Transcript 9oct_1015_Jean_Woo

Primary Care and Older Persons –
Key to Medical Social Integration
Introduction
Jean Woo
Director, Cadenza Project
Re-inventing primary health care: the
need for systems integration
• ‘…..developing primary care
networks that are seamlessly
integrated into the rest of the
health system.’
Julio Frenk.Lancet 2009; 374:170-173
Cadenza: promoting an elderfriendly Hong Kong
• Impact of an ageing population on health and
social services
- chronic disease burden; Multi-morbidity
- organ system v. patient centred approach
- fragmentation v. integration of multiple services
• How should we structure our services? The
primary care setting has to be key
• Two case studies to set the scene: illustration of
the current piecemeal response to the ageing
society and lack of coherent policies
Case One
• F 80 years. Resident of Old Age Home
• Presented to A&E with fall, and screened
as part of a one year research project on
study of profile of fallers presenting at A&E
• Depression screen positive
• Goes out to swim daily and goes to social
centre
• Fell while standing on one leg in the park
Case One
• No one able to talk in OAH: all her friends
have died in the 10 year period since
moving in
• Need to be back early evening:
regimented existence
• Health talks result in anxiety: ‘Do I have
the disease?’
• Who can help her?
Case Two
• F 80 referred to Geriatric Clinic by Integrated Clinic: ?
Ischaemic heart disease.
• List of complaints:
-Chest pressure and shortness of breath on walking about 10
min, relieved by rest(1 year)
-chronic sputum producer for many years: current smoker
-Right should pain, left knee pain, back pain limiting
movements (I year)
-Left 4th trigger finger
- Lump in abdomen when standing up:
hernia awaiting surgical consultation-Requests euthanasia:burden to society: no one cares and no
one helps; long waiting list for multiple clinics; no medications;
bad experience in A&E
Case Two
• Cannot eat a lot: chest pressure after more than half a bowl of
rice
• Lives with unemployed daughter: lost husband, second
daughter and grand child in recent years.
• On CSSA $2330 per month
• Son gives her a mobile phone but she only answers if it is
from her son’s phone number. Does not know how to use
telephone booking
• Difficulty in rising from chair and getting out of bed. Walks
with a limp; cannot lift arm above shoulder level. Protrusion of
abdominal contents on standing up
List of diagnoses
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Gastroeosophageal reflux disease
Ischaemic heart disease
Chronic obstructive airways disease
Osteoarthritis of knees; frozen shoulder;
osteoporosis with vertebral collapse
• Reactive depression
Geriatric Day Hospital
• Sorting out multiple medical and social
problems in one place
• ‘Therapeutic video’…requested a repeat!
• Little complaint of pain
• Revealed new problem of urinary
incontinence for which she was too
embarrassed to mention to doctor
• Used humour frequently as a coping
strategy
VIDEO
Summary points of video
• Sharp health and social commentary on all the current
ills of our society! Inadequacies of current health and
social services to deal with a not uncommon situation
• No one takes ownership of her care
• Services not achieving its aim of helping, although
intentions are good
• Service providers not attuned to needs; lack of
humanistic response and empathy; over-reliance on
technology and processes
• Depression and higher suicide rates in the elderly not
surprising
Exploration of solutions in the
primary care setting
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Management of chronic diseases
Role of social services
Social services: success and obstacles
Caregivers; psychological problems;
outreach support; self-management; family
doctor’s perspective
• Development of models of primary care for
the elderly