Special Care Considerations for the Seriously Ill Older Adult

Abstract

AbstractAlmost all current and future medical providers will take care of older adults in their careers, thus knowing how to approach this patient population is essential. The current, fragmented US healthcare system often does not meet the needs of older adults with serious illnesses, which results in frustrating and confusing experiences for patients; high costs for society, patients, and families: and harms from under- and overdiagnosis and treatment. Although geriatrics and palliative medicine are specialties designed to improve the experience and outcomes of care for older persons, access to these services is inadequate and variable. This chapter focuses on optimizing healthcare during serious illness for adults 65 years old or older within the United States with a review of the influence of the physiology and biology of aging on treatment, the implications of aging demographics on healthcare systems, common geriatrics syndromes and their interaction with coexisting serious medical illness, and the range of evidence-based models shown to improve experience and outcomes of care during serious and complex illness. This chapter also discusses the rapidly spreading “4M’s” framework (focusing on Mobility, Mentation, Medications, and what Matters) for organizing care delivery for older people.