As the baby boomer generation becomes the silver tsunami in the coming years, more resources and creative ideas will be needed to care for the growing number of American seniors. According to the Administration on Aging, nearly a quarter of Americans will be age 65 or older by 2050.

The latest thinking in senior health care takes a step back from the traditional focus on providing medical services in response to sickness, instead reaching out into the community to coordinate a web of social services and medical care providers to keep older adults healthy at home and out of the hospital.

With this in mind, Mills-Peninsula launched the Peninsula Circle of Care as a pilot program in 2012 with funding from the Gordon and Betty Moore Foundation and an anonymous donor. The program is a partnership of Mills-Peninsula, the Palo Alto Medical Foundation and Peninsula Family Service, a not-for-profit community organization that serves older adults and families. Peninsula Circle of Care supports older adults as they transition from a hospital stay to their return home. The goal is to avoid unnecessary and expensive hospital readmissions by providing a free network of services, including home visits from a nurse and social worker, meal delivery, short-term caregiver support, a wellness coach and transportation to follow-up doctor visits.

“Older adults really benefit from help navigating services at a time they need it most – when they leave the hospital,” says Yvonne Chan, program manager for Peninsula Circle of Care. “Health isn’t just about a person’s medical condition. It can also be affected by the support system a person has and what is happening at home. This program goes beyond care coordination in the hospital to ensure patients are discharged with the right programs and connected to the right community support when they go home.”

The Peninsula Circle of Care pilot was so successful that it has been fully adopted by the hospital. Data also shows the program works. An independent 2010-2013 study found the number of Circle of Care participants who had to return to the hospital within 90 days after they were discharged home was 41 percent less than those who did not have the additional support. Program participants reported feeling more empowered, stable and confident about managing their health at home.

Assessing Risk

The Peninsula Circle of Care team created a tool to help determine a patient’s risk for having to return to the hospital. It works with the electronic health record system to flag patients who are at high risk for hospital readmission. The tool uses an algorithm to assess medical and social aspects of a patient’s health, such as how many medications a patient takes, the number of hospital stays in the past three months, living situation and caregiver support, then classifies the patient as low, medium or high risk for readmission. The tool is so useful at Mills-Peninsula that it is now being used by other hospitals in the Sutter Health system (of which Mills-Peninsula is a part).

Expanding the Circle

Peninsula Circle of Care works closely with Sutter Health’s Advanced Illness Management (AIM) program, referring patients who are extremely ill and need more intensive care and support. AIM provides care planning, medical support and palliative care for patients with late-stage or advancing chronic illness.

Focus on Independence

Mills-Peninsula’s Senior Focus program also strives to keep older adults thriving and living independently as long as possible without going into a nursing home or a hospital. Staffed by nurses, physical and occupational therapists, social workers and dementia care specialists, Senior Focus provides adult day health care and Alzheimer’s day health care for San Mateo County residents who have chronic illnesses or who are disabled or medically frail.

To learn more about Peninsula Circle of Care, visit mills-peninsula.org/pcoc or call 650-240-8004.

To learn more about Senior Focus, visit mills-peninsula.org/seniors or call 650-696-3660.

One in five adults in the United States has been diagnosed with some form of arthritis, according to the Centers for Disease Control and Prevention.

Despite the chronic pain associated with the condition, there are simple steps you can take to treat arthritis and manage its impact on your life.

Exercise, particularly in water: For osteoarthritis, the most common form of the condition, exercise is one of the most effective ways to control pain and increase range of motion. The buoyancy of water lets people exercise with less impact on joints. Mills-Peninsula offers an arthritis aquatics class in a heated pool and led by an Arthritis Foundation-certified instructor.

Maintain a healthy weight: Even a few pounds less weight on your joints makes a difference in daily comfort and your ability to stay active.

Protect your joints: Keep arthritis pain under control by limiting the pressure and pounding on joints, according to the Arthritis Foundation.

Talk to your doctor. Some prescription medications and supplements can help reduce symptoms, as can relaxation techniques.

Learn self-management strategies: Mills-Peninsula offers an Arthritis Self Management course, originally developed at Stanford University to help improve quality of life for people with arthritis. This class offers a small-group setting in which participants can share and learn helpful tips and skills for living well with arthritis.

“The class explores different facets of living with arthritis and how to take charge,” says Jennifer Trizuto, senior physical therapist at Mills-Peninsula. “You can learn techniques to better manage fatigue and pain and even cut down how often you need to visit your doctor.”

Visit the Mills Arthritis and Osteoporosis Center for additional resources and information.

When Sylvia Aftel was born, the American flag had only 46 stars. It was 1910, two years before the Titanic’s fateful voyage, when most U.S. homes did not have telephones and a gallon of milk set you back 32 cents. Now at 102 years old, Aftel is a regular at Mills-Peninsula’s Senior Focus adult day health program, which she’s been attending since March of 2010. Aftel is still mentally sharp and in excellent health. She lives in her own home, with help from a caretaker, on a quiet cul-de-sac in San Mateo. She is proud of her independence, but says the brightest days in her week are the three she spends at Senior Focus.

“The best part of coming here is meeting people – everyone is very friendly here,” she says. “At home, I’m alone with the telephone – people call wanting to know if I plan to sell my house or buy new windows.”

Recent research suggests that regular socializing is a vital component of health for older adults. The study, published in the Proceedings of the National Academy of Sciences, found that social isolation can shorten the lives of seniors. The adult day health program at Senior Focus provides group activities – such as painting, light exercise and listening to music – physical and occupational therapies and medical care from registered nurses.

“I’m happy and lucky I still have my good health,” Aftel says

In addition to socializing at Senior Focus, Aftel says she enjoys the daily exercises led by Senior Focus staff and the music, sometimes with live performances.

“Coming here to Senior Focus has been a very good thing for me,” she says. “I look forward to getting out of the house.”

Aftel has outlived her children, sister, two brothers and husband of 66 years. She worries about being a burden to her granddaughter, so she tries not to ask for too much, she says. Her granddaughter and two great grandchildren live one block away. Close enough that when her grandson-in-law cooks up an especially delicious meal, he sends a plate over to Aftel’s house, free delivery courtesy of the great grandkids.

She’s proud of the volunteer work she did throughout her life, working in stateside support of U.S. army soldiers in her younger years and later spending 20 years as a volunteer at a hospital in Denver.

To mark the special occasion of her 102nd birthday last December, the Senior Focus team threw a big birthday bash, complete with a visit from an Elvis impersonator. Framed pictures of Aftel and “the King,” kicking back against his pink Cadillac, hang on the walls of Senior Focus.

“It was the best party we’ve ever had,” Aftel says. “Everyone had a great time.”

As Aftel shows no signs of slowing down, it might be time to start planning an even bigger bash to celebrate 103.

For older adults experiencing decreased appetite or waning interest in food, a few simple adjustments to your cooking habits can help, according to Cathy Hazlewood, R.D., CDE, outpatient dietitian and diabetes educator at Mills-Peninsula Health Services.

Keeping up good nutrition is important at all stages of life, but senior nutrition is especially vital. Older adults need fewer calories, so they should eat nutritious foods that count, particularly fruits, vegetables and dairy.

Tips for eating well:

Use fresh herbs and spices (not just salt!)

As we age, our ability to taste and smell is diminished. Making food more flavorful with seasonings and spices can boost appetite and mealtime enjoyment, Hazlewood says. The delicate flavors of fresh basil, dill and mint are best added at the end of cooking, whereas thyme and rosemary benefit from longer cooking times.

Smell your food and enjoy the way it looks

Taste also involves smell, so take time to smell your food to boost its appeal. Enjoy your meals slowly and remember to also appreciate the presentation.

Organize a weekly  meal with friends

Get together with neighbors or friends for a weekly potluck or restaurant outing. Dining alone is a common reason for poor eating, so share meals whenever possible.

Cook simple meals or go raw

Choose two-person recipes and simple to prepare meals such as salads with easy-to-digest butter lettuce, canned garbanzo beans for protein or grilled chicken breast that can be frozen and repurposed in other meals.

Pictured, left to right: Marie Pochyla, John Macalik and Jana Hrdinova.

The people of Nivnice, a small town in the Czech Republic, may speak a different language, but they share some of the same challenges in caring for an aging population as we do in the United States.

While visiting family in Nivnice this past summer, John Macalik, co-chair of the Patient/Family Advisory Council at Mills-Peninsula, stumbled upon an opportunity to speak at the town’s senior care facility. Macalik’s father grew up in Nivnice. Residents and staff of the Senior Charity Home of Nivnice, which houses and cares for about 20 seniors, wanted to learn more about how communities in the United States are supporting healthy aging. 

Easing the Way Home

Macalik introduced them to an innovative new program for people over age 65 who are discharged from Mills-Peninsula Medical Center in Burlingame. Called Peninsula Circle of Care, the free program aims to prevent hospital readmissions by easing a patient’s transition home after a hospital stay. It helps with seemingly simple things – such as managing medications, delivering fresh meals or scheduling a follow-up doctor visit – that can go a long way toward preventing a return to the hospital.

Despite receiving only one day’s notice, Macalik wanted to put together an engaging presentation. He shot an email to Zani Weber, Mills-Peninsula’s vice president of patient experience, who immediately connected him with Yvonne Chan, R.N., MSN, the program manager for Peninsula Circle of Care.

“They worked their magic and in a few hours I had in my hands specific information about the Circle of Care program, including pictures and graphic art. With their quick response, I was able to put on a multimedia presentation,” he said.

Finding Common Ground

Charity Home staff – particularly Jana Hrdinova, Macalik’s relative who works at the facility – were engaged and asked many specific questions.

“Peninsula Circle of Care is such an innovative program,” Macalik said. “A nurse or social worker goes out to the home. The program also can coordinate food delivery, help with medications and get people to doctor appointments. It is helping keep older people healthy at home. The people at Charity Home thought it was wonderful. They were writing down information and asking questions. They were truly inspired.”

In fact, Macalik says Senior Charity Home of Nivnice is now studying the possibility of launching a similar type of program for seniors in the Czech Republic.

“It is amazing how from halfway across the world you can help each other by sharing ideas, lessons learned and what really works,” he said. “They face some of the same issues in the Czech Republic as we do in the U.S., in terms of caring for their senior population. A lot of older people there are worried about being able to get around and having support in their later years.”

Peninsula Circle of Care is a partnership between Peninsula Family Service, the Palo Alto Medical Foundation (Mills-Peninsula Division) and Mills-Peninsula Health Services, made possible by a generous donation from the Gordon and Betty Moore Foundation and an anonymous donor.

Most people look forward to the golden years, but after age 75 many medical issues arise that can compromise quality of life, says Mike Menefee, Ph.D., director of Outpatient Services at Mills-Peninsula’s Behavioral Health Services Center. “Joint and back pain is especially prevalent among seniors,” he says. In fact, the National Institutes of Health report about half of older Americans living on their own have chronic pain. To manage this pain, many older Americans use opiates, Dr. Menefee says. “Taken over time, they can develop a tolerance for the medication, so either their dosage has to increase or they have to stop taking the medication, go through withdrawal and start a new opiate.”

 Dependency vs. Addiction

While developing a tolerance for a pain medication is concerning, Dr. Menefee draws a distinction between being chemically dependent on a medication and addictive behavior. “Many people become dependent on opiate medication, but if they take the medication as prescribed, it’s not a problem,” says Dr. Menefee. According to Dr. Menefee, patients who have developed an addiction don’t adhere to a prescription. They take more medication to relax or ease anxiety.

Risk Factors for Addiction

Many facets of life for older Americans make them vulnerable to addiction:

• Isolation: A senior may lose a spouse or close friend, or retire. He or she becomes increasingly isolated. According to Dr. Menefee, this lack of social structures or organized activities leaves people feeling isolated and lonely. ”Living alone and not meeting daily challenges is fertile ground for anxiety disorders,” he says. “Dealing with the world every day eases anxiety. Seeing the world through the TV, people become fearful about whether they can cope.”
• Deterioration of physical function: As people age, their livers don’t process alcohol as they once did. So the same two drinks someone has throughout their lives become too much in their 70s and 80s. “Drinking too much puts older adults at risk for falling,” says Dr. Menefee.

Danger Signs for Substance Abuse

Mike Menefee, Ph.D.

If a family member suspects that a loved one may be abusing drugs or alcohol, what are the warning signs?

• • Falls and unexplained bruises
• • Poor grooming
• • Poor eating
• • Using multiple pharmacies (“This is a common way to shop for drugs,” Dr. Menefee says. “It is also harder to monitor on the Internet.”)

Helping Seniors Help Themselves

Finding a way to overcome the social isolation associated with aging is paramount to recovery for older Americans. For many, learning to use the Internet and having access to email can help ease social isolation, as does getting involved in activities. “Seniors can keep some contact with the world through email. They can communicate with grandkids and friends,” said Dr. Menefee. “But we want them to exercise, go to senior centers or walk with friends, too.” Mills-Peninsula also offers senior behavioral health services to help manage depression and recover from substance abuse. The program meets two to four days per week for four hours, with lunch provided. “Sometimes we help people move from the home they used to share with family to senior housing or assisted living,” says Dr. Menefee. “We reconnect them to volunteer services and senior centers, and we help them form new bonds with peers. It’s been very successful for a lot of seniors.” For more information on Mills-Peninsula’s senior behavioral health services, call 650.696.4666.

If an injury or sickness leaves you unable to communicate your treatment preferences, an Advance Health Care Directive (AHCD) can ensure your wishes are followed and save your family unnecessary grief.

Frances Huang, Mills-Peninsula medical social worker

On an AHCD you can indicate whether or not you want life-sustaining treatment and your preferences for other treatments, such as pain relief. The form also allows you to choose a person to make health care decisions for you, if you are unable. Any person older than 18 years can fill out an AHCD form.

Discussing your treatment preferences with your family and your physician and completing an AHCD is important to make sure your preferences are carried out and to ensure your family is not burdened with difficult decisions during a distressing time, says Frances Huang, M.A., a medical social worker at Mills-Peninsula’s Senior Focus.

“Many people at the end of life cannot make medical treatment decisions themselves,” she says. “And, when families are in distress they are not in a place to think clearly to ‘guess’ your wishes. Making difficult treatment decisions for a loved one can cause negative emotions like distress, agony, regret or guilt.”

You can download an AHCD form from Mills-Peninsula’s website, and forms are also available at the Mills-Peninsula Medical Center admitting office and at Senior Focus. You’ll also find resources for advance health care planning on the Coalition for Compassionate Care of California website.

Social worker Alison Johnson with Carmen Paez

Coming home from a hospital stay, especially during a prolonged illness, can be a stressful time for anyone. Patients often are sent home with a long list of medications and important home care instructions to facilitate healing.

The Peninsula Circle of Care program, created for older patients at Mills-Peninsula Medical Center, eases this transition by providing support for seemingly simple things  — from managing medications to scheduling a follow-up doctor visit — that can reduce the chance of having to return to the hospital, says Yvonne Chan, R.N., MSN, program manager for Peninsula Circle of Care.

The Program’s team also addresses social and physical activities, like joining an exercise class or going to lunch with friends. “We encourage people to explore what they want to accomplish in the next 30 days and how we can help make that happen,” Yvonne says.

Once a patient is discharged from the hospital, a nurse or social worker calls the home to schedule a visit, typically within one to two days. Depending on the patient’s needs the program can last from one to six months and can provide:

• free meals
• transportation to the first follow-up doctor visit
• short-term home and personal assistance
• connections to community services
• a wellness coach

Someone There to Help

Carmen Paez, who is 82 years old and lives on her own in Daly City, went through three hospitalizations in a year, first for heart failure last year, and this year a lung infection followed by an infection in her colon.

The care team supported her by delivering meals and providing personal assistance services, such as grocery shopping and laundry. “The meals really helped me,” Paez says. Upon returning home from the hospital, she says, “I had no appetite, couldn’t cook and had been eating only frozen food. But the food they brought was fresh and good, and I wanted to eat. It’s a wonderful program,” Paez says. “It is the best thing that could happen for patients who need it.”

Age-related changes in balance, combined with other factors such as medications, can lead to an increased risk of falling as we get older.

Kitsum Li, Mills-Peninsula occupational therapist, leading a FallProof class.

Staying on your feet is critical to maintaining health. In California, more than one million seniors fall each year, with approximately 100,000 of those falls resulting in serious injuries or fatalities, according to the San Mateo County Fall Prevention Task Force.

“If you are concerned about your risk factors for falling, talk to your doctor,” says Kitsum Li, a Mills-Peninsula occupational therapist who specializes in fall prevention.

“Your doctor can help address any illness that may be contributing to weakness or dizziness,” she said. “When appropriate, your doctor may also refer you to other services for preventing falls.”

Risk factors for falling include:

• A fall or near fall in the past six months
• Fear of falling
• Fainting or feeling dizzy
• Problems with your balance
• Muscle weakness in your legs
• Loss of feeling or numbness in your legs or feet
• Difficulty breathing or shortness of breath
• Changes in your vision
• Problems with routine activities (getting dressed, bathing)

Keeping your balance and strength also can help prevent falls. Mills-Peninsula offers a 12-session fall prevention program called FallProof, designed to improve balance, posture, strength and flexibility. The program begins with an assessment of your current balance and risk of falling.

For more information about FallProof or to schedule an individual assessment, call 650-696-4310. The next program begins Oct. 11.

For additional resources about fall prevention, contact the San Mateo County Fall Prevention Task Force at 650-573-3930 or http://www.smcfallprevention.org/.

“Many people have a fear of things in and around their eyes,” says Kenneth Chern, M.D., a Mills-Peninsula eye surgeon.

He remembers one 84-year-old patient whose vision was severely impacted by large cataracts in both eyes, but was so afraid of the procedure, she put it off for years.

“At last her family convinced her to change her mind,” says Dr. Chern. “After the surgery, she broke down in tears. She was so happy that she could finally see the color of her grandchildren’s hair.”

Vision of the Future
Dramatic advances in surgical materials and techniques in the last decade have made life-changing progress in vision correction and the treatment of cataracts and other eye diseases. Lens implants are used regularly in cataract surgery to restore the focusing power of the eye.

“In the last decade, exciting new lenses have been introduced that are custom-designed to meet the individual needs of each patient,” says Dr. Chern.

For example, “premium” lens implants can also counteract astigmatism. New multifocal lenses provide a range of focus that, in many cases, allows the recipient to see both far away (for
example, for driving) and up-close for reading, without the need for glasses.

These lenses are usually made of acrylic (a type of soft plastic) which is readily accepted by the body and lasts a lifetime.

The procedure typically takes only 30 minutes per eye using a local anesthesia and is very safe. According to statistics, the risk of infection is less than one in 10,000 cases.

“Recovery time is also pretty quick because the incisions are so small, about 2.5 millimeters,” says Dr. Chern. “Most people are back to their normal activities within a week or two.”

Two Minutes to 20/20 Vision
Lasik (laser) surgery can be used to permanently correct the vision of people who are nearsighted, farsighted or have astigmatism as an alternative to wearing glasses or contact lenses.

“Lasik has continued to improve year by year,” says Dr. Chern. Recent laser techniques now allow eye surgeons to shave a “flap” of the cornea to an amazingly thin 120 microns (thinner than a contact lens), reshape the corneal surface underneath with precise corrections to the person’s prescription, and then replace the flap. The actual procedure typically takes under 60 seconds per eye and both eyes are usually corrected in the same operation.

Just Enough surgery
New strides have also been made in the field of corneal transplants. The cornea is made up of five different layers. But in most eye diseases, typically only one layer is affected.

“In the old days, we had to replace the person’s entire cornea with a donor cornea,” says Dr. Chern. “But using new techniques, we can now repair just the layer that has been damaged, which means a greatly reduced chance of rejection by the body and a much faster recovery for the patient.”

Dr. Chern finds his job extremely rewarding. “The wow factor is great,” he says. “People experience so much happiness when their vision is so dramatically restored in such a short period of time.”

Pictured at left : Kenneth Chern, M.D.