Team approach needed on elder care

Co-ordinated system linking medical assessment, diagnosis and follow-up are needed to improve health-care delivery

A specialty in geriatrics, a mother in her 80s and an upbringing in Cabri, Sask., keep one doctor’s research clearly in focus for seniors in Saskatchewan.

Dr. Jenny Basran, an associate professor at the University of Saskatchewan in geriatric medicine, is working on projects ranging from developing devices to analyze falls to closing gaps in health-care delivery.

She is one of 13 researchers at the University of Saskatchewan who were showcased in the recently released report, Impacting Seniors’ Health, The Value of Aging-Related Research in Saskatchewan.

It addresses Canada’s aging population and the challenges the health-care system faces as the number of Canadian seniors, aged 65 and older, is projected to double to 25 percent of the population within two decades.

“For now, we need to get everybody to a certain standard of care because the baby boomers are coming and we’re not quite ready yet,” she said.

Today, her mother and her own insights into realities in rural versus urban health-care settings continue to keep her grounded, said Basran, whose parents operated the Chinese restaurant in Cabri.

She is currently collaborating with groups such as the Canadian Geriatrics Society to push for training in her specialty for all medical practitioners.

Basran, the only geriatrician in Saskatchewan, said new approaches are needed when complex medical concerns such as dementia are in play.

“Each area focuses on our own area. We haven’t really looked at how we can do this altogether,” said Basran.

She suggested care plans that could be updated as the elderly patient moves through the system.

Current electronic health records often have gaps in information or require significant searching.

She said the health system was set up to find and fix problems.

“If you have more than one problem going on at a time, the health system is not set up for that,” said Basran, noting that multiple health concerns will be more common as seniors live longer.

“We need to adjust the system to recognize that. Patients don’t just come into the system and get fixed. It’s a journey through a continuum,” said Basran, stressing the importance of a team approach and good communication between all involved.

“When the baby boomers come into health care, that’s when the system will really be in trouble,” she said.

In order to modernize the current system, she is helping to evaluate dynamic models of care to study such problem areas as the numbers of patients coming to emergency wards.

Many could be taken care of by family doctors, if they were available, while others aren’t admitted to wards because beds are needed for patients who cannot be discharged due to a lack of appropriate supports in their home communities.

“We can make things really great for one part of the continuum but that impacts other parts. In medicine, we often find we just pushed the delay further down the road.”

Andrew Kirk, head of neurology at the U of S, agreed with a broad-based team approach. He cited the Rural and Remote Memory Clinic at the Canadian Centre for Health and Safety in Agriculture on campus, which can provide a diagnosis for patients displaying dementia symptoms.

They spend a day being assessed by a neurologist, neuropsychologist, geriatrician and physical therapist. The patient and family then meet to discuss the diagnosis and a plan for care.

Patients are then followed via telehealth, which reduces trips back to the city.

He said the only problem is the clinic is open just one day a week and has a long waiting list.

“We have a huge tide of people getting diagnosed with dementia as the population ages,” Kirk said.

“The oldest baby boomers are just getting into the dementia years.”

The incidence of dementia is not increasing, but the numbers of elderly are rising dramatically.

“Just as there was a huge boom in schools in the 1950s and ’60s, now there is a huge boom of diseases that affect the elderly.”

Kirk cited studies underway with primary heath-care teams in Kipling, Sask., and Weyburn, Sask., to create co-ordinated and efficient management of people with dementia and their care and determine what tests are needed.

“Primary care teams should be able to look after these people,” he said of people with frontotemporal or Lewy body dementia and Alzheimer’s, among the most common types of dementia.

These conditions can complicate investigations into why the elderly fall, something Basran is hoping to improve on through a wearable device that would give doctors more information when falls occurred.

The elderly may fall because medications blurred vision or blood pressure suddenly dropped when they stood up, she said.

“It’s hard to recall that information, and if you have cognitive impairment, it’s really a lot harder to figure that out,” Basran said.

Saija Kontulainen, a professor in the U of S’s kinesiology college who is studying fall prevention and bone health, said it all begins with promoting good nutrition and an active lifestyle in childhood.

“That’s when you build the foundation for bone strength. It helps to prevent fractures in later ages,” she said.

Exercise is key.

“We need to do it or we lose it.”

Her recent research exploring bone strength looks beyond just measures of bone density.

She compared it to building a bridge and examining the strength of the structures supporting the body.

Kontulainen stressed the importance of exercises to improve balance to prevent falls and specific weight bearing exercises.

For hip health, she recommended squats, lunges and high impact jumps.

“After a hip fracture, only one-third will return to normal activities,” said Kontulainen.

Walking is good, but it isn’t sufficient on its own. She cited research showing a thinning of the shell around the bones in post-menopausal women.

“It’s hard to build any more bone,” she said.

Types of dementia

There are many types of dementia, but symptoms generally include loss of short- and long-term memory, judgment and reasoning, changes in behaviour and changes in the ability to communicate.

  • Alzheimer’s disease is the most common dementia, at about 63 percent of cases. It is a progressive, degenerative and fatal brain disease in which cell connections in the brain are lost.
  • Vascular dementia is the second most common at an estimated 20 percent of all cases. Problems with the blood supply to the brain, like during a stroke, is a common cause.
  • Frontotemporal dementia tends to occur in younger people and primarily affects the areas of the brain associated with personality and behaviour.
  • Lewy body dementia occurs because of abnormal deposits of a protein inside the brain’s nerve cells. Why or how this happens is unknown.

Source: Alzheimer Society of Canada

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