Study recommends better coordination of elder services

By Susan L. Silk
Published: November 6, 2008

The Dukes County Health Council (DCHC) elder affairs and rural health scholars advisory committees on October 22 received the results of a study of how Martha's Vineyard might better meet the healthcare needs of the elderly.

The research, conducted by students enrolled in the UMass Worcester Community Health Clerkship 2008 program, concluded that in order to create a safer and healthier environment for seniors, an effort must be made to collaborate between towns and coordinate services.

The study was conducted during a two-week period in September by two Clerkship Program participants who are first-year UMass Worcester medical students and two second-year graduate school of nursing students. During their research visit to Martha's Vineyard the students conducted two focus group meetings with seniors as well as more than 30 meetings with a wide variety of healthcare providers, public safety officials, and senior advocates across Martha's Vineyard.

According to the study results, presented as a power point presentation in the hospital's staff medical library, the most prevalent health and safety threats to seniors are falls and the injuries that result from falls. Island, state, and national data presented also documented both the cost and frequency of hospital emergency room visits as a result of falls. The CDC estimates that the treatment of someone who has suffered a fall costs, on average, $20,000 and women are 67 percent more likely to fall than men.

Researchers offer ways to prevent injuries to elderly from falls

"Injury and Fall Prevention for the Elders of Martha's Vineyard," a study conducted by researchers participating in the UMass Worcester Community Health Clerkship 2008 program, offers recommendations and suggests practical steps older Islanders, family members and the community can take to create a healthier and safer living environment.

In order to prevent falls, by far the most frequent reason for visits to the Martha's Vineyard Hospital emergency room, the researchers stressed the need for seniors to practice "self-care."

Seniors should be encouraged to do strength training and flexibility exercises; wear proper/supportive footwear; practice proper nutrition and hydration; be sure that their living space is safe (equipped with grab bars in bathrooms, for example, and free of clutter and loose rugs), properly manage medications, and have regular medical checkups.

The report includes recommendations for improvements in the community that would assist seniors. These include: create better sidewalk lighting; create accessible sidewalks; install "walk" lights at busy intersections; and encourage seniors to enroll in AARP safe driver courses.

The UMass researchers concluded that Martha's Vineyard is doing "a great job" of supporting seniors and their families. However, there are still needs here.

The student researchers noted that the territorial nature of Martha's Vineyard's towns has created, in some cases, unneeded redundancy of services and in some instances a gap in services for seniors. "For example, two towns may have scheduled back-to-back days of AARP safe driver courses when only one is needed and the second town could offer something else that seniors need," said researcher Diana Moore, RN.

The study recommends that Martha's Vineyard designate an organization (other than the Hospital) to coordinate all Vineyard elder healthcare and community services. This organization would help to "recognize redundancy and facilitate better use of Island resources," according to the study.

The study also recommends that an elder health forum be organized that would bring together all of Martha's Vineyard's organizations and individuals involved with elder support services to initiate the collaboration process.

"There are a lot of resources and guides, but there are discrepancies in what people know about," said medical student Joel Bradley. "There needs to be a faultless clarity to the resources for seniors. There needs to be one resource guide."

Echoing these remarks, medical student Megan Furnari said, "the goal is to facilitate a dialogue between service providers, recognize the overlaps, encourage collaboration and create a better use of the resources for elder care on Martha's Vineyard." RN Jennifer Mistretta was the fourth member of the student research team.

The UMass Worcester Community Health Clerkship Program is six years old and was created to help students understand how to look at a community and diagnose a community's health care needs, according to the Program's director Suzanne Cashman, ScD.

"People who have been here a long time see the barriers; new people see what is possible," Ms. Cashman said in explaining the benefits the Program brings to the communities that host the student researchers. There are 24 different community healthcare issues from which the students may select an area of interest. The students who came to Martha's Vineyard this year had all selected an interest in rural healthcare issues.

The researchers' study also identified the need for counseling services specific to elder issues and needs and the need for a geriatric psychiatrist (on Martha's Vineyard or on a consulting basis).

Members of the elder affairs and rural health scholars advisory committees attending the presentation said they were grateful for the research findings. Karen Meeks, of the Vineyard Nursing Association, said she was excited by the recommendations. "I like the collaboration activities they are recommending. We should all be working together."

Elder Affairs Committee chairman Jacque Cage, the Martha's Vineyard director of Elder Services of Cape & Islands, commented that the researchers "have done a lot of work; now we need to follow through. They have put us in the position where we have an opportunity to work at what they have recommended and follow through on their process."

The two graduate nursing students are each required by UMass to complete an additional 40 hours of community services to receive their degrees. According to Patsy McCornack, chairman of the rural health scholars committee, if the nursing students want to complete those 40 hours here on Martha's Vineyard they could be very helpful in completing an island-wide resource guide. The local next steps will be discussed by the DCHC in the coming months.