Caring for Frail Elders, the Swedish Way
<p>With health systems around the world facing challenges in treating elderly adults with complex needs, two promising programs from Sweden show how it’s possible to provide frail seniors with effective and responsive care. Two new Commonwealth Fund case studies, written by Bradford H. Gray, Ulrika Winblad, and Dana O. Sarnak, show how these care models work.</p><p><strong><a href="/publications/case-study/2016/sep/swedens-esther-model-improving-care-elderly-patients-complex-needs">Sweden’s Esther Model: Improving Care for Elderly Patients with Complex Needs.</a></strong> Inspired by the harrowing health care journey of a real patient, the Esther model was launched in the late 1990s by Mats Bojestig to encourage caregivers to maintain a constant focus on the needs, preferences, and concerns of their older patients dealing with multiple health issues. </p>
<p>With the question “What is best for Esther?” always in mind, the program emphasizes treatment in the home or close to home; sharing of information about the patient’s experiences across provider organizations; and continuous quality improvement through coaches, training workshops, and Esther “cafes” held in municipalities throughout the year. Those adopting the model have achieved reductions in hospital admissions and readmissions, as well as shorter length of stays.</p>
<p><strong><a href="/publications/case-study/2016/sep/swedens-senior-alert-program-how-information-system-can-reduce">Sweden’s Senior Alert Program: How an Information System Can Reduce Health Risks Among the Elderly.</a></strong> A national preventive care dashboard for the elderly, Sweden’s Senior Alert program, now active in all the country’s 21 counties, seeks to identify and reduce specific health risks in the elderly, such as injuries from falls, pressure ulcers, malnutrition, and oral health care issues. The process begins with a risk assessment: for patients found to be at risk, a prevention plan is quickly developed and implemented—typically in the same day—and later evaluated. Information at each step is entered into the national Senior Alert database.</p>
<p>Between 2011 and 2014, the program achieved a 30 percent reduction in falls among seniors, as well as significant improvement in pressure ulcer rates and weight maintenance.</p>