Using a Health Risk Appraisal to Improve Health Care for the Elderly

Health care issues for all, including the elderly, just came to the forefront recently as Medicare has had closer scrutiny in Washington D.C. While the many health care reform options that were reviewed and voted on are still unknown as to how they will be implemented, most observers noted that big changes are on the horizon and that personal health care responsibility will be a vital key to it. And with May being designated as “Older Americans Month,” it is apropos for us to focus on these issues.

By 2030, there will be an estimated 70 + million Americans aged 65+and comprising 20 % of the total US population. Minority populations are projected to represent 25 % of the elderly population in 2030. Medicare and Social Security insolvency projections may vary but all seem to point to a health care system out of control. (National Academy of an Aging Society, 2010)

The combination of the changing profile of older Americans and the increasing costs associated with their higher utilization has shifted attention to a more proactive approach to health care: promotion, prevention, care management with an integrated continuum of services, and personal responsibility for health status and well-being.

How can older Americans take charge and manage their own health? How can they know when their health status has improved? How can social work clinicians, in addition to addressing the emotional, supportive and care giving concerns of their geriatric clients, incorporate a broader means of assessing them, in order to facilitate the physician and other health care providers in these critical holistic issues?

Part of the answer may be found in a Health Risk Appraisal (HRA). With the exponential increase in the numbers for the overall 50 and over age group expected over the next few decades, it is critical to examine the aging of the baby boom and other cohort groups from a wider perspective, including the role of health, lifestyle choices and individual responsibility.

An HRA is a tool, available in a wide variety of forms, for measuring various factors that contribute to one’s overall health. It identifies behavioral or physical health indicators that pose an unwanted level of personal risks such a smoking, lack of exercise or a high fat diet. Professional counseling and educational interventions, such as support groups, are then provided or given as referrals to clients to address the specified needs, such a heart and fitness activities for weight control and/or cardiovascular concerns.

One study in the American Geriatrics Society Journal addressed the reliability of screening criteria, such as an HRA. A major conclusion of the study was:

…brief surveys about the presence of health risk factors could be used to estimate an elder’s risk of future hospitalization and thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization. (Boult, Dowd, et al, 1993, p. 811)

Through an HRA, an individual can learn what choices he or she can make to maintain or work towards good health. However, it’s important to remember that an appraisal is not a substitute for a check-up or physical exam from a physician. The HRA’s purpose is to help people identify ways they can lower their risk of getting sick or injured in the future.

For Social Work clinicians, an HRA may also help to identify dysfunctional health and mental health concerns that are impacting the well being of elder clients and/or their care givers who are dealing with stress and the need for support.

While an HRA is not designed for people who already have serious health or mental health concerns, it can serve to help people take charge of their health at any age, and not just for elders. Specific measures, such as weight, blood pressure and cholesterol levels, as well as indicators of social isolation, can form the basis from which an individual and/or care givers can take personal responsibility to monitor health and mental health individually, as a family unit and in conjunction with one’s Primary Care Physician and/or Psychiatrist.

Thus, programmatic changes are expected to accelerate in future health and mental health care services for the elderly, including more of an emphasis on health promotion, prevention and care management. (Schultz, R. & Johnson, A. C., 1990). However, individual responsibility for health care will be critical as well. The HRA is one means that social work clinicians and others can enhance the partnership between the individuals, family members and other providers of care.

For more info about HRAs and how clinician’s can incorporate them into their practice for geriatric clients, check out: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2043334/.

References

American Journal of Geriatric Psychiatry (May/June 2004). Family Caregiving of Persons With Dementia: Prevalence, Health Effects, and Support Strategies; Schulz, Richard Ph.D.; Martire, Lynn M. Ph.D.
Volume 12 - Issue 3 - p 240-249.

Boult, C., Dowd, B., et al. (1993). “Screening elders for risk of hospital admission.” Journal of American Geriatrics Society, 41, 811-817.

National Academy of an Aging Society (2010). Public Policy & Aging E-Newsletter. (2010). Volume 4, Number 2, March 2010.

Schultz, R. & Johnson, A. C. (1990). Management of Hospitals and Health Services: Strategic Issues and Performance. St. Louis, MO: The C.V. Mosby Co.

Keith Horcasitas, LCSW, MHA