Clinical Practice Guidelines for Assessing Health of Older Adults

J Clin Pathways. 2023;9(4):16-17.

As the average age of the population continues to rise, there is an increasing need to assess and address the health concerns specific to older individuals. Clinical pathways provide a comprehensive framework for conducting assess­ments and implementing appropriate measures to ensure the well-being of older adults. These pathways are particu­larly relevant in promoting independence and determining the level of caregiver support required for older individuals in the community.

One valuable tool for such assessments is the Medicare Annual Wellness Visit (AWV), established by the Centers for Medicare & Medicaid Services (CMS). The AWV serves as a proactive yearly assessment for Medicare beneficiaries to identify issues early on and prevent costly conditions. Despite its benefits, a study by Health Affairs found that less than 20% of eligible Medicare beneficiaries receive an AWV.¹

The AWV encompasses various elements, including a health risk assessment covering demographic data, self-assessment of health status, psychosocial and behavioral risks, activities of daily living (ADLs), instrumental ADLs, and more. Addition­ally, it involves establishing medical and family history, obtain­ing vital measurements, assessing cognitive function, reviewing depression risk factors, evaluating functional ability and safety, establishing a screening schedule, identifying intervention risk factors, providing personalized health advice, and optionally offering advance care planning services. Fall assessment, as rec­ommended by the Centers for Disease Control and Prevention, is also an integral part of the evaluation.

While the AWV is a significant component, a broader evalu­ation framework known as “Who CARES ME” is recommend­ed for older adults. This framework encompasses Wellness, Care Coordination/Caregiver support, Acute issues, Rx man­agement, End-of-life planning, Social determinants of health (SDOH), and MEntal health.

Wellness includes not only preventive care, such as vaccina­tions, but also focuses on critical areas that directly impact an adult’s health as they age, such as hearing, vision, and fall risk assessment. Addressing these areas can significantly improve a patient’s quality of life by preventing injuries and maintaining overall well-being.

Care coordination and caregiver support are essential as­pects that go beyond the fragmented care often experienced by older adults. Lack of caregiver support frequently leads to emergency room visits or admission to long-term care facilities. Therefore, it is crucial to identify and address care coordination and caregiver support to ensure comprehensive and effective care for older adults.

Addressing acute care issues, both preventive and when they arise, is critical. Preventive screening plays a significant role, as common chronic conditions among older adults can have a substantial impact on clinical and financial outcomes. The most impactful chronic conditions for older adults, ranked from highest to lowest in terms of their effect on life expectan­cy, include cardiovascular disease, cancer, chronic respiratory disease, diabetes, and Alzheimer disease and other dementias. Early detection and appropriate management of these condi­tions can improve outcomes and enhance quality of life.

Prescription management, particularly in older adults, in­volves assessing medications that may present low or negative value, where the costs of adverse events outweigh the benefits. This assessment becomes increasingly important as the likeli­hood of drug–drug interactions or adverse events rises with age and prolonged medication use.

End-of-life planning goes beyond obtaining advanced di­rectives and goals of care. Discussions regarding end-of-life care can be supported by determining life expectancy. Various tools are available, such as the Social Security life expectancy table or personalized approaches through platforms like www.ePrognosis.com. These tools help facilitate individu­alized discussions and decisions, ensuring appropriate care aligned with patients’ preferences.

SDOH are nonmedical factors that significantly influ­ence an individual’s health outcomes. For older adults, these factors can include access to resources such as food, housing, education, transportation, social support, economic stability, employment, and discrimination. Health care providers can identify and address these factors through screening tools and community partnerships, connecting older adults with relevant resources and support services. By addressing SDOH, health outcomes can be improved, health care costs reduced, and health equity promoted.

Finally, mental health, including cognitive assessment, is a crucial aspect of caring for older adults. Various cognitive assessment tools, such as the Mini-Mental State Examina­tion, Montreal Cognitive Assessment, and Clock Drawing Test, evaluate different cognitive domains like executive func­tion, orientation, attention, and memory. Performance-based measures like the Trail Making Test or the Stroop Test can further assess cognitive abilities related to executive function. By integrating cognitive assessments within clinical pathways, health systems and providers can improve both clinical and financial outcomes when caring for older adults.

In conclusion, clinical pathways play a vital role in guiding the care of older adults. By utilizing comprehensive assess­ments and appropriate interventions, health care providers can ensure the well-being and independence of older individuals. The relevance of this topic extends beyond political consider­ations, and its importance lies in the effective implementation of clinical pathways to optimize care for older adults.