Helping Older Adults and Their Caregivers Manage Health Challenges Together

December 2018Diana Austin

“As we age, we tend to collect [chronic medical] conditions,” says Mijung Park, assistant professor of Family Health Care Nursing at the UC San Francisco School of Nursing. Those conditions, she adds, go beyond physical illness; many older adults and their caregivers also experience mental health challenges, most notably, depression.

In fact, the Centers for Disease Control and Prevention estimates that three in four Americans aged 65 and older have multiple chronic conditions that require ongoing medical care and often limit their activities of daily living. And the likelihood of having depression increases as the number of chronic conditions increases. For example, about 20 percent of community-dwelling older adults who have two chronic medical conditions have depression. This number grows to more than 30 percent among those with three chronic conditions.

In response, Park’s program of research attempts to answer this question: How can older adults and their families best manage these chronic illnesses together?

Creating Collaborations Among Patients, Families and Their Providers

Mijung Park In her most recent project, for example, Park and her research team are testing an intervention called FACE (Family-Centered Care for Older Adults with Multiple Chronic Conditions). The FACE program helps participants create what Park calls a “triadic collaboration” among patients, family caregivers and health care providers to improve care coordination and stress management.

The program is based on interviews with patients and caregivers that Park and her colleagues conducted during her doctoral studies at UCSF and her time on the faculty at the University of Pittsburgh. Those interviews revealed five key areas where older adults and their caregivers need help: navigating the health care system, polypharmacy, insurance complexity, financial challenges and technology-related challenges. Additionally, during her postdoctoral studies at the University of Washington, Park and her colleagues examined several large data sets to identify individual and family strengths and weaknesses that could affect care and outcomes.

Based on those qualitative and quantitative data, the team then developed and tested a variety of holistic interventions and conducted a small, randomized clinical trial to test their efficacy. They’re currently analyzing data from the trial and submitting the results for publication – and Park hopes to expand the study once the analysis is complete.

How the Primary Concerns Can Play Out

One surprising finding from her initial interviews, says Park, was how much worries over medication affect caregivers’ mental health. “I realized how emotionally taxing it is to manage a parent’s medication,” she says. “It was a very big deal for both the caregivers and the patients.”

Park was also struck by the problems posed by the complexity of health insurance in the United States. “I’m a nurse, but even I wasn’t aware of how complicated Medicare and Medicaid can be,” she says, noting that one patient switched Medicare plans without realizing that the new plan didn’t cover physical therapy, which the patient needed to maintain her mobility. Park says the patient eventually changed plans and got the therapy one year later, but might have recovered her mobility sooner had she had earlier access to the care she needed.

The interviews also made poignantly clear the discouraging nexus between inadequate insurance, poverty and health problems among the elderly. “Money ties everything together,” says Park. “I’ve had patients who rationed medication, husbands and wives with similar conditions who share medication, and there are lots of examples [of poor outcomes] related to that.”

The Promise and Challenge of Technology

Finally, Park points out that information technology appears to hold both promise and risk for older people with chronic conditions and their caregivers. On the one hand, new technologies – ranging from simple text-message medication reminders to comprehensive “smart home” and remote-monitoring systems – can help people age in place more safely. Yet lack of access to and inexperience with technology reduce its potential positive impact for older people and introduce new problems.

For example, Park has concerns about the way technology can increase the disconnect between providers and patients and, in turn, have real consequences for health. She describes an incident in which a doctor was so busy typing into the electronic medical record that he failed to notice the patient struggling to move from one chair to another – until she fell.

While an incident like that may simply require training clinicians to look up from the computer, other challenges, like financing care and workforce issues, are much more complex and will require comprehensive changes to the way health care for older, chronically ill people is managed.

Park knows interventions like those she is studying can’t address all the structural issues with the health care system for older patients and their caregivers, but she hopes her work does lead to a more holistic approach to addressing their needs. “Everything is so interconnected, yet a lot of interventions target only one thing, which may be why they fail,” she says.

Investigating Environment’s Impact on Cellular Aging

Park’s interest in a more holistic approach to addressing the health challenges of older adults is reflected in another aspect of her work: studying the connection between cellular aging and socioeconomic issues, such as family structure, neighborhood environment or food insecurity.

In 2015, she and a group of researchers from the University of Pittsburg (where she was an assistant professor at the time) and Amsterdam’s Vrije Universiteit looked at data from a large epidemiological study of adults aged 18 to 65 and found an association between poorer neighborhood quality (based on perceived disorder, fear of crime, and noise) and shorter leukocyte telomeres, a biomarker of cellular aging and an indicator of increased risk for aging-related disease.

This confirmed for Park that, “It’s all connected. Your mind is connected with your body, and your surroundings impact your entire body.” Now she plans to look at how better management of health conditions and improving social supports and environment can positively affect cellular aging. The goal is not to prevent aging but to observe and confirm what works and what doesn’t to keep people healthy with good quality of life as they age.

In the meantime, Park is optimistic about how families cope with aging and health challenges. She says, “Somehow they make it work. Family caregivers and older adults manage to keep things moving. They have their own systems that work for them. In my view, that’s good news.”