- Email: [email protected]
Finding trans-Atlantic common ground in caring for older adults
Geriatric Nursing 38 (2017) 266e267
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AGS Section
Finding trans-Atlantic common ground in caring for older adults Debra Saliba, MD, MPH, AGSF President, American Geriatrics Society, USA
There is an adage that England and America are two countries separated by a common language. John Adams, America’s second President, was more diplomatic, noting that the two nations retain “an entire esteem, confidence, and affection.tho’ separated by an ocean and under different governments.”1 (p. 150) Whether that trans-Atlantic divide exists remains a compelling question todaydand it is not limited to linguistics or legislation. In the clinical care of older adults, are Great Britain and the United States “separated by a common language” on aging, or are we brought together by a “shared esteem” for person-centered wellbeing? Experts representing the American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) are poised to explore that question in even greater detail thanks to a newly launched series of intellectual exchanges.2 They began earlier this year with joint editorials published in our respective research journals on one of our field’s hottest topics: multimorbidity.2 The rise in chronic conditions is a global challenge.3 Multimorbidity accounts for more than 65 percent of total health expenditures in high-income countries like the U.K. and U.S., and can contribute to more than 60 percent of deaths reported annually across the globe.3 Against this backdrop, professional societies like the AGS and BGS play an important role in helping our colleagues identify, understand, and embrace best practicesdparticularly for older adults. Released in 2016 by the U.K.’s National Institute for Health and Care Excellence (NICE), “Multimorbidity: Clinical Assessment and Management” is one of the newest guidelines to advance that goal. It aims to optimize care for older adults in the U.K. “by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care.[and improving] quality of life by promoting shared decisions based on what is important to each person.”4 (p. 4) Importantly, the NICE recommendations were informed by the earlier work of experts “across the pond” here at the AGS. In 2012, our Expert Panel on the Care of Older Adults with Multimorbidity unveiled our own new stepwise approach to managing multiple chronic conditions.5 As our guideline notes, we worked not only to
E-mail address: [email protected]. 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2017.05.015
push for better and more coordinated care across discrete diseases but also to “facilitate the development and growth of an evidence base by which clinicians [could] make sound care decisions., including the testing of better processes for decision-making.”5 (p. 2) Sodmore than five years after the release of AGS guidance and less than a year after the launch of the U.K.’s NICE recommendationsdhow well have we bridged the trans-Atlantic divide when it comes to coordinating care? Quite well, according to AGS and BGS experts writing in their first set of joint editorials. “The NICE guideline on multimorbidity challenges physicians and healthcare providers to adopt an holistic approach that takes full and proper account of multimorbidity. It addresses a common flaw in all contemporary health services that frail, multi-morbid patients are often subjected to futile or even harmful investigations and treatments,” noted David J. Stott, MBChB, MD, FRCP, and John Young, MSc, authors of the BGS editorial and Editor-in-Chief and Associate Editor, respectively, of Age and Aging (the BGS’s research journal).2 (para. 2) William B. Applegate, MD, MPH, AGSF, Editor-in-Chief of the Journal of the American Geriatrics Society and author of joint commentary from the AGS, noted: “From the U.S. perspective, the NICE guideline statement is both comprehensive and compelling. It is comprehensive in that it is truly patient-centered, focused on a broad array of health domains.It is compelling because it clearly articulates a balanced, thoughtful approach to care that transcends the limited algorithmic organ system approach.. Most of the substance of the report is already appreciated and practiced by geriatricians in the U.S., but less often by the wider health care delivery system..”6 (p. 1) Both sets of experts go on to commend the U.K.’s guidance for embracing a growing trend in Europe and North America when it comes to eliciting person-centered care goalsda trend that has been driven in large part by the cutting-edge clinical work of AGS and BGS members. As Dr. Stott and Prof. Young note: “The aim is to give the recipients of care control over decisions and actions affecting their health.a philosophy of clinical practice that should be integral to the management of all patients, multi-morbid or not.”7 (p. 2) That these theoretical best practices are becoming actual best practices across our two nations reinforces the importance of the
AGS Section / Geriatric Nursing 38 (2017) 266e267
AGS and BGS cross-cultural exchange. And in the context of our work to build better bridges across professions and national borders, continued commentary from experts at home and overseas will do much to advance how we identify and embrace the future gold standards of geriatrics care. As always, that work begins with champions like the AGS and BGS membersdnurses, geriatricians, pharmacists, social workers, physician assistants, researchers and so many others who share “esteem, confidence, and affection. [even when we are] separated by an ocean.”1 (p. 150) References 1. Giunta MA, ed. Documents of the Emerging Nation: U.S. Foreign Relations, 1775e1789. Wilmington, DE: Scholarly Resources, Inc; 1998.
267
2. New Collaboration Looks for Trans-Atlantic Common Ground in Geriatrics. From American Geriatrics Society. Retrieved from: http://www.americangeriatrics. org/press/news_press_releases/id:6825; 2017, March 27. 3. Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a crosssectional, population-based, multi-country study. J Gerontol Ser A Biol Sci Med Sci. 2016;71(2):205e214. http://dx.doi.org/10.1093/gerona/glv128. 4. National Institute for Health and Care Excellence. Multimorbidity: Clinical Assessment and Management. Retrieved from: https://www.nice.org.uk/ guidance/ng56; 2016, September 21. 5. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012;60(10):E1eE25. http://dx.doi.org/10.1111/j.1532-54. 6. Applegate WB. Across the pond. J Am Geriatr Soc; 2017. Advance online publication. http://dx.doi.org/10.1111/jgs.14803. 7. Stott DJ, Young J. “Across the pond”da response to the NICE guidelines for management of multi-morbidity in older people. Age Ageing; 2017. Advance online publication. http://dx.doi.org/10.1093/ageing/afx031.
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AGS Section
Finding trans-Atlantic common ground in caring for older adults Debra Saliba, MD, MPH, AGSF President, American Geriatrics Society, USA
There is an adage that England and America are two countries separated by a common language. John Adams, America’s second President, was more diplomatic, noting that the two nations retain “an entire esteem, confidence, and affection.tho’ separated by an ocean and under different governments.”1 (p. 150) Whether that trans-Atlantic divide exists remains a compelling question todaydand it is not limited to linguistics or legislation. In the clinical care of older adults, are Great Britain and the United States “separated by a common language” on aging, or are we brought together by a “shared esteem” for person-centered wellbeing? Experts representing the American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) are poised to explore that question in even greater detail thanks to a newly launched series of intellectual exchanges.2 They began earlier this year with joint editorials published in our respective research journals on one of our field’s hottest topics: multimorbidity.2 The rise in chronic conditions is a global challenge.3 Multimorbidity accounts for more than 65 percent of total health expenditures in high-income countries like the U.K. and U.S., and can contribute to more than 60 percent of deaths reported annually across the globe.3 Against this backdrop, professional societies like the AGS and BGS play an important role in helping our colleagues identify, understand, and embrace best practicesdparticularly for older adults. Released in 2016 by the U.K.’s National Institute for Health and Care Excellence (NICE), “Multimorbidity: Clinical Assessment and Management” is one of the newest guidelines to advance that goal. It aims to optimize care for older adults in the U.K. “by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care.[and improving] quality of life by promoting shared decisions based on what is important to each person.”4 (p. 4) Importantly, the NICE recommendations were informed by the earlier work of experts “across the pond” here at the AGS. In 2012, our Expert Panel on the Care of Older Adults with Multimorbidity unveiled our own new stepwise approach to managing multiple chronic conditions.5 As our guideline notes, we worked not only to
E-mail address: [email protected]. 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2017.05.015
push for better and more coordinated care across discrete diseases but also to “facilitate the development and growth of an evidence base by which clinicians [could] make sound care decisions., including the testing of better processes for decision-making.”5 (p. 2) Sodmore than five years after the release of AGS guidance and less than a year after the launch of the U.K.’s NICE recommendationsdhow well have we bridged the trans-Atlantic divide when it comes to coordinating care? Quite well, according to AGS and BGS experts writing in their first set of joint editorials. “The NICE guideline on multimorbidity challenges physicians and healthcare providers to adopt an holistic approach that takes full and proper account of multimorbidity. It addresses a common flaw in all contemporary health services that frail, multi-morbid patients are often subjected to futile or even harmful investigations and treatments,” noted David J. Stott, MBChB, MD, FRCP, and John Young, MSc, authors of the BGS editorial and Editor-in-Chief and Associate Editor, respectively, of Age and Aging (the BGS’s research journal).2 (para. 2) William B. Applegate, MD, MPH, AGSF, Editor-in-Chief of the Journal of the American Geriatrics Society and author of joint commentary from the AGS, noted: “From the U.S. perspective, the NICE guideline statement is both comprehensive and compelling. It is comprehensive in that it is truly patient-centered, focused on a broad array of health domains.It is compelling because it clearly articulates a balanced, thoughtful approach to care that transcends the limited algorithmic organ system approach.. Most of the substance of the report is already appreciated and practiced by geriatricians in the U.S., but less often by the wider health care delivery system..”6 (p. 1) Both sets of experts go on to commend the U.K.’s guidance for embracing a growing trend in Europe and North America when it comes to eliciting person-centered care goalsda trend that has been driven in large part by the cutting-edge clinical work of AGS and BGS members. As Dr. Stott and Prof. Young note: “The aim is to give the recipients of care control over decisions and actions affecting their health.a philosophy of clinical practice that should be integral to the management of all patients, multi-morbid or not.”7 (p. 2) That these theoretical best practices are becoming actual best practices across our two nations reinforces the importance of the
AGS Section / Geriatric Nursing 38 (2017) 266e267
AGS and BGS cross-cultural exchange. And in the context of our work to build better bridges across professions and national borders, continued commentary from experts at home and overseas will do much to advance how we identify and embrace the future gold standards of geriatrics care. As always, that work begins with champions like the AGS and BGS membersdnurses, geriatricians, pharmacists, social workers, physician assistants, researchers and so many others who share “esteem, confidence, and affection. [even when we are] separated by an ocean.”1 (p. 150) References 1. Giunta MA, ed. Documents of the Emerging Nation: U.S. Foreign Relations, 1775e1789. Wilmington, DE: Scholarly Resources, Inc; 1998.
267
2. New Collaboration Looks for Trans-Atlantic Common Ground in Geriatrics. From American Geriatrics Society. Retrieved from: http://www.americangeriatrics. org/press/news_press_releases/id:6825; 2017, March 27. 3. Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a crosssectional, population-based, multi-country study. J Gerontol Ser A Biol Sci Med Sci. 2016;71(2):205e214. http://dx.doi.org/10.1093/gerona/glv128. 4. National Institute for Health and Care Excellence. Multimorbidity: Clinical Assessment and Management. Retrieved from: https://www.nice.org.uk/ guidance/ng56; 2016, September 21. 5. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012;60(10):E1eE25. http://dx.doi.org/10.1111/j.1532-54. 6. Applegate WB. Across the pond. J Am Geriatr Soc; 2017. Advance online publication. http://dx.doi.org/10.1111/jgs.14803. 7. Stott DJ, Young J. “Across the pond”da response to the NICE guidelines for management of multi-morbidity in older people. Age Ageing; 2017. Advance online publication. http://dx.doi.org/10.1093/ageing/afx031.