Aging Well

June 1, 2006

Site Staff,

We are an aging nation. People aged 65 and over, just 2 percent of the population in 1900, now comprise more than 12 percent. By 2020, one in five Americans will be a senior citizen. This demographic shift is slowly changing the marketplace. From cars built for comfort to universal design in housing to small portion grocery items, the market responds to the needs and preferences of older people.

Health care, too, faces demands as the population ages. Supermodel Farrah Fawcett may claim, “Sixty is the new 30!” but 80 is not the new 50. We, collectively, are in better health and living longer than past generations, but we do grow old. Many New Hampshire health care providers are developing new approaches to meet the needs of elders.

Dr. Tom McGovern, an orthopedic surgeon at Exeter Hospital, explains that joint replacement was once too risky for people in their 70s and 80s. Now it is generally considered safe and effective for elders. New surgical techniques, improved replacement materials and more precise administering of anesthesia have reduced risk.

But there are other factors to consider. The 80 to 85 year old patient is less vigorous than a younger patient and may need more time for rehabilitation. The older patient is more likely to live alone or with a spouse who is unable to take over during the recovery period. “Imagine an older patient who would benefit from joint replacement,” says Dr. McGovern, “but who is the primary caregiver of a spouse with Alzheimer’s disease. I couldn’t in good conscience recommend the elective surgery.”

McGovern says that a treatment plan must include the home situation as well as the medical. Exeter Hospital’s orthopedic department provides patient education and case management. Pre-surgery classes help patients know what to expect. Patients who will need post-surgery help are identified. The facility has substantially increased the number of nurse/case managers in the past decade. A case manager helps a patient locate essential resources, such as home care. If a patient needs to spend a few weeks in a long-term care facility, the case manager may make the arrangement. She or he may speak with family members, to enlist their help with the plan for rehabilitation and recovery.

Medical procedures continue to improve, McGovern says, but the social issues will become more difficult as the population ages. In 1988, planners at Catholic Medical Center in Manchester saw the trends — people living longer, the Boomer generation at mid-life. They asked, “What should we be doing?” They engaged Ken Dychtwald, sociologist and author of “Age Wave,” to help them prepare for the growing senior population. Their decision was to develop a wellness resource center for seniors. The center would bring together in one convenient location a wide variety of resources on physical, social and spiritual health.

The center, named Prime Time, opened in 1989 in a downtown location. Recently it moved to a mill building across from Catholic Medical Center. Today, there are 12,000 members. Open daily, Prime Time provides an impressive variety of activities and resources, most free of charge. Regular health screenings help members know their vital numbers — blood pressure, cholesterol, bone density, for example. “No one leaves a screening without a one-to-one consult,” says Program Director Connie Jones. Each person talks with a nurse or health educator about the results. Memory screening is done in collaboration with the mental health center.

Dozens of health-related classes are offered throughout the year on such topics as diabetes management, depression, heart-healthy living, fitness and nutrition. Personal enrichment classes include financial planning, computer skills, yoga and brain aerobics. Three years ago, Prime Time initiated a men’s group, with columnist John Clayton as a speaker at the first meeting. “The advisory board felt that retirement can be especially difficult for men,” recalls Jones. “They often lose contact with former friends and find it hard to make new friends.” The group was an immediate success, and attendance continues to be about 40 at each meeting.

Prime Time’s Great Day Program provides the services of a geriatric nurse practitioner three days a week. The walk-in service is devoted to helping frail elders. The nurse does testing, interprets medical advice and makes referrals as needed. She gives the extra time that many people need to understand their medical conditions. In partnership with the faith community, Catholic Medical Center manages the parish nurse program. Two employees plus several volunteer nurses provide nurse consultation at 13 churches throughout the city.

Jones says that these varied programs help seniors avoid hospitalization. Screening identifies potential health issues before a crisis occurs. Health education teaches people how to maintain good health. When a Prime Time member does need health care, she will likely know what questions to ask the physician and how to carry out the treatment regimen. And last but not least, members have a lot of fun.

In the Monadnock Region, Home Health Care, Hospice and Community Service (HCS) has entered the age of telemedicine. The Keene-based agency provides a range of home health services, including visiting nurses, to more than 4,000 people. HCS nurses have installed AMD Telemedicine’s “Care Companion” home monitoring devices in the homes of some thirty patients. The Care Companion interacts with the patient through an easy-to-use touch-screen, which provides medication reminders, prompts for clinical assessment questions and collects data from various medical devices connected to the system. The system sends the data to a Web-based server through the patient’s home phone line. The home care nurse can preset thresholds for the patient’s condition and be notified if any medical intervention is needed.

Diabetics and heart failure patients with multiple diagnosis and frequent hospitalizations were the first to be offered the use of the home monitor. Cheryl Rooney, telemonitoring nurse, says that the daily remote collection of vital sign data and health status monitoring, right in the patient’s home, makes it possible to intervene at the earliest sign of a problem. Just five months into the program, telemonitoring has demonstrated its effectiveness. By alerting patients and nurses to problems, serious medical episodes have been avoided. The agency anticipates expanding telemonitoring to more than 100 systems in the next two years.

The current senior population of New Hampshire is 147,000. It is projected to be 408,000 in 2025. New ways to provide health care will be essential, to maintain the quality of life that New Hampshire residents enjoy. NH

oblems, serious medical episodes have been avoided. The agency anticipates expanding telemonitoring to more than 100 systems in the next two years.