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You Shouldn’t Need a Golden Ticket to Stay Mobile as You Age

Health systems are challenging assumptions about aging and mobility


Part of the Age-Friendly Health Care Special Report

(Editor’s note: This content is provided by The John A. Hartford Foundation, a Next Avenue funder.)

Perhaps no movie has better staying power than Willy Wonka and the Chocolate Factory. Many of us raised our children — and now our grandchildren — on the 1971 hit. In a movie filled with iconic scenes, one that really resonates with me involves Charlie’s four grandparents.

It’s hard to forget Grandpa Joe being confined to a bed, as life in the house goes on around him. He’s seemingly living out his later years as a passive observer — that is, until Charlie brings home the golden ticket. He chooses Grandpa Joe to come with him to the mysterious factory. Consequently, Grandpa Joe pops out of bed for the first time in 20 years, and a song and dance naturally ensues. Orchestral strings and horns soundtrack the family’s joy, as the impossible comes true.

What does it say about our assumptions of older people and their ability to get around?

The scene is truly an iconic moment in cinema history, but what does it say about our assumptions of older people and their ability to get around? A magical golden ticket — a once-in-a-lifetime opportunity — should not be needed to get up and moving.

Unfortunately, this was our approach to mobility for too long. Older patients’ deteriorating mobility was taken as inevitable, so if the doctor prescribed a medication or ordered a procedure that had a negative impact on a patient’s function, it was seen as the cost of doing business.

Thankfully, that mindset is starting to change.

Changing Attitudes About Mobility

Hospitals and health systems participating in The John A. Hartford Foundation and the Institute for Healthcare Improvement’s Age-Friendly Health Systems initiative prioritize older patients’ mobility in the planning and delivery of care.

Christiana Care in Delaware, for example, launched an initiative this month called Activity and Mobility Promotion, which gets hospital patients up and moving every day. It’s a departure from the historical tendency to keep patients in bed, for fear of falls and other negative consequences. Getting hospital patients up and moving with the help of their care teams can prevent muscle atrophy, ulcers, respiratory complications and other negative effects of bed rest. It can also reduce the risk of patients being readmitted to the hospital shortly after discharge.

This exciting movement goes beyond Delaware. Change is happening in California, within the Kaiser Permanente system, and in Maryland, at the Anne Arundel Medical Center, where teams of doctors, nurses and other clinicians are developing innovative mobility solutions.

At Kaiser, they’ve incorporated range-of-motion exercise worksheets into the care of older patients at the Canyon Oaks skilled nursing facility. The worksheets guide patients and their caregivers through exercises throughout the day, so they get stronger, more limber and home sooner — something that’s of the highest importance to many patients.

At Anne Arundel Medical Center hospital, older patients come together for 40-minute group exercise sessions. It’s part physical therapy and part social gathering. The latter is important because traditional hospital stays limit the amount of social interaction a patient has, which can result in the patient feeling isolated and lonely. Socializing in this way has the added benefit of patients progressing faster in their recovery compared to individual physical therapy sessions.

These and other hospitals and health systems in the Age-Friendly Health Systems initiative focus on older patients’ mobility as just one part of the 4Ms framework that guides the initiative. The others include focusing on What Matters (aligning care with each patient’s specific care goals and preferences); Mentation (preventing, identifying, treating and managing dementia, depression and delirium across care settings) and Medication (using medications that don’t interfere with what matters to patients, their mobility or mentation).

While remakes didn’t work out so well for the Willy Wonka franchise (sorry, Johnny Depp), they are a welcomed innovation in health care. Systems are rebooting the way they care for older patients to prioritize what matters to them, rather than what’s the matter with them — resulting in improved patient care, outcomes and satisfaction.

By Terry Fulmer
Terry Fulmer is the president of The John A. Hartford Foundation, a foundation in New York City dedicated to improving the care of older adults. Established in 1929, the Foundation has a current endowment of more than half a billion dollars and is world renowned for philanthropy devoted exclusively to the health of older adults. She serves as the chief strategist for the Foundation and was recently recognized for her leadership as one of the top 50 Influencers in Aging by PBS’ Next Avenue. Fulmer is chair of the Bassett Medical Center Board in Cooperstown, N.Y. — an affiliate of the Bassett Health Network, which covers more than 5,000 square miles of predominantly rural communities upstate New York.

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