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Are you a caregiver for an older adult? Have you noticed a change in their health or mental wellness? They may benefit from seeing a geriatrician, a doctor that specializes in medical care for older adults. Learn more in this episode of the DocTalks Podcast as host Ian Gillespie interviews St. Joseph’s President and CEO Roy Butler and Chief of Geriatrics Dr. Sheri-Lynn Kane.
Welcome to the DocTalks Podcast, a conversation on what’s new and relevant in the world of Canadian medicine and hospital health care. Join us for each episode, as we interview physicians, patients and caregivers to dive deep into what it’s like to treat and live with some of today’s most common health challenges. Hosted by Ian Gillespie.
Note: The content of St. Joseph's DocTalks Podcasts is for informational purposes only. The material is not intended for and should not be used as a substitute for direct medical advice from a licensed health care practitioner.
Are We Ready for a Tsunami of Older Adults in Health Care? w/ Dr. Sheri-Lynn Kane & Roy Butler [TRANSCRIPT]
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[00:00:00] Ian Gillespie: Welcome to the Doc Talks Podcast, a conversation on what's new and relevant in the world of Canadian medicine and hospital healthcare. I'm your host, Ian Gillespie, and I'm here to ask the questions and find the answers you need to know. We want to help our listeners know how to prevent and detect illness and how to navigate our healthcare system. Be sure to subscribe to the Doc Talks Podcast is stay up to date on new episodes and follow us on Twitter at St. Joseph's London or visit Sjhc.london.ca/podcast.
Hello. I'm Ian Gillespie. Welcome to the Doc Talks Podcast brought to you by St. Joseph's Healthcare, London. On today's episode, we're talking about the specialized healthcare services available for older adults in London and area. We all know as we age our bodies and our minds are more susceptible to injury and disease. Life expectancy as a species has doubled in the past 100 years and that's brought with it a lot of challenges to our healthcare. Geriatric care is focused on caring for older individuals and St. Joseph's is the lead organization in providing and coordinating geriatric care in Southwestern, Ontario. And today, I'm talking with St. Joseph's chief of geriatrics, Dr. Sherry Lynn Kane, who's also the chair of the division of geriatric medicine at Western university, and also we're joined by Roy Butler, St. Joseph's president and CEO. Thank you both for joining us on Doc Talks.
[00:01:52] Dr. Shery-Lynn Kane: Thanks Ian.
[00:01:53] Roy Butler: Thanks Ian.
[00:01:54] Ian Gillespie: So let's start with some general questions. I've got a stat here that was provided by the Canadian Frailty Network that states there are 1.2 million older adults living with frailty in Canada, and about 3.75 million caregivers providing care to those older adults.
First of all, I maybe Dr. Kane, we'll start with you. What are some of the most common conditions that we suffer as we age,
[00:02:19] Dr. Shery-Lynn Kane: Age is a risk factor for most chronic conditions. So the ones we know, you know, cardiovascular disease and, and arthritis, heart disease, diabetes, but in fact, having multiple chronic conditions or what's called multimorbidity,
is a risk factor for developing frailty. It's one of the risk factors.
[00:02:42] Ian Gillespie: So more complicated, more complex needs by the patients.
[00:02:46] Dr. Shery-Lynn Kane: Yes. And so as geriatricians, what we would see is, is actually we would kind of specialize in those people who are experiencing frailty and, we would see them, you know, for consultation in
falls, change in their thinking skills, you know, be it suddenly in, in a delirium or, more chronically changes in, in thinking over time with mild cognitive impairment or, or dementia. So we, those are just some, I mean, continent is another area that, you know, is more common as we age causes a lot of difficulties for individuals and does impact function. So these are all of the, kind of syndromes or some of the syndromes that we would see people for.
[00:03:35] Ian Gillespie: Right. And what kind of services does a geriatrician or a geriatric team offer that's different than other areas of medical care?
[00:03:43] Dr. Shery-Lynn Kane: So what a geriatrician would do that that is a bit different is, we would do, what's called a comprehensive geriatric assessment.
So we would look at each of the domains of a person's medical conditions, you know, especially the interplay of those conditions. we would look at medication issues, psychologic, social, functional, and also how the person, if they have a caregiver, how the caregiver is doing, and we would do an assessment of the person's kind of overall status, according to those different areas.
And then, you know, develop a plan in accordance with the patient's, values and priorities. That's kind of the starting point for, geriatrics.
[00:04:27] Roy Butler: Yeah, thanks, Dr. Cam, we have just add to that, and just build upon that, you know, I think at, at St Joseph's and our specialized geriatric services, you know, we have a, we have a full multidisciplinary team who are trained and specialized in older adults with frailty. This, this is what they do.
this in, in some other organizations, specialized services, this would not be an area of specific expertise necessarily for the team and see the, those individuals both on an outpatient basis. So people who would come to the hospital for a consultation or a visit also in the community. So seeing, individuals in their home, and where they live to provide consultation expertise.
[00:05:06] Roy Butler: Support them to live higher quality of life. And we're fully at home as well as we have specialized beds for people who do need an admission as part of their care journey, then we also have that expertise, in house. And the other, you know, area that makes us specialize is we, have a mandate, not just on providing clinical care,
but on training clinicians. so an educational, mandate as well as conducting research in the areas of fraility and in geriatrics.
[00:05:32] Ian Gillespie: Hmm. And Roy, obviously, you're, you're speaking about the, the Southwest frail senior strategy, is that right? You were, you took leadership of that in 2019 designed to, improve outcomes and experiences for older adults.
Do you have an idea of how many patients or individuals you process at St. Joseph's or through the, the, the frailty program?
[00:05:52] Roy Butler: well, what I can, what I can speak to is certainly the growing number that we're seeing in our community. Right. And sort of that aging demographic we're seeing across the system.
so the number of individuals over the age of 65, it's more than, you know, kind of tripled in the last three to four decades. Today, approximately one in five are over the age of 65. In the next 25 years, that will become one in four. So 25% of our, of our population. And those age 75 and over who, who have a higher incidence of, of fraility is even growing at a more accelerated rate.
[00:06:29] Roy Butler: So we are certainly seeing that happen. across our system. We are, we've been a long standing, what we say is a regional geriatric program. So there were regional geriatric programs that were set up across the province years ago. And, Usually affiliated or always affiliated with also an academic university.
So in our, in our case, Western, and had that role of providing, a regional expertise, support training consultation, planning of services, for the region, there is now a, provincial geriatric leadership Ontario is what's called across that provides, guidance now across Ontario related to this.
With still specialized geriatric services regionally. And so for us, we're, we're that regional player in the Southwest, but to your, to your question, Ian, in addition to that, the former local health integration network came to us and asked us to provide leadership on planning services for the Southwest, for older adults, with fraility
and, and that's what, in the last three years we've been focusing on some key strategies. Meeting the needs of our community, in, in multiple different aspects. Right.
[00:07:36] Dr. Shery-Lynn Kane: Yeah. And Ian, I don't know if it, if it helps, but just in London, Middlesex in 2020, there were 90,000 individuals living with frailty. And for 2030, that's projected to be 124,000.
And that is just London, Middlesex. And we have numbers for each of the surrounding regions. In fact, the. province.
[00:07:59] Ian Gillespie: Can you define frailty? How do we define frailty? When is an individual known as frail?
[00:08:05] Dr. Shery-Lynn Kane: So, so frailty is actually a syndrome it's, it's has multiple contributing factors that ultimately lead to a person having decreased strength, decreased endurance, and increase vulnerability to, having functional dependence and death.
So that's kind of, globally, what frailty is, is, is kind of defined as, but it's that vulnerability to, changes in any kind of health or mental health or psychosocial, you know, just a, a change can tip someone experiencing frailty to a greater level of, of dependence and, kind of poor outcomes.
[00:08:50] Ian Gillespie: So at what point then do we know, whether it's a family member or the individual themselves, that they need to see a geriatrician?
What's that sort of tipping point?
[00:09:00] Dr. Shery-Lynn Kane: Yeah. So, you know, we work together with, you know, primary care, health providers. And there are a number of things that I think a primary healthcare provider could screen for in the office that would indicate that a person would benefit from comprehensive geriatric assessment in, in any form.
And so things like, unintentional weight loss, changes in mobility or falls, family or friends reporting changes in cognition, the person becoming more functionally dependent in ways that they weren't before, people presenting to hospital multiple times, or all of a sudden the primary care provider, seeing issues with medications that they had not seen before.
All of these, I think, markers that the person would benefit from comprehensive geriatric assessment.
[00:09:51] Ian Gillespie: Right. And how does one then go about accessing this specialized care?
[00:09:55] Dr. Shery-Lynn Kane: Well, we, we do need, the referral of a physician or a nurse practitioner, and we're very fortunate to have the, the geriatric, ambulatory, access team or the GAAT team, runs through St.
Joe's. That's really the. Kind of screening and triage team for geriatric services, not just medicine, but geriatric services across our region for both St. Joe's L HSC and the regional partners. And Roy, maybe you can speak to the work being done in the regions too.
[00:10:26] Roy Butler: Yeah, no thanks Dr. Kane. Yeah. So Dr. Kings referring to the, the geriatric ambulatory access team, which is, a relatively new entity, but was really set up to, kind of centralize and coordinate referrals.
Triage those and then make an assessment of, you know, what's the most appropriate pathway and referral for that, for this individual right now. Similarly, the work we're doing in the Southwest frail senior strategy is setting up coordinated intake for the various kind of subregions around us. And so again, one point of access, triage, look at what the needs of the individual are, and then start to make those appropriate referrals, which really just reduces the amount of time people are, are spending, going through that process and gets them to those, services in a more efficient way.
[00:11:16] Ian Gillespie: And, and I imagine that for many patients, I mean, You said, it's this kind of all these symptoms, these complex symptoms come together.
So the care strikes me would be in many cases, very, very long term. Is that fair to say? Dr. Kane is shaking your head, but it's not like I just go cuz I got a broken toe and it's done right.
[00:11:35] Dr. Shery-Lynn Kane: Well, I mean, it really, really depends because sometimes there is one or two kind of crucial contributing factors that can actually be reversed and a person's, health status improves significantly.
Other times, people, you know, require kind of a longer treatment plan, always done in conjunction with, you know, primary care. But, you know, then they may have another episode where they require like a repeat comprehensive assessment and that may be in a different part of the system. So I, I would say it's, it's an ebb and flow and it really does depend on the contributing factors.
I don't know what your thoughts are, Roy?
[00:12:19] Roy Butler: Yeah. Dr. Kane I certainly, variability in terms of kind of what that need is and, and who's needed, but I, I take your point, Ian, that it is, you know, it's not like breaking your ankle, right. Where, where the, the course of treatment's fairly standardized and time limited.
And you didn't know you were gonna be back on your feet in a certain amount of time, especially for those older, individuals with multiple comorbidities and, multiple conditions. And in that case, yes, we're talking about a longer term plan. That's gonna sort of more multifactorial, I guess, in terms of supporting those individuals.
[00:12:55] Ian Gillespie: Yep. Right. So, Dr. Kane what about, and I even kind of these individuals in my own family, of course, and perhaps we all have a family member, you realize that their medical needs and concerns are growing, but they are reluctant to seek or accept care. They either are in denial or they're just stubborn or they don't wanna change.
How does one deal with a situation like that?
[00:13:21] Dr. Shery-Lynn Kane: Well, so there could be multiple reasons that a person does not want to seek assessment and, you know, that could be born out of fear and it could be born out of actually, decreased insight, which is our brain's ability to recognize our own kind of strengths and weaknesses.
And so if we don't recognize truly we're not in denial, we simply do not recognize that there's a problem, why would we seek an assessment for something that we don't really perceive exists? Which is a bit different than denial, and I know this trips family's up quite a bit. There are people who have had, you know, difficult experiences in the past with the healthcare system and, have, you know, a real reticence.
And, and so I think first of all, empathy and understanding would be, would be my, my first suggestion, trying to find out a little bit more about that resistance. And then, maybe working with a healthcare provider who knows them the best that they, may have a, a greater level of, comfort with. But there's also a group of people who feel that the changes that they see are simply due to aging,
and there's nothing that can be done about it. Mm-hmm, like, that's just the way it is. Right. And, that's probably one of the more common myths that I, tried to dispel because there are often a number of things that could help to either reverse completely, slow or optimize things for both the patient and perhaps the caregivers such that they are going to be experiencing a better quality of life.
And that's. You know, we aim to do with the assessment.
[00:15:04] Ian Gillespie: Oh, well, that's good to hear. The pessimist in, in me just comes out and I think, well, it's all downhill from here. Right. But speaking of myself, but ,
[00:15:13] Roy Butler: it does not have to be all downhill from here. And the, I think to Dr. K's point, the importance of the family as part of that circle and, and, or, or whoever the caregiver may be, in those situations to ensure,
a, you're getting a full picture of what's going on, but also getting a more informed path about what those options are for the individual going forward as well. You know, I, I have my own, I have my own family member who, despite, despite that they should have, been in a different living situation that would've been safer for their physical health, you know, weren't gonna leave their home until they needed to.
And unfortunately wait for that kind of critical incident to happen before then it forces upon them. cause I was really just trying to in the front, right. Start to identify whether are those,decisions that maybe would help inform a better quality of as you go forward and not to be afraid of it, but to just be aware of it and, and to work with the family, in those decision.
[00:16:08] Ian Gillespie: And Roy are, we I've heard this phrase that well, everyone uses the phrase as an analogy, but there might be some tsunami of care needed for our aging population. Are, are we prepared? And particularly at St. Joe's and elsewhere to deal with this coming need from our older individuals.
[00:16:28] Roy Butler: Yeah, so tsunamis, I would say it's an appropriate term, in terms of what, you know, we're we are already seeing and what will continue to grow over the next, you know, two decades, as more and more higher percentage of people.
A greater number of people are in that category of 65 and over 75 and over, and it also forms a greater proportion of our overall population. So as I mentioned earlier, going from one in five to one in four, over the next two decades. A couple of challenges, and then Dr. Kane I'm sure will, You know, sees this on the front, the front end, front line as well, but, one is just our health human resources.
and the availability of both geriatricians, geriatric psychiatrists, care of the elderly physicians, into the scenario, you know, physios, OTs, nursing, the, the gamut right now, where we are provincially, is, we have some of the highest vacancy rates in, in healthcare right now than we've had the last kind of four or five years.
[00:17:26] Roy Butler: And we need to continue to invest and grow that pool to meet the need of our aging community. One of the other areas is, suitable options for housing, for individuals as well. So assisted living that's affordable and accessible, supports in the home that allow people to do. live successfully at home, through home and community care and community support services.
And for some, they're going to need a long term care environment where there's greater nursing hours available, greater supports available. But for a number of individuals, they could still live successfully at home. If we had more options and supports in the community to support them at home. So investment in long term care, but also investment in supports to, have people live successfully at home in different environments around assisted living are, are required to, to meet the need of what's gonna happen over the grow over the next, two decades. But Dr. King would welcome your, your insider on that as well.
[00:18:22] Dr. Shery-Lynn Kane: Yeah. So I, I mean, I agree with everything. I. I think the one thing that our healthcare system for sure, and, our society in general is going to need to grapple with is, is the degree of ageism that exists. And, you know, there, there is a, a negativity and, you know, kind of a blanketing of, you know, I always say that the, the group 60 and older, which is, you know, an arbitrary chronologic cutoff, You know, is used more for population health, research.
That group is one of the most heterogeneous groups in all of our population brackets. And so yes, specialized services and, and housing options need to be there for the group most in need. But we forget that the older adult population is first of all, incredibly resilient, and I would suggest more resilient than, than a lot of the other age groups.
And they're a resource. They're an amazing resource. These are people with time and talent that I don't think, I don't think it's appreciated. And I don't know, I'd be interested in anyone else who, who, could, talk about, you know, what it's gonna take to move the needle on that. But, you know, I'm on the steering committee for the provincial geriatric leadership, Ontario, and the, there,
we're we're trying to look at this resilience project because we do need to change the perception that you know, anyone with white hair and a blue gown is going to be a drain on the healthcare system
[00:20:00] Roy Butler: or no hair.
[00:20:04] Dr. Shery-Lynn Kane: That that gives you safer, longer.
[00:20:07] Ian Gillespie: that's just for my own benefit. That's very interesting.
Yeah. And how do we change that vast public conception or misconception?
[00:20:14] Dr. Shery-Lynn Kane: Well, we're going to be, we're all walking into it. Mm-hmm so I, I would think that there would be incredible motivation to change. I I've been in the business a while. I wish, I wish I could say it was changing faster because really the, the numbers are increasing, but the numbers of equally talented, resilient, and resourceful, older adults are increasing to.
Yeah,
[00:20:39] Roy Butler: it's a great point. yeah. Great point, Dr. Kid. It's interesting. We, the fastest growing household type right now is multi-generational households, right? So we are in, and all accounts are gonna see that I think continue, obviously to grow for the reasons we've already talked about on, on the, on the other side of that age, dimension
our younger adults who are living at home in their, you know, twenties, early thirties. And part of that is the, just the affordability right now on, on, on housing. But that sets up these multi-generational households and other parts of the world, a support system. Right. And, and, and an interplay. We're the older adults in that family are seen in a way,
Dr. Kane I think, is youre saying has having experience, knowledge, expertise, guidance, advice in terms of how we should, we should all be living that we need to, kind of continue to tap into as well.
[00:21:33] Ian Gillespie: Wow. Okay. Is there some, of course that we're gonna segue into it's it's a political question in many ways, I guess, right?
I mean, we need funding for these programs and so forth. maybe one at a time. Are, are you optimistic about our ability to deal with this approaching tsunami and I'm making air quotes with my fingers there. Roy, what do you think?
[00:21:54] Roy Butler: Yeah, well, I'm, I'm go. I'm an optimist by nature. So I'll I'll but I'll say, I'll say yes in that I think there's recognition for the need that we're seeing some movement towards that, although it may late coming, on, on those that are kind of the most frail, we are seeing investment in increased
hours of nursing within long term care and investment in that. We are seeing a movement towards building of additional long term care beds. Now to Dr. Kane's point, those are the people at the very end of the spectrum of, of, of frailty in need, but we're seeing some there. The other thing that we're seeing more of, and maybe one of the silver linings of pandemic.
Is a much more integrated and partnering approach to the delivery of services. And, so seeing community support services, home, and community care, hospitals, primary care, really working in a more integrated way, to focus on certain populations, that we serve. And I, I don't, you know, that's, we're not gonna back the bus up on that.
That's gonna continue to be the approach, as we go forward and older adults with is one of those populations that are being looked at across many of the regions is the priority focus for the reasons we've talked about going forward in all those sectors. So I'm optimistic. It's not a short term fix, but I'm optimistic in the medium to long term that, we can make investments in the right way and work together.
[00:23:19] Ian Gillespie: Excellent. Dr. Kane, are we well positioned? Do you think for this, these coming challenges?
[00:23:24] Dr. Shery-Lynn Kane: Well, I think what there needs to be is more flexibility in how the money. Spent and, I'm an observer, not an expert that it's, we need to think less about buckets and more about how can, money allocated be spent in the most effective way.
So, you know, for instance, if you know, hospitals are not funded for X program, but X program actually keeps more people, you know, receiving the care that they need in their homes and not in hospital than that is an overall win for the patient, first of all, and the system, secondly, because, you know, so I could give lots and lots of examples, but, You know, I, I just, I hope we can get to a point where at a government level, there's more flexibility in the buckets of, of money that really truly helped to provide that integration, even more so that Roy was talking about.
[00:24:29] Roy Butler: Yeah, you're right. Dr. Kane may, but part of it is, the funding mechanisms need to support that integrated approach. And, we're not there yet as a system, for sure. And at the same time, I do see even our frail senior strategy, you know, our steering committee sitting around that table for the Southwest as representation from every sub region and from every sector and people come to the table,
not territorial, but looking at system solutions for how do we serve our older adults with frailty better,as we go forward and I think that will continue to be continue to strengthen.
[00:25:03] Ian Gillespie: Excellent. Well, I think we've, we've touched on a lot of the issues and we've, raised a lot of questions and hopefully we've, we've, answered some too, but I want to thank you.
Dr. Kane, Roy Butler for joining us on the doc talks podcast.
[00:25:16] Dr. Shery-Lynn Kane: Thank you for the opportunity.
[00:25:25] Ian Gillespie: That's it for this episode of the doc talks podcast. Thanks for joining us and join us next time when we'll continue our conversation on what's new and relevant in the world of Canadian medicine, in hospital healthcare, be sure to subscribe and follow us on Facebook and Twitter at St. Joseph's London or visit sjhc.london.on.ca/podcast.
Until then stay healthy.