Health outcome measures for older people

Asangaedem Akpan (tweets at @asanakpan) is an Honorary Clinical Lecturer at the Institute of Ageing & Chronic Disease, University of Liverpool and Geriatrician, who was part of a global network of experts, including older people and carers, that developed a standard set of health outcome measures for older people.

The background to these set of health outcome measures has previously been discussed in a couple of previous blog articles accessible here: part 1 and part 2. Key partner organisations included the International Consortium for Health Outcome Measurements (ICHOM), NHS England and Age UK.

In a recently published open access article we describe how these health outcome measures were developed. In an era of increasing medical sub-specialisation with an increasing number of people with multimorbidity, that proportionately affects older people, a set of health outcome measures that can unify the agendas of health and social care providers, older people and those who pay for health and social care services has the potential to align health and social care services to what matters to people and their carers.

This completed projected has been successful in defining a set of health outcomes that most older people and their carers, health and social care providers and payers of health care services could work with. A key advantage of having a standard set of outcome measures would be the potential for health systems to be able to compare themselves and learn from each other by collating these health outcome measures on a regular basis.

A fixed cut off for being classed as an older person is variable depending on where one is in the world. In this project an old age cut-off that was recommended if required was to be defined by subtracting ten years from the expected life expectancy in a particular place. The outcome measures were developed for use in routine practice and not for research. Balancing a comprehensive set of measures against what could be practically done was also a key consideration. Sources of information included a focus group of older people, a panel of international older people and carers, with experts from a wide range of expertise including gerontologists, literature reviews and existing registries.

13 health outcome measures were developed at the end of the project and these are summarised in the picture below.

These outcome measures can be the language or lens through which health and social care providers start a conversation with older people and their carers enabling them to share their concerns and what matters to them. Providers of care can then explore each outcome raised leveraging their knowledge and skill in their field to support the older person achieve the identified outcomes. For policy makers and payers of health care and ancillary services, these outcome measures provide a common set of terms or language that can be used to have good discussions with older people and their carers, health and social care providers in developing services.

These outcome measures are hopefully the first in a series of further improvements and work that will now be done in this area by those interested in this type of approach. Feedback and comments are very much welcomed including suggestions on how this work could be improved.

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