Category Archives: Health Services

The Potential for Clinical Trials at Collington

As we move forward with our repositioning of health care at Collington,  of necessity the potential of Collington as a research location has taken a big of a back burner – but only for now.

This New York Times article is a timely reminder of how us seniors are often forgotten when it comes to clinical trials:

Salt matters to geriatricians. It’s associated with conditions many older people contend with, particularly high blood pressure, but also swelling and heart failure.

Though doctors frequently urge older patients to reduce salt in their diets, it’s not clear how much reduction is necessary to improve health, or even how much salt most people actually consume.

“There’s a lot of controversy, but that’s why we need the data,” said Dr. Covinsky. So he read on, until he reached the paragraph explaining that the study used “randomly selected, nonpregnant participants aged 20 to 69 years.”

He did a double-take. Once again, the population probably most affected — older adults — had been left out of an important study.

“How is this possible? Unacceptable!” Dr. Covinsky protested on Twitter. “I can think of no good rationale for this exclusion. This has got to stop.”

Indeed, I have been told by researchers that it is hard to recruit seniors for trials.  This may be for a variety of reasons, lack of trust, fear of the unknown, inconvenience, failure to understand modern protocols and informed consent.  As the Times adds:

Starting next January, [NIH] grant applicants will have to explain how they intend to include people of all ages, providing acceptable justifications for any group they leave out. The agency will monitor investigators to make sure they comply.

Moreover, there are often problems with exclusions of research candidates who have multiple medical conditions (like almost all seniors.)

This has all led to the idea that Collington may indeed be a perfect research partner.  We have many scientists here, and many with experience with statistics, data, and research protocols.  We are an easy to reach population, and we are also racially diverse — another important consideration.  Moreover, we might be able to help enroll and provide services associated with the research to those in the community.  (In particular, fear of not being helped with other conditions is a major deterrent to certain categories of patients.

So, as we move forward, lets keep this is mind.

Salt, anyone?

p.s. Dorothy Yuan adds the following thoughtful comment.

You have absolutely right that we have an ideal population for clinical trials.  I can already think of many parameters.  First, the age bracket is quite limited.  Second, living conditions are similar.  Third,  access to minimal  medical care is generally available.  Forth, although the daily menu provides a lot of choices it is still rather limited in scope. Fifth, and most important, easy access for researchers to do follow-ups.
Whereas these conditions are not suitable for all areas of study.  For example, salt intake will be rather difficult since we don’t prepare our own meals.  However, we would be ideal for many other studies.  
All we need is a way to advertise our availability. 

 

News and Perspectives on Strategic Planning and Implementation Steps

Editors Note:  Periodically we post perspectives pieces in which we offer some broader thoughts on where our community is going.  We do this not only for each other, but to show our friends what is happening here.

As many know, our Strategic Planning document has been published, and concrete steps have been announced to move its items forward (see page 15 of our Courier dated Feb 26 to March 4).  This is a very important document for all of our lives, and not just because of the concrete steps, such as completely repositioning our health care, that are being and will be undertaken under its banner.

Every few weeks, the Committee, which is a Board Committee with heavy resident and staff participation, will be releasing an update on activities and plans in the Courier.  Residents will also be hearing about that in various fora, including the RA Council and the Community Meeting.

Indeed, such an update is in the most recent Courier.  It includes the very important news with respect to the critical health care partnership, that:

After a significant amount of due diligence, we have narrowed potential partners down to 3 providers. We are continuing due diligence and believe a final recommendation will be made to the Board in June for their endorsement.

Similarly with respect to the physical redesign of the Creighton Center (which is of course deeply integrated with our conceptual redesign:

A Request for Proposals (RFP) has been developed and has gone out to several national and local architectural firms. An ad hoc committee of the Strategic Planning Committee will oversee the RFP process and final recommendations on an architecture firm. We expect this process to be completed by the end of June as well. 

The is no need to note what a wonderful acceleration this represents.

The Report notes that the “Collington Culture and Stakeholder Engagement” implementation rollout will begin in September, and the other two will start in 2019. This delay will enable us to take full advantage of what we are learning about how best to work together in the initial groups and apply that will the next ones.

Speaking for my self, I feel very confident that these processes will be rich in resident input, and that the transformative quality will be clear from how things work out  Just look at the Landing Bistro and the new Physical Therapy staff and spaces.  These both reflect the values and principles processes established in the Srategic Planning process.  I hope that these will similarly increasingly influence everything here at Collington.

 

 

 

 

Meet Dr. George Hennawi – As described by his colleagues – A great guy, a straight shooter, his patients love him

On April 19th, a much anticipated program took place as over 100 Collingtonians packed our auditorium and an unknown number watched from home on channel 972. Dr. Peter Fielding, Chair of the Health Services Committee, introduced us to Medstar Gerontologist, Dr. Hennawi.

Dr. Hennawi presented his vision for medical care here at Collington based on a model already in place in Baltimore. As he demonstrated his enthusiasm, his presentation included statistics documenting this model of care’s success. Watch for yourself, understand the future of gerontology and how we may be part of that trailblazing experience!

Vitalize360 Launching This Week — Meet and Greet Friday in the Game Room

This is the week that our Vitalize 360 program gets its real launch and sign-up opportunity.  A project of Kendal, it provides us Collington residents the opportunity to get a “life coach,” who will help us bring together whatever resources and help to decide what they want to achieve next in our lives.  If one of us does not yet know what this is, our new staffer Kim Rivers will help us figure that out too.  Once a goal is identified, Kim will help pull together the Collington resources, staff and residents, to support the process.

Often this is thought of in traditional medical terms, such as achieving a particular “vital sign” milestone, or getting physically strong enough to, for example, get on a plan to visit grandchildren.

But many of us feel that the most exciting engagements that this makes possible are more intellectual, political, academic, etc.  Dianna Cox, who runs the project, and was here for a great presentation yesterday, gave an example of a man who had decided to challenge his golf club’s men only policy, and did so successfully.  (Other more transformative possibilities might come to mind.)

Tomorrow, Friday March 9 at 10:30 in the Game Room, there will be a meet and greet to get to know  Kim and learn more about the project.

Here is the PowerPoint that Nancy Cox presented.

Here is a short video:

It is important to note that Vitalize 360 is a key pat of our strategic plan, both as a specific element, and as something that will help build culture-transformative energy.

Indeed, a recent article in the Journal of Aging Research and Healthcare, here, concludes:

In this project, COLLAGE [Vilalize at one location] 360, a comprehensive assessment system and wellness coaching program that focuses on prevention and wellness was implemented in one continuing care retirement community. Following completion of two assessment tools through directed conversations with a wellness coach, older adults developed an individualized vitality plan that outlined life goals, supporting goals and action plans for goal achievement. Results from this program suggest engagement in the assessment and wellness coaching process via the COLLAGE 360 program translated into sample older adults sensing that they live in a more supportive environment when compared with elders not receiving any wellness coaching. In addition, the older adults had positive responses in the areas of mood and life satisfaction. Strategies to improve health and well being need an extended focus beyond the older adult‘s medical conditions and consider psychological, spiritual and social needs with personal preferences being paramount. These issues are foundational to a person- centered, health promotion approach needed among older adults.

Do not miss the opportunity.

 

The Coming Decline of Hospitals and Implications for Our Strategic Plan

An important article in the New York Times highlights the the ongoing reduction of hospital admissions.

Consider this: What year saw the maximum number of hospitalizations in the United States? The answer is 1981.

That might surprise you. That year, there were over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981.

In addition to the impact of increasing infection risks:

The number of hospitals is also declining because more complex care can safely and effectively be provided elsewhere, and that’s good news.

When [the writer] was training to become an oncologist, most chemotherapy was administered in the hospital. Now much better anti-nausea medications and more tolerable oral instead of intravenous treatments have made a hospital admission for chemotherapy unusual. Similarly, hip and knee replacements once required days in the hospital; many can now be done overnight in ambulatory surgical centers. Births outside of hospitals are also increasing, as more women have babies at home or at birthing centers.

Studies have shown that patients with heart failure, pneumonia and some serious infections can be given intravenous antibiotics and other hospital-level treatments at home by visiting nurses. These “hospital at home” programs usually lead to more rapid recoveries, at a lower cost.

This has huge implications for the system as a whole.

As these trends accelerate, many of today’s hospitals will downsize, merge or close. Others will convert to doctors’ offices or outpatient clinics. Those that remain will be devoted to emergency rooms, high-tech services for premature babies, patients requiring brain surgery and organ transplants, and the like. Meanwhile, the nearly one billion annual visits to physicians’ offices, imaging facilities, surgical centers, urgent-care centers and “doc in the box” clinics will grow.

It also has huge implications for our already well-advanced planning for implementation of our strategic goals with respect to health care at Collington.  For example:

It will become possible for more and more of us to be treated for more contiditions as outpatients.

Our skilled nursing units will have new uses as lower levels of care during treatment are appropriate.

Potential medical system partners will become even more interested in Collington as “off-site partners.”

The need for focused research on the impact of these changes will be greater, making the appeal of a research friendly partner even greater.

Integration of our holistic services with broader service networks will become crucial and practical.

In other words, we are moving toward “modern gerontology” at just the point that other systems will need our partnership.

Stay tuned.