’s ability to take charge of their disease, and improve their level of well-being.

A patient-centered medical home is a healthcare delivery model that consists of a team of medical and community personnel that are trained to help monitor and educate patients regarding their diseases. Doctors monitor the patients’ health and suggest possible modes of treatment. Trained community workers then teach the patients how to handle their diseases, mental health, motivation, and set realistic health goals through courses given in small groups. They also help the patients access healthcare programs to help pay for medical expenses.

This type of structure already exists in New York City where the research participants were selected to participate in the study. But the researchers wanted to know if adding extra layers of intervention — wellness coaches, a social media support structure, and health records patients can access – would provide any extra improvements in the participants’ quality of life.

The researchers selected 129 participants from the South Bronx area, of which 121 completed their program and were included in the results. The participants were mostly women, mostly Hispanic, with an average education level of nine years, an average age of 72 years, who mostly lived alone or with just one other person, and were dealing with two or more chronic diseases.

Over the course of six months, the study participants were followed by doctors and community volunteers at the patient-centered medical homes and were given courses on how to manage their lives, which allowed the older adults with chronic diseases to take control of their well-being. They were also given access to their personal health record, which showed them their basic health information and tracked their health progress over time. They were also able to communicate with other participants through social media. Half the participants received only this intervention level.  The other half received an extra layer of help. They were assigned wellness coaches that communicated with them regularly and helped set and monitor personal health goals.

While the overall physical exercise levels of both groups were about the same, the participants who were assigned the wellness coaches and stayed in contact with them regularly reported an overall improvement in physical functioning in their daily lives.  The same was not seen in the group without wellness coaching. It seemed that adding wellness coaching after the participants had finished their well-being courses made a positive difference in their quality of life.

While these results are quite promising in an urban setting, where the elderly participants were able to increase their physical activity by walking outside more often in the city, there were some limitations that may prevent the same results in other socio-economic settings. These include lack of resources, such as difficulty finding funding for patient-centered medical homes and for community personnel training, and the inability to have access to a family doctor. The researchers also discussed some socio-cultural differences that may prevent some patients from believing that they can change the outcome of their diseases. And finally, other issues like consistent long-term funding of programs, living conditions for the patients, and various familial obligations might make it difficult for patients to successfully follow a long-term care program for their diseases.

However, the study does suggest that a structured medical environment that guides patients, as well as providing self-help training and long-term follow-up with wellness coaching, may be the key to helping older adults with chronic diseases to take control of their well-being in a successful and long-term manner.

 

Written by Nancy Lemieux

 

References:

  1. Study examines a new model for older adult wellness. (2020). Retrieved 26 January 2020, from https://www.eurekalert.org/pub_releases/2020-01/cums-sea012120.php
  2. Mielenz, T. et al.(2020). Creation of the Person-Centered Wellness Home in Older Adults. Innovation in Aging. Retrieved 26 January 2020, from https://academic.oup.com/innovateage/article/4/2/igz055/5707518
  3. Sun, J. (2020). Self-Perceptions of Aging and Perceived Barriers to Care: Reasons for Health Care Delay. The Gerontologist. Retrieved 26 January 2020, from https://academic.oup.com/gerontologist/article/57/suppl_2/S216/3913318
  4. Grady, P., & Gough, L. (2020). Self-Management: A Comprehensive Approach to Management of Chronic Conditions. J. of Public Health. Retrieved 26 January 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103232

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