In many countries, health care is going through many changes. To find new ways to meet the challenges of tomorrow, we must consider co-creation.
The Safe Senior Life program did just that. Safe Senior Life was a collaborative effort between the municipalities of Horsens, Thisted, and Faaborg-Midtfyn to find new ways to detect and prevent depression in older adults and improve their mental health and quality of life.
Depression among seniors (those 65 and over) is a major — but not always visible — issue all over the world. It is estimated that about 10 percent of the elder population in Denmark will suffer from depression. This represents about 115,000 people out of a total population of 5.8 million.
Despite the size of the problem, depression is widely under-diagnosed and mishandled in older adults. It is estimated that more than half the cases are not detected, and among those that are, only about 10-20 percent receive relevant treatment.
This has many major consequences. Elderly people — men, in particular — are overrepresented in suicide statistics. Also, internationally and in Denmark, researchers identify depression as one of the most expensive illnesses on a societal level.
According to the World Health Organization, solutions for complex problems that are challenging on both the individual and societal levels — such as depression among older adults — must be co-created and developed in close collaboration with representatives of the population in question.
Finding Those Most in Need
Before Safe Senior Life, the local community health care services already had initiatives to address depression in older adults. They offered home visits, depression screening, and events at the senior centers. Some organizations also provided activities aimed at preventing loneliness and creating open communities, including weekly walks, shared dining, excursions, talks, and knitting groups.
Despite this, both volunteers and professionals felt that the people who would benefit the most from these activities frequently “fly under the radar.” Since social isolation is often a major component of depression, they suspected that the people most in need of support were not always visible and getting the support they needed.
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Creating a Safety Net
In pursuit of the Triple Aim, Safe Senior Life created and tested several new cross-sector change ideas. In Horsens, for example, volunteers had organized a networking program for single seniors. The program was popular, but the volunteers questioned whether it helped those who would benefit the most. During Safe Senior Life, a new collaboration was established, and now local health care workers refer people to the activity.
The volunteers came from many community organizations. Most of them are close to or above the age of 80, so they have firsthand experience with many of the challenges of aging, though not necessarily depression. The volunteers shared a willingness and commitment to spend time and effort to make a difference in the lives of their fellow seniors. Using the Model for Improvement, volunteers and professionals developed interventions and driver diagrams together.
The collaboration created more local activities — including shared dining and networking groups — to which older adults at risk of depression could be referred. This, consequently, gave health care professionals more time to provide intensive support to those who needed it. In addition, the volunteers have now developed relationships with the health care professionals and know who to contact if any senior needs a referral to a professional. This has created a safety net in the local communities without spending additional resources.
After two years, Safe Senior Life has ended, but the methods and activities will continue in the municipalities. It is too soon to see the long-term effects on depression yet. However, the data the project collected indicates that more people now participate in activities for seniors, and that more people have been made aware of the signs of incipient depression. The participants also discovered that co-creation can enrich the lives of professionals, volunteers, and seniors.
The collaboration with the three municipalities in this project taught the Danish Society for Patient Safety that together we are better. Community organizations and volunteers can contribute in areas where professionals cannot, and professionals can provide better health care when they know about local activities and support. You get better outcomes when you bring participants from different sectors together, and no one group could have reached the results by themselves.
Vibeke Rischel is Head of Healthcare Improvement, Danish Society for Patient Safety.
Editor’s note: Experiences from the Safe Senior Life program will be shared at the 2019 IHI National Forum in workshop MF05: Driving Complex Change Through QI Collaboratives on Monday, December 9 from 8:30 AM - 4:00 PM.
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