The journey of the frail older adult with heart failure: implications for management and health care systems

SummaryThe heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.

Download Full-text

UNDERSTANDING NON-MEDICAL COSTS FOR HEALTH CARE: EVIDENCE FROM INPATIENT CARE FOR OLDER PEOPLE IN CHINA

Innovation in Aging ◽

10.1093/geroni/igz038.2686 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S733-S733

Author(s):

Wei Yang

Keyword(s):

Health Care ◽

Older People ◽

Health Care Systems ◽

Significant Proportion ◽

Medical Costs ◽

Urban China ◽

Substantial Part ◽

Rural And Urban ◽

Care Systems ◽

Health Payment

Abstract Non-medical costs can constitute a substantial part of total health care costs, especially for older people. Costs associated with carers, travel, food and accommodation for family members accompanying and caring for older people during their medical visits can be hefty. This study seeks to examine the effects of non-medical costs on catastrophic health payments and health payment-induced poverty among older people in rural and urban China. Using data from the China Health and Retirement Longitudinal Survey 2015, this study finds that inpatient costs account for a significant proportion of household expenditure, and non-medical costs can account for approximately 18% of total costs. That share is highest for those who belong to the lowest wealth groups. Non-medical costs increase the chances of older people incurring catastrophic health payments and suffering from health payment-induced poverty. Such effects are more concentrated among the poor than the rich. The results also show that the rural population are more likely to incur catastrophic health payments and suffer from health payment induced poverty compared to the urban population. This paper urges policy makers to consider reimbursing the non-medical costs of patient care, improving health care systems in general and for the rural populations specifically.

Download Full-text

Biomarkers in acute heart failure

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0034 ◽

2021 ◽

pp. 409-424

Author(s):

Rajiv Choudhary ◽

Nicholas Wettersten ◽

Kevin Shah ◽

Alan Maisel

Keyword(s):

Heart Failure ◽

Health Care ◽

Acute Heart Failure ◽

Health Care Systems ◽

High Sensitivity ◽

Medical Problem ◽

National Health Care ◽

Acute Dyspnoea ◽

Galectin 3 ◽

Care Systems

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. Biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have come close to an ideal biomarker and prove extremely useful in determining whether acute dyspnoea has a cardiac aetiology. Furthermore, they are useful for prognosis and may have a role in guiding management of heart failure. Additionally, high-sensitivity troponin, sST2, and galectin-3 are increasingly used with mounting clinical evidence for utility. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, bio-adrenomedulin, mid-regional proatrial natriuretic peptide, and procalcitonin.

Download Full-text

Healthcare Systems and Variation in Healthcare Utilization at the End of Life Across Countries

Innovation in Aging ◽

10.1093/geroni/igaa057.1842 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 560-560

Author(s):

Jennifer Ailshire ◽

Cristian Herrar ◽

Margarita Maria Osuna

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Service ◽

End Of Life ◽

Low Income ◽

Health Care Systems ◽

Social Health Insurance ◽

Social Health ◽

Care Utilization ◽

Care Systems

Abstract With rapid population ageing, providing better end-of-life care (EOLC) is becoming a source of social demand and financial pressure for public and private budgets in many countries. This paper uses data from harmonized end-of-life interviews in the HRS family of studies to assesses variation in health care utilization across different income groups and how they differ across different health care systems. Hospital stay did not vary across health care systems, but nursing home stays were lower in countries with either national or statist social health insurance systems. Hospice use was low in all countries, but particularly in national and social health insurance systems. Lower income was associated with greater use of nursing homes in both the private and social health care systems. Low income was also associated with greater use of hospice in national health service, but lower use in social health service.

Download Full-text

Comparisons of palliative care utilization in metastatic cancer patients between multi-payer non-universal health care and single-payer universal health care systems.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.10110 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. 10110-10110

Author(s):

Raymond Nienchen Kuo ◽

C. Jillian Tsai

Keyword(s):

Health Care ◽

Palliative Care ◽

Cancer Patients ◽

Health Care Systems ◽

Metastatic Cancer ◽

Care Utilization ◽

Universal Health Care ◽

Single Payer ◽

Care Systems ◽

Universal Health

Download Full-text

Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

European Heart Journal Supplements ◽

10.1093/eurheartj/suz236 ◽

2019 ◽

Vol 21 (Supplement_L) ◽

pp. L36-L38

Author(s):

Andrew J Stewart Coats

Keyword(s):

Heart Failure ◽

Health Care ◽

Elderly Patient ◽

Older Patients ◽

Large Scale ◽

Health Care Systems ◽

The Elderly ◽

Heart Failure Management ◽

Care Systems ◽

Effect Of Age

Abstract With the ageing of populations heart failure is becoming more common and more complex. It is affecting ever older patients and the number of prevalent comorbidities is rising. Even as we continue to gain success in large-scale clinical trials with more effective therapies so our patients are becoming more complex. One of the biggest challenges is the effect of age. Frailty, comorbidity, sarcopaenia, cachexia, polypharmacy, and cognitive decline are all challenging our patients as never before and these challenges will be difficult for cash strapped health care systems to manage. For these reasons, the Heart Failure Association brought together a panel of experts to debate and review this complex area, championing the need for us to establish better ways of caring for the patients of the future.

Download Full-text

The prehospital patient pathway and experience of care with acute heart failure: a comparison of two health care systems

ESC Heart Failure ◽

10.1002/ehf2.13089 ◽

2020 ◽

Author(s):

Joseph McCambridge ◽

Ciara Keane ◽

Myra Walshe ◽

Patricia Campbell ◽

James Heyes ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Acute Heart Failure ◽

Health Care Systems ◽

Patient Pathway ◽

Experience Of Care ◽

Care Systems

Download Full-text

Health and Care of an Ageing Population: Alignment of Health and Social Systems to Address the Need

Journal of Health Management ◽

10.1177/0972063421994992 ◽

2021 ◽

pp. 097206342199499

Author(s):

Sangay Thinley

Keyword(s):

Health Care ◽

Older People ◽

Long Term Care ◽

Health Care Systems ◽

Population Ageing ◽

Demographic Shift ◽

Term Care ◽

The Social ◽

Care Systems

Population ageing is both an achievement and challenge, an achievement as longevity is the result of successful prevention and control of diseases, decreasing fertility rates and overall socio-economic development. It is at the same time a challenge as the increasing number of older people and the resultant demographic shift are accompanied by the need to adjust and scale up the social and health care systems. The challenges are of particular relevance to the developing world where the demographic shift is occurring much faster. Comprehensive efforts based on country contexts are required in the following areas: (a) older persons and development, (b) health and well-being and (c) enabling and supportive environments to address population ageing needs. This article, however, focuses only on three most crucial issues, that is, livelihood, health care systems and care of the older dependent people. Measures to sustain the livelihood of older people, to align the health systems to provide care and to develop long-term care systems are highlighted. Person-centred care, integration and functional capacity are advocated. Further, ageing in place or living in one’s own home, community or a place with the closest fit with the person’s needs and preferences is considered very important for healthy ageing. In terms of enhancing livelihood, major policy changes and reforms to improve the social security systems and expanding coverage as well as increasing the amounts to minimum subsistence levels are highlighted. Another area which needs to be strengthened is the tradition of existing family support systems. The health systems alignment required are reflected for each health system building block, and focuses mainly on (a) developing and ensuring access to services that provide older-person-centred care; (b) shifting the clinical focus from disease to intrinsic capacity; and (c) developing or reorienting the health workforce to provide care as per alignment. Long-term care systems would best meet the needs of dependent older people if families, communities, civil society organisations and private sector are equally involved while governments play leadership roles in setting up and monitoring quality.

Download Full-text

Screening for psychiatric morbidity in the population - a comparison of the GHQ-12 and self-reported medication use

International Journal for Population Data Science ◽

10.23889/ijpds.v3i1.414 ◽

2018 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Foteini Tseliou ◽

Michael Donnelly ◽

Dermot O'Reilly

Keyword(s):

Health Care ◽

Older People ◽

Health Care Services ◽

Economic Status ◽

Health Care Systems ◽

Psychiatric Morbidity ◽

Medication Use ◽

Screening Tools ◽

Care Systems ◽

Population Mental Health

IntroductionUptake of psychotropic medication has been previously used as a proxy for assessing the prevalence of population mental health morbidity. However, it is not known how this compares with estimates derived from population screening tools. ObjectivesTo compare estimates of psychiatric morbidity derived by a validated screening instrument of psychiatric morbidity and a self-reported medication uptake measure. MethodsThis study used data from two recent population-wide health surveys in Northern Ireland, a country (UK) with free health services and no prescription charges. The psychiatric morbidity of 7,489 respondents was assessed using the GHQ-12 and self-reported use of medication for stress, anxiety and depression (sDAS medication). ResultsOverall, 19% of respondents were defined as ‘cases’ and 14.3% were taking sDAS medication. Generally, the two methods identified the same population distributions of characteristics that were associated with psychiatric morbidity though nearly as many non-cases as cases received sDAS medication (46.4% vs. 53.6%). A greater proportion of women and older people were identified as cases according to sDAS medication use, while no such variation was observed between socio-economic status and method of assessment. ConclusionsThis study indicates that these two methods of assessing population psychiatric morbidity provide similar estimates, despite potentially identifying different individuals as cases. It is important to note that different health care systems might be linked to variations in obstacles when accessing and using health care services. Highlights There was a reasonable correspondence between the different methods of assessment. A greater proportion of women and older people were identified as cases through the self-reported use of medication. An almost equal amount of GHQ-12 cases and non-cases reported being in receipt of medication.

Download Full-text