1. Lifespan Planning in the 4th Quarter:
PlanYourLifespan.org
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2. What Do We Plan For? Birth 20s 40s 60s 80s Death “4th Quarter”
Planning often involves end of life care, not planning for health events that happen as people age.
Death
“4th Quarter”

3. http://projects.newyorker.com/story/ chast-parents/
Roz Chast
chast-parents/
The truth of the matter is, however, that seldom do we want to have conversations of our own about topics of death and dying, or even about topics related to the inevitabilities of aging, including often reduced physical and cognitive function, the need to seek alternate housing arrangement, and the need to make hard decisions.
So we tend to be more aligned with Roz Chast’s parents, who note: Can’t we talk about something more pleasant?”
We tend to not want to think about it, so we tend not to plan or to push off planning

4. Are we talking about Hospice/End of Life?NO
…think years before you die.

5. Will you be hospitalized? Will you experience a fall?
Will you develop Alzheimer’s?
Many older adults do not understand their health trajectory and future health needs.
Subsequently, friends and family must react to the crisis.

6. Let’s PLAN for these emergencies instead of reacting to them.
Provide older adults a voice in their future.
Doctors, nurses, and social workers know about the clinical life events and resources available to people as they age and needs grow.
Together we can prepare…

7. Overview Background, Development of PlanYourLifespan.org
Navigating PlanYourLifespan.org
Research Study Findings
Concluding Thoughts

8. TAILOR THIS SLIDE TO DESCRIBE YOUR GROUP, ORGANIZATION
Our Team
We are seniors, geriatricians, community members, university researchers, social workers, communication experts and home care specialists
TAILOR THIS SLIDE TO DESCRIBE YOUR GROUP, ORGANIZATION

9. Aim: Develop a planning tool to assist older adults in making informed choices about issues in their health trajectory.

10. Content Development
Focus groups with 62 older adults (age 65 and older) living in rural, suburban and urban areas.
Participants discussed advanced life events, long term planning, decision-making, barriers, and resources that might have an impact on their ability to remain in their own home.
Three independent coders used content and
constant comparative analysis.

11. What We Learned: What events do older adults think will impact their independence?

12. Advanced Life Events Alzheimer’s Disease Hospitalization
Fall at Home/Physical Function Decline
Spousal Death
Inability to Care/Maintain Home

13. Selected quotes: Advanced Life Events
Hospitalizations
I was in the hospital for a month…in a rehabilitation place for two more. I couldn’t walk. I couldn’t do anything. By the time I was conscious enough to be aware of what was going on, I was so horrified. I thought I’d rather die than live like this.

14. Selected quotes: Advanced Life Events
Falls/Functional Loss
I have lived in the same walk up for 30 years. I’ve done various things with falls…I’m up and down the stairs, but I know it’s going to happen quick…it won’t be a slow thing.
And I think…If I’m someday in a wheelchair, how am I going to get through here? How am I going to navigate? That is a big question so that means I might have to move.

15. Selected quotes: Advanced Life Events
Dementia/Cognitive Loss
My dad had Alzheimer’s... but my mother never could get herself to really realize that he had Alzheimer’s. And she had to put him in a nursing home… and she just never got to the reality of her husband…they had been childhood sweethearts.

16. Selected quotes: Advanced Life Events
Spousal Illness/Loss
My son is in San Francisco. My daughter is in North Carolina. My other daughter is on a farm…home schools [her] kids. My other daughter is disabled. Now who am I going to get? It’s scary having someone come in… I’ve heard so many scary things about what has happened to people with aids coming in.
My wife and I both have long term care insurance and we are beginning to think about what happens if one of us becomes disabled or ill. We have begun to examine or look into retirement homes.

17. Why not plan ahead? Barriers to Planning
Uncertainty over the future
Too healthy/too sick
Offspring influences
Denial and Procrastination
Overwhelmed and Perceiving a Lack of Options
Financial Concerns
Pride

18. Selected quotes: Barriers to Planning
Too Healthy/Too Sick
Both of us are in fairly good health right now, so we’re not worried, but we also know that tomorrow that could change drastically.
I’m on borrowed time. I’m not going to worry about where I’m going to go for my old age, because I don’t think I’ll have one.

19. Selected quotes: Barriers to Planning
Financial & Offspring Influences
You know…I don’t have a way to discuss that too much with my daughter because she doesn’t want to hear it.
I’m frightened, like a lot of people, that I will outlive my money.
I have a daughter who said, “…you’re much too old to start having problems now. Don’t worry, you’ll be fine.

20. Selected quotes: Barriers to Planning
Denial & Procrastination
I think what I would prefer would be just to drop dead. But who’s that lucky, you know?
You keep kicking the can down the road, and the months turn into years.
I’ve decided I’m not going to have dementia.

21. Selected quotes: Barriers to Planning
Lack of Knowledge, Awareness
I don’t know where to look or even who to talk to.
I don’t know where to start.
What will I need?

22. Final Product: Online & Paper-based Planning Tool

23. Plan Your Lifespan© addresses:
Talking to Others
Hospitalizations
Falls
Finances
Memory Loss and Alzheimer’s

25. Planning for Hospitalizations
Planning … for a hospitalization?
Rehabilitation choices (e.g., physical therapy)
For each day of hospitalization, it may take
2-3 weeks to fully recover
Physical therapy helps; offered in several settings
Medicare online comparison:

32. Other Sections

33. Preventing Falls at Home

34. Long Term Goals

35. Talking to Others

36. Conversation Starters
“I went through this website (Plan Your Lifespan) and have been answering some questions about planning for my future. I wanted to share my answers with you to see if you have any thoughts.”
Refer to a situation about someone who faced a health event. For example, “I was thinking about what happened with (Aunt Martha) and it made me think that I want to be prepared in case that happens to me.”
“I know right now, I'm doing okay... but there's always a chance something could happen and it's scary. I'd like to talk about what I may need in the future so we're both prepared.”

37. Summary

38. Does it Work? Let’s Test It.
Tested in a randomized control trial (n=385)
Participants recruited in Illinois, Fort Wayne, Indiana, and Houston, Texas
Rural, Suburban, Urban areas
English-speaking, at least 65 years old
Recruitment through community-based stakeholders

39. Study Design

40. Outcomes Planning behavior change
Perceptions of importance of planning
Understanding of home services (knowledge)
Confidence in accessing home services
Communication with others

41. Selected Results N=385 Mean age: 72 years Range: 65-89 years
Female: 79.5%

42. Selected Results
At one month, participants in the PlanYourLifespan.org arm had a planning behavior score that was significantly higher than those in the attention control arm (p=0.0054).
Planning behavior score included questions such as:
I have planned for an unexpected hospitalization.
I have communicated my preferences for my future healthcare to people who may need to make decisions for me.
Participants in the PlanYourLifespan.org arm had a significantly higher score mean knowledge score than those in the attention control arm (p=0.0003).
Knowledge measured with six-items pertaining to areas such as understanding home services and rehabilitation options.

43. PlanYourLifespan.org launch
Publically available as of September 15, 2015
Nationally available with links to local resources
No cost, free to use
Secure website
Paper-based version

44. Concluding Thoughts
Questions to think about.
Have you thought of what you would do if you could no longer live alone? Future living arrangements?
What are you going to do if you get sick or need help at home?
Have you talked to your family/Power of Attorney about what your plans are?

45. Concluding Thoughts Plan your lifespan.
We may not know the future, but we can have a voice.
Plan your lifespan.
Identify preferences, values and goals.
It’s a process.
You are not alone.
Plans change; will need to revisit.

46. Lifespan Planning in the 4th Quarter:
PlanYourLifespan.org
INSERT YOUR LOGO,
IF APPLICABLE
[INSERT NAME, CONTACT INFORMATION]