Canada's dedicated resource for home and long term care solutions. Home & Long Term Care is a monthly publication/website focusing on solutions for caring for a loved one at home or in a long term care facility.
Ben Hartung is no stranger to dementia care. With a mother who’s a nurse and grandparents who lived with dementia, he was inspired by his own life experience to become a geriatric nurse.
As he transitioned from nursing school to the professional world, Hartung noticed many of his peers going through a difficult adjustment period.
“You learn a lot of textbook knowledge in school,” says Hartung, now an advanced practice nurse at Baycrest. “But as a new nurse, you’re faced with another reality of a patient with dementia who could be pacing the halls, yelling, looking for their loved ones. Handling that can be emotionally burdensome.”
What Hartung was picking up on is a phenomenon called ‘reality shock’. The term was coined by theorist Marlene Kramer in 1974 to describe the reaction of new graduate nurses who discover the theoretical work situation they prepared for in school doesn’t match up with the realities of the practical field.
Psychologically adapting to the reality of dementia care can be so difficult for new nurses that they choose to leave geriatrics, or even nursing altogether. This increased turnover can result in worse continuity of care for patients and more money spent by institutions and the healthcare system at large.
Hartung is on a mission to help make that transition for new nurses smoother. That’s why he developed a new dementia communication workshop for nursing students.
Funded by the Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, Hartung’s
Ben Hartung is an advanced practice nurses at Baycrest who has developed a new dementia communication workshop for nursing students.
The workshop covers common behaviours of dementia patients, frameworks of responding to those behaviours, and simulated case scenarios to implement new knowledge—taking theory and connecting it to practice in a more cohesive way.
“This way, students can have a couple of tools and techniques in their pocket instead of experiencing a whirlwind of not knowing what to do,” Hartung says.
The workshop ran in September 2018 at Baycrest, where Hartung presented to 43 first-year nursing students. He collected survey evaluations from the students before, directly following, and nine weeks after the workshop. The results are being used to measure the workshop’s efficacy.
Hartung’s project was funded through CABHI’s Spark Program, which supports the development and testing of promising early-stage innovations in seniors’ care by point of care staff. He worked on the CABHI application with his supervisor, Baycrest’s Professional Practice Chief of Nursing Calen Freeman.
“Point of care staff are some of the best innovators. We are involved with patient care throughout the spectrum,” Hartung says. “At times it seems daunting and difficult to operationalize any of our great ideas, but a good idea can go very far here at Baycrest. I’ve been really fortunate to work with CABHI, which helped make my project possible.”
On top of the funding, CABHI supported the project by partnering Hartung with Baycrest’s Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), which is assisting with analysis and reporting results.
“CABHI’s added a tremendous amount of value,” Hartung says. “They’ve been really supportive.”
In the future Hartung would like to make the workshop accessible not only to more students and staff at Baycrest, but to students across the province or even the country, as an e-learning module.
“The more we can do to advance care for dementia patients, the better,” says Hartung. “And that all goes back to the nurses.”
What images come to mind when thinking about community? Strolling around, admiring the neighbors’ gardens, seeing children play, walking to work or to shops… These thoughts about a community are all related to enjoying the outdoor environment. What happens when someone is held back from enjoying this outdoor environment? The risk of isolation and loneliness grows.
As people age, their bodies often become frailer and their range of movement can become more restricted, making it much harder to get outdoors. This would cause isolation and loneliness in anyone, let alone the often frail people living in long-term care.
Recognizing the benefits, Therapeutic Support Services staff at Bruyère Continuing Care decided to look for ways to get residents outdoors. When the idea of Cycling Without Age was proposed, they could not turn the opportunity down.
What is Cycling Without Age?
Cycling Without Age (CWA) is an innovative program that helps seniors stay active and stay connected with their communities. Originating from Demark, CWA makes it possible for seniors or those with mobility challenges to get back on bicycles, allowing them to enjoy their scenic communities. This initiative started in 2012, and has expanded to 28 different countries.
CWA uses a special 3-wheeled rickshaw bike. These “trishaws” have a two-seater passenger carriage in the front. They are propelled by volunteer “pilots” who sit on a bike in the back. The bike pilot can easily chat with the passengers, often connecting people from different generations through conversation, storytelling, and reminiscing.
Cycling Without Age at Bruyère
Bruyère Continuing Care (Bruyère) opened Ontario’s first CWA chapter in 2016, in collaboration with community partner Gary Bradshaw. The program evaluation was supported by the Bruyère Centre for Learning, Research and Innovation in Long-Term Care (CLRI). Bruyère runs two long-term care homes Saint-Louis Residence and Élisabeth Bruyère Residence and also operates the Bruyère Village for independent seniors’ living, all located in Ottawa.
Bruyère’s Therapeutic Support Services Department runs the CWA program at all of these Bruyère sites, and has had tremendous success.
In the first summer season of the program, the CWA program served 46 residents of Saint-Louis Residence, or 1 in 4 who live in the Residence, as well as 48 Bruyère Village tenants, family members and friends who accompanied residents on their outings. With such a high demand, over 121 hours were pedaled in that first summer alone. Alternating between more than 34 trained volunteer bike pilots, the average ride was 60 minutes long and each participating resident had an average of three rides in the warm summer months.
The first season was an overall success, with a 99 per cent satisfaction rate. Participants commented on their enjoyment of the rides and the beauty of nature, bringing laughter and smiles as they waved at the neighbours passing them on the bike path and in the community. Pilots shared in that enjoyment, loving the exercise, nature, and discussions with new friends. The launch was similarly successful at Élisabeth Bruyère Residence in 2017, proving that this program can run in both homey suburban and busy urban settings.
Want more information? Watch our webinar!
Most recently, the Bruyère CLRI hosted a webinar covering the CWA program. Presented by Kim Durst-Mackenzie (Therapeutic Recreation and Volunteer Coordinator, Bruyère) and Gary Bradshaw, (Community Partner), the webinar focuses on the concept of CWA and why it is an essential program, as well as offers a more detailed explanation of the ins-and-outs of running CWA in long-term care homes with a large group of dedicated volunteers.
This article draws on the findings of the evaluation of the first season of the Bruyère Cycling Without Age program, that was partially supported by the Government of Ontario through the Bruyère Centre for Learning, Research and Innovation in Long-term Care. Opinions expressed in this report do not necessarily reflect those of the Government of Ontario.
Michaela Berniquez is a Communications Assistant at Bruyère Research Institute and Bruyère Centre for Learning, Research and Innovation in Long-Term Care.
Many Canadians think that vaccines are just for children. Too many don’t realize that the protection vaccinations can decrease over time and a booster shot may be necessary, putting older people at greater risk for some diseases and for severe complications. According to the US National Institute of Health, adults age 60 and older are more than 2.6 times more likely to die from a vaccine-preventable disease than someone between 20 and 59 years old.
As a caregiver, you have an opportunity to educate your clients, their families, and visitors and to encourage them to make sure that their vaccinations are up to date. Don’t forget, healthcare providers need vaccinations, too!
In addition to vaccinations for diseases that are more common among older people (e.g., herpes zoster), adults should also keep their routine vaccinations up-to-date. Don’t rely on clients’ recollections about their vaccination history; get verification whenever possible. Health Canada reported recently that while most adults believed they had received all necessary vaccinations, in fact, less than 10% were actually up to date on their immunizations.
Adult vaccination recommendations vary slightly from province to province, but the Canadian Immunization Guide offers a general overview.
Guide to Adult Vaccines
Who Should Receive It
Everyone, every 10 years
People with medical, occupational, or lifestyle risks; travellers to high-risk areas
People with medical, occupational, or lifestyle risks
People 60 and older (may be administered to people age 50 and older)
HPV (human papilloma virus)
Females and males 9 to 26 years of age (may be administered to females or males 27 years and older who are at ongoing risk of exposure)
Annually, especially for people at high risk of complications
People who have not had the vaccine or the disease
People with specific medical conditions and those living in communal residences
People who have not had the vaccine or the disease
Everyone, once in adulthood
Everyone 65 and old who has a strong immune system; people younger than 65 who are living in long-term care facilities; people with specific medical conditions
People who have not had the vaccine or the disease
Everyone, every 10 years
People who have not had the vaccine or the disease
Source: Adult Immunization: What Vaccines do You Need? Immunize Canada. https://immunize.ca/adults
Easing the Process
Some clients may be reluctant to get vaccinations due to fear of pain associated with the injection. Here are a few simple steps you can take to make the process easier.
Allow the person to get comfortable. Some people may prefer to sit up; others may want to lie down.
Ask the person to take a slow, deep breath and then to exhale slowly.
Try to distract the person by talking about something that interests him/her, playing music, or putting on the television.
Topical anaesthetics such as EMLA®, AMETOPTM Gel, or Maxilene® can reduce the pain from a vaccination, but they must be applied according to the manufacturer’s instruction long enough prior to the injection so they will have time to numb the skin.
Ellen Kirk-Macri is a registered nurse and certified diabetes educator. Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at email@example.com
Ensuring there are a sufficient number of health care workers to care for our aging population is one of the most pressing issues facing’s B.C.’s continuing care sector.
A rapidly aging population, high worker injury rates, funding shortfalls, low recruitment, and the increasing acuity level of seniors are all contributing factors to the health human resource crisis facing long-term care, assisted living and home health care providers. The workforce is also aging and recruiting younger workers in the sector has become a challenge.
Earlier this year, over 170 stakeholders came together at the 2nd Annual BC Continuing Care Collaborative—a partnership between BC Care Providers Association and the Ministry of Health—to address training, recruitment and retention challenges of the next generation of continuing care workers. The event brought together government and health authorities, unions, training colleges, continuing care employers and frontline workers to not only identify the most pressing HHR issues, but also seek out opportunities to tackle them.
BCCPA believes the strategy must be developed collaboratively with governments, health authorities, unions, continuing care employers, post-secondary institutions and frontline workers themselves.
“The seniors care sector has identified the critical shortages of qualified frontline staff as one of our biggest challenges,” says BCCPA CEO Daniel Fontaine.
“We are grateful for all of the contributions of so many stakeholders to date, and I highly recommend that everyone who is interested in the future of seniors’ care in B.C. downloads and reads the Perfect Storm report. It will serve as a useful reference handbook as we try to address the staffing crisis in seniors’ care.”
Current labour shortages in the continuing care sector are creating an environment where workloads are unbalanced, contributing to worker stress and burnout, as well as increasing physical wear and tear. Continuing care employers report that staffing levels in the sector have not kept pace with the increasing acuity of residents and clients, despite recent increases to direct care hours in long term care.
It is imperative that governments provide sufficient funding for increasing staffing levels and direct care hours that support the health and safety of health care workers. Increasing staffing levels and increasing the number of workers in the sector would be effective strategies to address worker retention.
With our aging workforce and low recruitment rates, it will be crucial to attract a younger generation of workers into the continuing care sector. Providing tuition relief and bursaries for students, as well as other financial incentives to address affordability challenges, will be effective strategies to boost recruitment into the sector.
Expanding the delivery of dual credit programs will also allow career-orientated students to graduate from high school ready to work in an industry that is growing quickly and offers long-term job stability. Many young people lack awareness of job opportunities in the sector. While it is well known that sectors such as high tech will experience excellent growth, the public lacks awareness of the strong growth in the health care sector, and in seniors’ care in particular.
A comprehensive awareness building campaign, including job fairs and social media, will be needed to complement these financial incentives and advertise job opportunities in the sector.
There is also a need to clear a pathway for international students and workers. Hundreds of qualified nurses and health care assistants enter Canada every year, only to discover that they can not start practicing in B.C. in a timely manner due to red tape and financial barriers.
Similarly, international students represent an untapped pool of potential labour, but restrictive immigration policies currently discourage and block entry into the continuing care sector. Reducing red tape, removing financial barriers, and improving access for international students and workers will be a key component of the larger strategy to address B.C.’s labour challenges.
We need to better retain the workers we already have. It is well known that health care workers are at a high risk of occupational injury and long-term disability.
High injury rates in the continuing care sector negatively affect worker retention and reduce continuity of care for residents and clients. The sector’s reputation for having high injury rates–particularly with respect to violence–prevents potentially qualified candidates from entering the sector.
Opportunities exist for continuing care employers and post-secondary institutions to work more closely to ensure that all health care workers have the skills necessary to stay safe at work. By committing to staff safety and investing in health and safety training, leadership teams can create organizations that have a strong culture of safety.
Although labour shortages in the sector have reached a crisis point, feasible solutions that can be implemented with stakeholder collaboration over the next few years have been identified.
BCCPA is confident that by implementing the solutions and strategies outlined in the Perfect Storm report, challenges and barriers experienced by continuing care providers can be overcome. However, few of these solutions can be implemented in isolation.
BCCPA is committed to working in collaboration with stakeholders across the continuing care sector to secure the next generation of seniors’ care workers, and invites you, the reader, to be part of this vital work.
“Depression affects two to eight percent of older adults and causes isolation, increased rate of hospital and long term care admissions, and elevated mortality,” says Dr. Akshya Vasudev, principal investigator and associate scientist, Lawson, and geriatric psychiatrist, LHSC. “Problem Solving Therapy is a time-limited skills-building treatment which addresses an individual’s problems, validates them, and teaches the individual to manage those problems in order to reduce or eliminate the symptoms of depression.”
Over the next year, 30 seniors, who have been diagnosed with depression by a trained rater, will receive group based Problem Solving Therapy at their local London Public Library branch. “Our libraries are accessible in all neighborhoods and are a welcoming access point for community services,” says Carolyn Doyle, coordinator, Adult Services, London Public Library. “The older adults we hope to serve will receive support in a comfortable community environment that is free of stigma.”
In 2016, a pilot project successfully showed that a community model to deliver Problem Solving Therapy is feasible and meets this need in the community. “We expect those who receive this therapy will see an improvement in mood and accompanying disabling symptoms such as anxiety, insomnia and reduced quality of life,” adds Dr. Vasudev.
Marek Kubow is Lead, Communications & External Relations at Lawson Health Research Institute.
At Altamont Care Community in Toronto, the majority of residents are bilingual with English as their second language. Several of them are active members of the book club.
Until recently, they have struggled to find books in their native languages to connect them to their cultural heritage. Now that’s all changed thanks to a new digital reading project for seniors offered through Family Councils Ontario (FCO) and e-book retailer Kobo.
Alyson Gillian is the new digital librarian and co-president of the family council at Altamont, which is owned by Sienna Senior Living. She submitted a successful application for the care community to become one of six in Ontario participating in the second phase of the project. She is supported at Altamont by Nancy de Vera, the Director of Resident Programs, and Saira Haq, the Resident Relations Coordinator.
“Access to reading materials in languages of origin expand the availability of literacy support for seniors,” said Saira. “Some of the residents revert back to their mother tongue, and I think this has to do with dementia and Alzheimer’s. As you get older, your short-term memory dissipates and your long-term memory retains, so people actually revert back to their childhood and books they loved to read.”
One resident at the care community speaks English for about two hours in the morning, and Greek for the rest of the day.
This is the first time that Kobo has partnered with the long-term care sector, and through the FCO has gifted Altamont with its Aura H20 e-readers, free book credits and instant access to a vast digital library that includes hundreds of free e-books. This has allowed residents to discover and read books in their own languages, which they didn’t have access to with the paper library. They can now re-read books they once read as a child, connecting them to their youth and aiding a vital bridge in the process of memory care.
“We are one of the more multicultural homes in Sienna,” said Nancy, who recognizes that a lot of residents will be reading a book on a screen for the first time. But as yet, she hasn’t had anyone say that it isn’t for them.
The book club is now both print and digital, and meets every week to discuss which titles they would like to download. They even weeded out some of their lesser-used print books and sold them off at a quarter a piece, raising $120 for the club to invest in the digital library.
Every resident can get a rotation of an e-reader and sign it out for a week at a time. All the devices are connected, so when a resident requests a book, it is purchased on a computer and automatically added to each one. Once they have finished a title, the exact percentage read can be confirmed on the device and added to a metrics report.
Altamont Care Community Resident Kumar with his degree certificate and graduation photo.
Kumar is an 85-year-old resident from Sri Lanka, and uses the new digital library. He is a strong believer in lifelong learning, and earned his degree at the age of 70. Another resident, Bert, was born in Austria in 1933 and stores his personal library of 1,500 books at his son’s house. Bert has read all his life, and thinks it’s important for seniors to continue to read and enlarge their knowledge in later life. He is currently halfway through an e-book.
“I like how you can touch it and it turns the pages,” he said. “When I read a heavy book in bed, my arms would get tired. But this is fantastic.”
The e-readers also allow residents with vision difficulties to fully participate through adjustable text, whereas before they would have to order books in large print. They are lightweight, shatterproof, and manageable in size for seniors to operate.
Samantha Peck is Director of Communications & Education at FCO. She was involved in the selection of participants for the project based on the strength of their teams, established relationships, and the commitment to carry out the project successfully. There are 630 long-term care communities in Ontario, and about 80 percent of them have an active family council.
“It’s not so much a challenge around literacy in long-term care, but a challenge around appropriate literature for people with a cognitive impairment,” she says. “What we are hearing and why I think the project is so valuable, is around access to literature in other languages. As people progress through Alzheimer’s and dementia, they often lose that second language. Being able to easily access something in a language the person still understands can make a huge difference to their quality of life.”
Saira Haq, and Nancy de Vera with members of the book club at Atlamont Care Community.
She is collecting qualitative and quantitative feedback from participants to provide a clearer picture of whether this is something that works well in long-term care.
The project was launched at Altamont in January, and runs through June. After this, Nancy is hoping they can run their own research project around literacy in long-term care.
“Cognitive ability among people with dementia is really pivotal in allowing them to exercise their brain,” she said. “Reading is one way that recreation can assist them to keep using that function in their brain that connects them with their previous life and where they are right now. It only enhances their quality of life when we are able to provide resources like this.”
Drew Tapley is a writer for Sienna Senior Living. For more information visit www.siennaliving.ca
Have you been inspired, encouraged or empowered by an employee or a colleague?
Have you or your loved one been touched by the care and compassion of an outstanding nurse?
Do you know a nurse who has gone above and beyond the call of duty? Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 7th to 13th) contest.
Nominations can be submitted by patients and/or family members, colleagues or managers. Please submit by April 6th and make sure that your entry contains the following information:
Full name of the nurse
Facility where he/she worked at the time
Your contact information
Your nursing hero story
Along with having their story published, the winners also will take home:
1st PRIZE: $1,000 Cash Prize
2nd Prize: $500 Cash Prize
3rd Prize: $300 Cash Prize
All nominees will also be listed in our special Nursing Week Supplement
If you do not receive confirmation within 24 hours of emailing your nomination, please follow up at firstname.lastname@example.org or by telephone 905.532.2600 x2234.
Please email submissions to email@example.com or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3
What comes to mind when you hear the word “massage”? A relaxing day at the spa? A sleazy storefront in a disreputable part of town? What about geriatric massage? While that’s not the first thing that comes to most people’s minds, it is a practice that may help many of your clients.
What is geriatric massage?
In some ways, geriatric massage resembles a lighter form of Swedish massage, but there are some important differences. Geriatric massage involves using the hands to gently rub the soft tissues to improve blood circulation, relieve pain, and increase range of motion, but it employs specialized techniques designed for aging skin and muscles. Characteristics of geriatric massage include the following:
Prior to the treatment, the massage therapist should consult with the client’s healthcare team to become aware of any problems that may be encountered during the massage.
The massage therapist needs flexibility in positioning aging clients. Some clients may not be able to get on or off a massage table easily, and options might need to be explored.
Body placement is important. For example, someone with respiratory problems should not be placed in a prone position, and the back should be worked with the person in a sitting position or lying on his/her side.
Long, stripping strokes should be avoided, because skin thins with age. A technique called fluffing, which combines rhythmic stroking and gently lifting and squeezing the skin, may be more appropriate.
In most cases, stretching techniques should not be used.
While the focus is on gentle motions, on occasion stronger movements may be needed—for example, to improve flexibility of the shoulders.
Sessions should be short—usually no more than 30 minutes.
Benefits of geriatric massage
Older people are prone to developing age-related diseases that limit their physical capabilities and cause poor circulation. Geriatric massage can help some people regain certain physical functions and mobility. Additionally, many seniors are lonely, anxious, or depressed, and geriatric massage can provide comfort to touch-deprived elderly clients and improve their quality of life. Other benefits of geriatric massage include:
Speeding recovery from injury or illness
Enhancing the length and quality of sleep
Easing anxiety and improving sensorimotor functions after a stroke
Reducing the physical signs of agitation (e.g., pacing, wandering, resisting) in Alzheimer’s sufferers
Improving lymphatic flow, which increases the excretion of toxic substances from the body
There is also some evidence that geriatric massage can have an effect on memory. Repetitive touch can help the elderly—particularly those with Alzheimer’s disease—to retain some body memory, and that in turn can trigger the recall of other memories.
In general, geriatric massage is considered safe for most seniors; however, there are some cautions to be aware of.
Calf pain with heat can be a sign of phlebitis and should not be massaged.
If a client has a blood clot or an aneurism, a doctor’s permission must be obtained before that client can receive a massage.
Do not perform deep tissue massage on elderly people, because their skin is thinner and can tear more easily.
Do not massage:
open sores, skin ulcers, or burn wounds
eczema or undiagnosed rashes
the site of an injury or surgery
sore, enlarged lymph nodes
Every client is different, and it is important to evaluate each one individually to determine if geriatric massage is an appropriate addition to the care program.
Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at firstname.lastname@example.org.
We can all think of someone we know who takes a number of prescription drugs. Maybe it is a parent, a friend or it might even be you. Using many prescription drugs at the same time can lead to “problematic polypharmacy”. Problematic polypharmacy is the use of more drugs than clinically needed. Problematic polypharmacy can result in a number of side effects such as falls and negative impacts on attention and thinking.
Why are seniors at higher risk for “problematic polypharmacy”?
As our population ages, there are more people living with chronic diseases. Prescription drugs play a key role in disease and symptom management. According to the Canadian Institute for Health Information (CIHI), nearly two-thirds of people aged 65 and older are taking at least five prescription drugs, while nearly 40 per cent were taking 10 or more prescription drugs. Polypharmacy is of particular concern for older adults as they respond to medication differently. Older adults can also be frail and are not typically a part of the research used to develop the guidelines used when drugs are prescribed. Polypharmacy increases the risk for things like bad side effects or drug interactions, falls and broken bones, hospitalizations and higher healthcare costs. Polypharmacy can also contribute to a decline in how people function or think. Polypharmacy can also lead to confusion in how to take prescription drugs properly or can lead to people not taking them at all.
What is “deprescribing”?
Deprescribing is the planned and supervised process of dose reduction or stopping medication that may be causing harm or no longer providing benefit. The goal is to reduce the negative impacts of prescription drugs and harm in patients, while maintaining or improving quality of life. Deprescribing should always be done with planning and supervision by a health care provider to make sure it is the best plan for the patient and is safe.
How does deprescribing help to address “problematic polypharmacy”?
As life changes, medication needs may change as well. Prescription drugs that were once a good choice might not be the best choice over time. Over the course of a patient’s life, health care providers want to keep in mind balancing the benefits of a drug with the harms. Deprescribing is part of good prescribing – backing off when doses are too high, or stopping prescription drugs that are no longer needed.
Deprescribing is a team effort. Conversations about deprescribing among health care providers and patients can be made easier when everyone is aware of the benefits and harms of certain drugs, how these can change over time, and what to do about it. In partnership with a health care provider, it is possible for patients to improve the number and kinds of drugs they take with the goal of maintaining a healthy quality of life.
The Bruyère Deprescribing Guidelines research team
The Bruyère Deprescribing Guidelines research team is based out of the Bruyère Research Institute in Ottawa. The team is lead by Dr. Barbara Farrell, Scientist at the Bruyère Research Institute and Pharmacist at the Bruyère Geriatric Day Hospital. As a pharmacist, she sees many older people often taking more than 20 prescription drugs a day. However, working closely with doctors and a team of other health care providers, patients and their families, she is able to help reduce or stop medications safely. Her clinical experience at the Day Hospital was the reason behind the development of the deprescribing guidelines. At the Day Hospital, Dr. Farrell saw that health care providers were aware of the risks of problematic polypharmacy but they needed more education, tools and support to deprescribe.
With funding from the Ontario Government through the Ontario Pharmacy Evidence Network, the Bruyère Deprescribing Guidelines research team developed three drug-specific, evidence-based guidelines. They support health care providers in safely reducing or stopping prescription drugs and monitoring for effect. Further deprescribing guidelines and tools and resources have also been designed to build awareness, knowledge and capacity amongst health care providers and the public, with support from the Canadian Institutes of Health Research, l’Institut universitaire de gériatrie de Montréal, the Government of Ontario through the Bruyère Centre for Learning, Research and Innovation in Long-Term Care, the Canadian Foundation for Pharmacy and the Centre for Aging and Brain Health Innovation to develop
Available resources and staying informed
A number of deprescribing resources, including decision-support algorithms, whiteboard videos, information pamphlets, and infographics, have been developed by the team. These resources are available for free on their website, deprescribing.org. Some of the resources inform patients and family caregivers about deprescribing and support them in talking to their health care providers about their prescription drugs. Other tools were designed in partnership with healthcare providers to provide education and decision support around the deprescribing process. To stay up to date on the activities of the team follow them on Twitter (@Deprescribing) or sign up for their quarterly e-newsletter. For more information on the Bruyère Deprescribing Guidelines research team, their evidence-based guidelines and support tools, please email email@example.com.
Michaela Berniquez is a Communications Assistant at Bruyère Research Institute and Bruyère Centre for Learning, Research and Innovation in Long-Term Care.
Older Canadians say their top priorities are better coordinated care systems and more community and home-based supports
By Katherine McGilton and John Muscedere
Today, over one million Canadians are medically frail – approximately 25 per cent of those over age 65 and 50 per cent past age 85. The aging of Canadian society and the growing number of older adults living with frailty poses unprecedented societal and medical challenges which will only increase in the coming years.
In 10 years, over two million Canadians may be living with frailty, which is defined as a state of increased vulnerability, with reduced physical reserve and loss of function across multiple body systems. Frailty reduces a person’s ability to cope with normal or minor stresses, which can cause rapid and dramatic changes in health.
Frailty isn’t simply getting older. The risk of becoming frail increases with age, but the two are not the same. Those living with frailty are at higher risk for negative health outcomes and death than we would expect based on their age alone.
To meet the challenges of increasing numbers of Canadians living with frailty, we’ll need to begin to reorganize how we provide both social supports and restructure the health care system to meet their needs – a tall order.
Key to the successful transformation of the Canadian health and social support landscape is evidence informed by persons living with frailty, their families and caregivers. Call it patient-centred care or a value agenda, we need to include the lived experiences of patients and families in how we do research, plan and care for them.
So what do they say is a priority when we take the time to ask them?
What we found was that their top priority concerned the organization of health systems. Older Canadians told us they want integrated and better coordinated care that would meet both their health and social care needs and those of their families and caregivers.
Not surprisingly, given Canadian geography and the fact that so many older Canadians live some distance away from family, the second priority was that care, services and treatments should be tailored to meet the needs of older Canadians who are isolated and/or without family and caregiver support or advocates.
Their third ranked priority involved having more community and home-based services, programs and resources to prevent, manage or slow the progression of frailty or minimize its impact.
The remaining priorities cover a wide range including providing alternative models of housing, such a multigenerational or shared living options; resources to reduce unnecessary hospitalizations and emergency department visits; and better and more-informed attitudes and skills from those providing care and services to those with frailty.
Older adults must have a voice in policy and program priority setting if we are to implement systems that are responsive to their needs. The need for patient involvement in setting both frailty research and policy priorities is particularly urgent since older adults have historically been underrepresented in decision-making in health and social care systems.
Priority setting with the voices of older adults can only make the health and social services systems better – for everyone. As our society ages, and as we begin to manage the challenges that come with an aging society, let’s make sure to listen to the voices of those living with frailty.
Katherine McGilton is a Senior Scientist at the Toronto Rehabilitation Institute-UHN, a Professor in the Lawrence S Bloomberg, Faculty of Nursing at the University of Toronto and a Network Investigator with Canadian Frailty Network.
John Muscedere is the Scientific Director and CEO of the Canadian Frailty Network (CFN). He’s also an Expert Advisor with EvidenceNetwork.ca, Professor of Critical Care Medicine at Queen’s University and an intensivist at Kingston General Hospital.