It is an interesting thing .. this position of "doctor to the soul" (term coined from being mistaken by staff as being a doctor.. originally because I used to wear heels and business suits, skirts, but now I have had to adopt a more causal attire due to the need for orthopedics, caused by excessive wear of heels) is a neverending job.

Yesterday I was at my church for a group when I noticed an elderly gentleman walking slowly, and a little unsteady I might add, down the hall towards the room that our group was using. I commented to him that I didn't see him here much outside of Sunday services. He explained that he thought there was a concert this evening. I decided that I'd better get him to sit somewhere, so I asked him into the next room and got him a chair that was close to the door. Then I went to room where my group was to check if there was some concert or function that I was not aware of. I then had to ask that the leader go call this man's son to come pick him up. Either way, the gentleman was showing signs of dementia and I thought the son needed to be aware of this incident. I didn't want to embarrass the man so I explained that it was not December but in fact November, and that no concerts were yet. He kept saying it was December and said he felt awful. But then he seemed to laugh as he said he was 91 ...
In the end, I called the son and explained the situation and asked if I should put his father in a cab, or would he like to pick him up. I think that the son was embarrassed as well but I tried to handle this as sensitively as possible. So I got to know this nice gentleman while we waited for his son to come. It was a surprising opportunity in a way, as I would never have been able to exchange more than pleasantries at service if this hadn't occurred.

This incident is not uncommon as seniors age and show signs of dementia. (Dementia refers to decrease of memory or brain function. As the cells age, or die, the brain ceases to function at optimal level. Dementia was erroneously but commonly referred to as Alzheimer's.) When I started in chaplaincy, I began my training in long term care (or nursing home). This type of story was a common factor for admission to long term care. The previous posts from the local paper about aging posit that it is often a fall that precipitates going to a care home or facility. But I think it needs to be clear that it is not that the individual falls and then are admitted to facility. This is not the goal for geriatric medicine. Often an admission to long term care is precipitated by numerous events such as the one I described. I have heard stories from my relatives and neighbors, persons in various parts of the country (Canada) telling me that they met or found a person wondering the streets who didn't know their name, were wearing proper attire for the weather, "then the lady started to strip off all of her clothes in the church" (luckily that incident was a weekday and not during the service), a woman that I met in the lobby of my previous building claiming she was waiting for her sister to come visit, and telling me that we were in New York, not in Canada ... There are numerous examples since I have begun health care chaplaincy. I am not saying this a problem and needs to be fixed. I'm merely saying this is how it is, a fact of living in this day and age. It makes for interesting times.

comment about "living our faith"

I ran across this article in a local rag and I get a kick out of a comment in it.

"Some people go to church, but black people have church. It's a different thing. It's a full-contact sport with us."

This is an interesting comment about the attitude or self-expression of worshippers of the Christian traditions in North America. The speaker goes on to say that Canadian congregants tend to reserved in their expression of their belief/praise in comparison with African -Canadian persuasions. Why is this? Why do we (Canadians typically not black, as per the speaker) not loosen up and shout praise? Why do we look with disdain upon those who do when they are within our walls, with a "thatisnothowwedothingshere" attitude. Is this something we learn? or or is this something that we do because it is this way, but don't really wish to ponder why we do what we do? I went through religious studies courses as part of my training and there was one course that the professor told us had a "smoker's warning", it was hazardous to our spiritual health. The course was called the "Psychology of Religion" and it basically was an opportunity to examine why I believe what I do. Is it because it was what I was raised with (because my parents made me) or because it was what I wanted. In my roundabout way, what I'm getting at is that "having church" versus "going to church" connotes an expression of how deeply one's spiritual life is manifested. Do we just get a weekly dose or put in our time, or do we express what is our lives everyday not just on the day of worship? Something to think about. And now the article, that goes on about a different tangent...

Although St. James Hall has long been deconsecrated, Marcus Mosley is happy that the site of the Sojourners' upcoming CD-release party was once holy ground. It's not that he minds performing in secular environments–the Sojourners see a lot of blues clubs when they're on the road with their friend and occasional employer, singer Jim Byrnes. Still, the sanctified aura that permeates the former chapel is going to make it easier for Mosley and his fellow vocalists Ron Small and Will Sanders to achieve their goal: having church.

"Some people go to church, but black people have church," says Mosley, calling the Straight from his Vancouver home. "It's a different thing. It's a full-contact sport with us."

The affable singer and former missionary is laughing, but he's serious, too. For people who have been brought up in the African-American tradition, one of the most puzzling aspects of Canadian life is the grave solemnity that attends religious functions north of the border. "I'm not criticizing Cana­dian church and worship," the Texas-born Mosley notes dryly, "but it's a little bit different than African-American Baptist or Pentecostal church services."

One difference, I posit, is that in Canada the church has generally been an instrument of social control, whereas African-American pastors preached a kind of liberation theology long before that term came into vogue. Mosley counters that it's not quite so cut and dried: in some southern areas of the U.S., the church encouraged obedience to obviously unjust laws. Still, Sunday services were one of the few opportunities slaves and sharecroppers had to join together as a community.

"The church was a source of survival, not just physical survival but spiritual survival," he says. "If you want to go back to the slave period, it was that one hour or so on a Sunday when blacks were allowed to gather together and form a circle and start singing their songs. It was that one moment where they were able to be totally open, and self-empowered, and in touch with their higher selves–and then, of course, it would be back to the whip and the slave-owner mistreating them. So it was an hour of personal expression and freedom–an hour of grace."

The conditions of exile that apply to Vancouver's small African-American community are not so harsh, but for many U.S. transplants the church retains its social purpose. "Many of us miss the kind of church that we have back home," Mosley says, and as the leader of the Christ Church Cathedral–based Good Noise Vancouver Gospel Choir, he's in a position to do something about it. The 85-voice ensemble is also home to Sanders, who leads the men's chorus, and Small, its de facto patriarch. But the Sojourners didn't come together until 2006, when Byrnes was putting together his own gospel-inspired House of Refuge.

"Jim called me and said, 'Marcus, I'm working on a CD project, so can you get a couple of guys together and do some background vocals?'" Mosley explains. "So we did, and that became House of Refuge, which has been really successful. I mean, he's gotten like at least five different awards for it, Junos and all that stuff. And then [guitarist and producer] Steve Dawson came to us and said, 'You know, you guys are probably going to go on tour with Jim, so I'd like to produce a CD for you so you'll have some product.' So we got our heads together and came up with some songs and some arrangements, and then went into the studio. We spent about three days and put it all down on disc. Very down-and-dirty, and not over-produced; we just kept it very simple. But I liked the way it turned out."

Hold On, the Sojourners' debut, justifies Mosley's pride. With Dawson's expressive slide lines and Roebuck "Pops" Staples–approved rhythm work fleshing out the sound, the disc is already finding favour with roots-music enthusiasts as well as gospel zealots. It's Small, however, who just might be the record's biggest fan.

"Ron's having his 70th birthday on the seventh of December," Mosley notes. "And when we've been performing, he's started telling the audience, 'I've been singing all my life, but since I've been with this trio, it's like I'm having a whole new career. So if I die, I'm going to get up to those pearly gates and say: "I'm ready to go back! I'm not finished!"'"

Does this mean that the Sojourners are going to be more than just a one-album experiment?

"Well, I'm sure hoping so," Mosley confides. "From your lips to God's ears, as they say!"

The Sojourners play St. James Hall on Saturday (November 24).

Poems and other sundries

I have been hunting for inspiration for a sermon I'm working on and went through my files...

On Chronic Bed of Pain You Lie


Deep rooted torment,
Soul slipping to lie dormant,
Racks your body these demonic years
Sanity sliced open with surgical shears.

Rage, rage at the cruel joke
Heaven rain down fire and smoke
Stupid accident, helpless instance
Terrible nerve - searing existence.

Change the pump, correct the leads
Dilaudid, morphine drip like sweats beads
One more time put me under
Before life is drained of all its wonder.


On chronic bed of pain you lie
Suffering soldiers give your hero’s cry

I AM

I was regretting the past
And fearing the future.
Suddenly my LORD was speaking,
“My name is I AM”.

He paused.
I waited. He continued.

“When you live in the past
with its mistakes and regrets, it is hard. I am not there.
My name is not I WAS.

When you live in the future,
With its problems and fears,
it is hard. I am not there.
My name is not I WILL BE.

When you live in this moment,
it is not hard. I am here.
My name is I AM.

Helen Mallancott.

IF I KNEW

If I knew it would be the last time that I'd see you fall asleep,
I would tuck you in more tightly and pray the Lord, your soul to keep.
If I knew it would be the last time that I see you walk out the door,
I would give you a hug and kiss and call you back for one more.
If I knew it would be the last time I'd hear your voice lifted up in praise,
I would video tape each action and word, so I could play them back day after day.
If I knew it would be the last time, I could spare an extra minute to stop and say "I love you,"
instead of assuming you would KNOW I do.

If I knew it would be the last time I would be there to share your day,
Well I'm sure you'll have so many more, so I can let just this one slip away.
For surely there's always tomorrow to make up for an oversight,
and we always get a second chance to make everything just right.

There will always be another day to say, "I love you,"
And certainly there's another chance to say our "Anything I can do?"
But just in case I might be wrong and today is all I get,
I'd like to say how much I love you and I hope we never forget.
Tomorrow is not promised to anyone, young or old alike,
And today may be the last chance you get to hold your loved one tight.

So if you're waiting for tomorrow, why not do it today?
For if tomorrow never comes, you'll surely regret the day,
That you didn't take that extra time for a smile, a hug, or a kiss
and you were too busy to grant someone, what turned out to be his or her one last wish.
So hold your loved ones close today, and whisper in their ear,
Tell them how much you love them and that you'll always hold them dear
Take time to say "I'm sorry," "Please forgive me," "Thank you," or "It's okay."
And if tomorrow never comes, you’ll have no regrets about today.

Life's Survival Kit

TOOTHPICK...To remind you to pick the good qualities in everyone, including yourself.

RUBBERBAND...To remind you to be flexible. Things might not always go the way you want, but it can be worked out.

BAND-AID...To remind you to heal hurt feelings, either yours or someone else's.

ERASER...To remind you everyone makes mistakes. That's okay, we learn by our errors.

CANDY KISSES...To remind you everyone needs a hug or a compliment every day.

MINT...To remind you that you are worth a mint to your family.

BUBBLE GUM...To remind you to stick with it and you can accomplish anything.

PENCIL...To remind you to list your blessings every day.

TEA BAG...To remind you to take time to relax daily and go over that list of blessings.

One perspective on prayer

I've been reading this book for my book club. There is an interesting statement by a character about his view of prayer. I realize that some of it is contextual for the story, but I thought it was an interesting way of looking at things. Especially the second paragraph.

I got to thinking about how easy my life is compared to Papa’s. Then I started thinking what a strange notion it is that Jesus supposedly got strung up on a cross to save zillions of other people – as if his one life, in exchange for zillions, was some kind of trade. It didn’t make much sense to me really, but what I thought was: What the hell. If that’s how things actually work, why not propose a similar swap—on a much smaller scale of course – to help Papa out. Why not ask God, if He exists, to let me do that for Papa what Jesus supposedly did for everybody on earth. Why not ask to trade some of my good luck for some of Papa’s bad, just to get his life back on track. …

Maybe the reason prayers never get answered is that everybody prays the wrong way, and for the wrong things. People ask God for good things all the time, and never offer anything in return. But if God exists, if He really made the world, and is all –powerful and all-wise and all that, then I figure He made all of the world, including the bad stuff. So if He ‘saw that it was good’, He meant just that. From His point of view, bad stuff must somehow be ‘good’, or at least must serve some of divine purpose. I was trying to give God the benefit of the doubt, don’t you see? …. If God is God, the only sort of prayer that seems to make any sense to me might go something like:

“Hello there, God. I know Thy Will is being done today, as usual, and I think that’s terrific as usual. Of course to me Your Will looks like a crazy mess that getting the rich richer and the poor poorer and the innocent killed and babies stomped and starved and the whole world in danger of being blown up any minute by atom bombs and all. But You know all about me thinking that, since ou made me. So, uh, sorry. And please, go right ahead and do Your Will no matter what I think, even if it kills us. Talk to you tomorrow, Lord! Love, Everett.

Article about Seniors/ Healthcare

llness can accelerate trip to residential care

Gillian Shaw, Vancouver Sun

Published: Saturday, November 03, 2007

Dr. Janet McElhaney wants to see B.C. seniors age well.

The head of geriatric medicine at the University of B.C., holder of the Allan M. McGavin chair in geriatric research at UBC and head of geriatric medicine for Providence Health Care, sees prevention as key to keeping seniors independent and active.

McElhaney is also behind VITALiTY, a research orientation to support healthy aging which stands for the Vancouver Initiative To Add Life to Years.

The point, she said, "is that we need to be looking at transitions in the health of older individuals and really understand how we manage risk to get preventable loss of independence.

"We can do that through vaccines, we can do that through a more comprehensive approach . . . a more goal-centred approach to the care of seniors, for instance, in the emergency department."

Going into emergency could be one transition point of risk.

"One in every three persons over the age of 70 admitted to hospital is discharged at a higher level of disability than before they got sick," said McElhaney, citing a U.S. study, but one she said probably translates into the Canadian experience as well.

"There has got to be something preventable there."

McElhaney said while people usually think about frail individuals when they think of geriatrics, geriatric specialists must also concern themselves with the task of preventing disability in the majority of older people who are out there and active in the community.

"There is a thing called catastrophic disability," she said. "This is, by definition, you lose up to three of your basic self-care activities of daily living -- like bathing, walking and toileting.

"The leading causes of those things are heart attacks, heart failure, influenza and pneumonia and strokes."

McElhaney said older people can lose up to five per cent of their muscle power for every day they spend in bed, typically with their legs most affected. So even a bout of influenza can be catastrophic.

"If you are in hospital 10 days and spend most of the time in bed you have lost 50 per cent of your strength," said McElhaney. "It doesn't take long to figure out how we get to this catastrophic disability.

"It is shocking. I think that every older person needs to understand the risk when they get sick."

Illness can accelerate the path to needing residential care, said McElhaney, who points to diet, exercise and vaccinations as key primary prevention strategies.

She said the job of geriatric health care won't fall only to the geriatricians, but to others in the health care system and the community as well.

Canada has 180 to 200 geriatricians -- probably about one-quarter of what it needs -- but among those, she said, many are not practising full-time but instead divide their time between research, administration and other academic roles.

"We have to get the whole health-care system to understand this requires a different kind of approach than we have in the past," McElhaney said.

There is a shift taking place here to a more collaborative practice among different health care disciplines, she said. "To keep people walking, to rehab them, requires more than a nurse-physician model."

McElhaney said there are initiatives aimed at making it easier to care for the frail elderly, but with the very brief exposure students get to it, the training period is too short.

Instead of tackling the entire issue of geriatric medical care, McElhaney said focusing on the transitions, such as entry to the hospital, is the first step.

The acute-care-of-the-elderly unit at Vancouver General Hospital is based on a successful model of care developed in the U.S., she said.

There is also a focus on seniors in the emergency department to ensure their needs are fully understood.

"It is to try and provide a little more comprehensive assessment in the emergency department to serve the needs of these individuals," said McElhaney. "You can't just hand them a prescription and send them home."

Elderly patients in major centres such as Vancouver may have better access to services, but outside of those centres, access can be sadly lacking.

"The challenge is that they [the elderly patients] usually have quite complicated needs and the treatment is difficult to access locally," said Dr. Chris Frank, president of the Canadian Geriatric Society.

"Multi-disciplinary approaches tend to be easier to access in larger centres and it leaves people having to travel quite far for treatment."

Frank is director of the Care of the Elderly program, clinical director of the Southeastern Regional Geriatric Program in Ontario, and an assistant professor in the medicine department at Queen's University with a cross-appointment in family medicine.

He recalled a recent patient who was in the hospital for "fairly basic physiotherapy and fairly basic occupational therapy," that wasn't available in his community.

"Realistically, if he had lived in Kingston he would have come to our out patient clinic a couple of days a week," he said. "Instead, his wife had to drive 21/2 hours each way twice a week, and at one time she had to sleep in their car because they were financially strapped. They were both in their late 70s."

Frank said when nursing staff learned of the woman's dilemma, they stepped in to help her find sleeping arrangements to get her out of her car.

gshaw@png.canwest.com

Article

I found this article today. Considering that I work with a lot of the "elderly" population, I was intrigued by the headline. It is true that a lot of people come into contact with others who might make them sicker, but some times, the GP isn't trained to see all the possible problems that arise. This article is yet another statement about how the medical profession has changed, how the shortage of physicans in certain areas is affected yet another large cohort of our population.

Key to elder care: Avoiding Hospitals

We need to keep the frail elderly 'happy and comfortable and home,' says Dr. John Sloane, who has one of the last house-call practices

Gillian Shaw, Vancouver Sun

Published: Friday, November 02, 2007

TODAY: A plea for proper medical home care as a far better option than hospital care.

SATURDAY: Home-care options that help keep ailing seniors where they want to be -- in their home.

It's a sunny fall afternoon and 82-year-old Rose Sorrenti turns her attention away from her afternoon television to point to a swollen and gaping wound on her calf the size of a baseball.

"My sister-in-law saw it and she said, 'you'd better get hold of your doctor and let him see that,' but I knew you'd be here," says Sorrenti, gesturing to Dr. John Sloane, who is perched on a nearby stool, his tablet computer open and ready for the scribbled notes that will record his patient's condition.

It's a somewhat complicated condition, as it is with most of the frail, elderly patients who make up Sloane's practice.

It is a practice that has taken him from an office to his Mercedes, appropriately enough a geriatric model itself, in which he tours around Vancouver seeing patients where they live.

In an age where "doc-in-a-box" drop-in clinics have replaced trusted family doctors making house calls, Sloane is from another era. And while a program out of Vancouver Coastal Health promises to continue serving his patients when Sloane retires in the new year, medical students aren't lining up to follow his lead.

Instead, many of them will end up being the doctors who see elderly patients when they land in emergency rooms and hospital beds, an outcome Sloane says is exactly counter to what the frail elderly need.

"As funding for reasonable coordinated home care of house-bound people has fallen, the venue of default has remained the emergency room," he said. "If you are in trouble, you push 911.

"Bang, in comes the ambulance and the person is hustled out and the next thing they know they are a bed-blocker in an emergency room.

"The truth of the matter is, the service of an acute-care hospital can't help the frail elderly, they just don't benefit. We have a frail elderly person occupying these terribly expensive and much-needed acute-care beds, and those people aren't benefiting.

"It all boils down to [the need for] an effective strategy for keeping the frail elderly out of the hospital."

"Frail, elderly" isn't defined by age as much as health.

"Once a person goes through a gate which we call frail, there is a linear deterioration punctuated by dying," said Sloane.

"Once they go into that situation, all of this preventative stuff, everything we do in hospital, most of the investigations are actually counterproductive and useless.

"What we need to be doing for those people is keeping them happy and comfortable and home. Nobody wants to spend a nickel on home care, but boy, is it cheaper than sending Granny through emergency."

People become frail through the irremediable inability to perform the activities of daily living. Many people may suffer that inability at one time or another, either through illness or an accident, but what separates the frail is that they will not get better. There won't come a day when they will be able to fend for themselves again.

If you fix stuff and the person goes right back to being normal like you and me, they are not frail," said Sloane. "Frailty and homebound-ness approximately coexist.

"My practice is homebound. All of my patients are frail and all of my patients are homebound and it is about the same group."

But when it comes to medical care, often the frail 85-year-old is treated as if he or she was 39 and all that is needed is for that broken hip to repair, or the heart problem to be stabilized and they'll be back up and running almost like new.

That doesn't happen. The 85-year-old stranded in the emergency department may suffer some form of dementia along with the ailment that landed him in hospital. He could already have several diseases from diabetes to Parkinson's to respiratory problems to a range of conditions -- a complexity that can overwhelm a medical system geared to dealing with what is wrong with a patient, not seeing the whole person and all the underlying issues.

"So what do we do with frailty is, you talk to them and get them to understand what is going on in their life," Sloane said. "We treat their illnesses from a medical point of view, we treat their disabilities, and we look after them psychologically.

"We do it at home and we do it on a primary-care level."

That, argues Sloane, is where the money should go and where the care should go.

"That kind of shutting them off from the acute-care system is the opposite of abandonment," he said. "Just ask any old person who has been in emerg in the last six months, or who has ever spent a couple of nights in hospital.

"They don't ever want to go back."

Sorrenti appears to share that sentiment.

"Oh, I hate that hospital," she said, recounting a litany of ailments from broken bones to heart troubles that have landed her in one hospital or the other -- some getting a better report from her than others and one clearly a target of her wrath: "I call it murdering hospital," she said.

Sloane ignores the jibes and, persuading Sorrenti to turn down the volume on the television, carries on his questions and examines the angry-looking wound. He calls in a prescription to the pharmacy from his cell phone and calls to arrange for a public-health-care nurse to come by to change dressings and monitor the infection.

Sorrenti, who looks younger than her 82 years -- "You should see me with my makeup and you'd think I was even younger," she says -- has definite ideas about checking out of this life and it doesn't involve hospitals.

"My mother had the perfect death," she said. "She went to sleep at 99 and didn't wake up."

At 88, Mary Goulah manages with the help of some home care, but she doesn't stir far from her chair in her living room -- certainly not far enough to get to a doctor's office.

"I had trouble with my feet for one thing," she said. "That was when he (Dr. Sloane) first started coming to see me.

"I wore him out, that's why he is retiring," she said with a laugh, her sense of humour clearly not dimmed by a range of ailments. "It's too much for me to go out to a doctor."

Sloane will likely be retiring before one of his patients, Jim Steele, does. The 91-year-old isn't quite ready to calls it quits with the wholesale bakery business he took on as a retirement project after his retail bakery closed.

One of Steele's sons was in school with Sloane in Kerrisdale from kindergarten on, and the elder Steele remembers the doctor as a young lad at class events.

Steele's balance is unsteady and he leans on a walker, but asked how he negotiates steep stairs at his premises, he is indignant.

"I walk up them just like any other human being," he said sharply when asked about the stairs Sloane aptly describes as "breaktakingly steep."

Paul Steele, another son, doesn't think Sloane can be easily replaced.

"It's going to be difficult if not impossible to replace people like John," said the younger Steele. "To find people with that experience in family practice and in gerontology, and who care enough to do this."

Watching Sloane care for his father, Steele is convinced that the health-care system would save money if there were more doctors ready to take on the care of homebound seniors. But it won't happen, he said, unless public policy makes it a worthwhile option for doctors.

"You have to make it attractive," he said.

gshaw@png.canwest.com

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What happens to our aging seniors with too few doctors to provide medical care?

The elderly are the fastest-growing segment of the Canadian population

Gillian Shaw, Vancouver Sun

Published: Friday, November 02, 2007

At a time when Canada's aging population means that seniors are Canada's fastest-growing population group and the fastest-growing segment is 85-plus, Canadian medical schools are barely turning out a handful of geriatric specialists every year.

Even young people are having trouble finding a family physician.

Where then does that leave the frail elderly, often with complicated medical issues that require much more time than the fee-mandated few minutes of an office visit?

They often find a visit to the doctor's office virtually impossible, and instead end up rushed by ambulance into overcrowded emergency departments when a health crisis hits.

Once in hospital, the situation can go from bad to worse. During a week in a hospital bed, they can go from being mobile to being unable to stand, let alone get themselves to the bathroom or do any of the things that were so vital to their independence.

The more fortunate elderly will have family to help navigate their way through the medical system.

But that takes its toll, with caregivers burning out. One elderly Ontario woman recently had to sleep in her car overnight while her husband was being treated for the after-affects of a stroke. They simply lived too far from the only centre that could provide the rehabilitation he needed, and she couldn't afford a hotel room.

The stress can bring out old grievances and sibling rivalries as the debate rages over just how to care for mum or dad. As one doctor points out, if your kids didn't get along when they were 16 and 17, they'll still be fighting at 50.

Medical care for the frail elderly doesn't stop with the doctor. Best practices suggests it takes a team, with nurses and social workers involved with doctors and specialists who get to know the patient and their circumstances and liaise with family or other caregivers. But unless you're fortunate enough to live in centre that has the services, plus live long enough to get to the top of the waiting list, you might be out of luck.

Faced with such an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not. Geriatrics is a poor cousin to the more lucrative specialties like cardiology or neurology. Students graduating with crippling loans have to maximize their incomes to pay them off -- not see one patient in the same time their cardiology colleague sees six.

Yet while students are steering away from a geriatric specialty, the reality is the average doctor will see more seniors than anyone else.

"Except if you are a pediatrician, the classes graduating now will spend 50 per cent of their time with people over the age of 65," said Dr. Laura Diachun, a geriatrician, associate professor of medicine at the University of Western Ontario and co-author of a study pointing to a shortage of doctors who practice geriatric medicine.

"Although 50 per cent of their time will be spent looking after people who are the age of 65, the amount of training they get in medical school is negligible."

Dr. Janet Gordon, a professor in geriatric medicine at Dalhousie University, did a survey of medical schools across Canada and found that students were exposed to anywhere from seven to 200 hours of geriatrics.

"In medical school, people do close to two years or more of classroom learning and then clerkship, on the floor-clinical learning," Gordon said. "Only half the schools have people do geriatrics even though all have them do pediatrics."

Gordon said in problem cases set for medical students at her university, she found only seven per cent of the cases had patients over the age of 65 and none included patients over 70.

"I think there is a belief geriatrics is too complicated to teach them early on," said Gordon.

Geriatrics is a complex and challenging field. It's not like a 40-year-old landing in emergency with a heart attack or pneumonia. Treat the problem in the younger patient and chances are the patient will be up and on his or her way.

For an 80-year-old, one ailment may be complicated by a range of other conditions. Is the confused patient suffering dementia or is the confusion coming from an infection and dehydration? If he's sent home after days in the hospital, is there someone there to ensure he eats? Takes medication?

In medical school, students spend days and weeks gaining pediatric experience. They spend only hours with the elderly. Yet the reality is that when they graduate, they are much more likely to be caring for old people than for children.

"The bottom line is this is not a sexy place to be," said Lynn McDonald, director of the Institute for Life Course and Aging and a professor in the faculty of social work at the University of Toronto. "It is not glamorous like brain surgery or saving children who are dying from leukemia.

"We live in an ageist society; there is the feeling, 'who cares?' They are going to die anyway. . . . There is no prize, no glory.

"It is hard, hard complicated work and it is work that requires many disciplines. It is an interdisciplinary team approach. Older people don't just have one problem, they have many problems, it is very complicated and there is a special knowledge base."

McDonald said when she first went to work in gerontology in 1970, no one even knew what the word meant. "Society is catching up, but not fast enough in my opinion," she said. "I think it was in 2001, seven doctors went into geriatric medicine in all of Canada -- we need hundreds."

Geriatrics is also lacking in nursing training, McDonald said, but the curriculum is so stretched there is little room for geriatric medicine.

"Maybe we get three or four nurses in the program a year," she said of a multidisciplinary program at U of T in aging, palliative and supportive care.

"That's not very many when you think most old people end up on the medical wards in hospitals and they end up in long-term care.

"Who's looking after them? People off the street -- that's who is looking after them, with a nurse in charge if you are lucky."

McDonald says in the United States, the John A. Hartford Foundation, dedicated to improving health care for older Americans, is putting millions of dollars into training professionals in nursing and social work in geriatric medicine.

"They know they are going to have an age wave," she said. "They are preparing and they are throwing money at the problem big-time, and it works.

"If you start to pay students for doing it, they are a lot happier than if they are doing it because it is noble."

Drawing on the Hartford example, McDonald wrote a proposal for a national centre of excellence in aging focused on the three professions that provide social, psychological and physical care to Canada's older population, the National Initiative for the Care of the Elderly.

We were shocked when we got this letter saying 'congratulations,' " said McDonald of the success of her proposal.

But the dollars are not lavish. While Hartford is pouring $25 million into a single profession -- nursing -- McDonald said that in Canada, by the time overhead is paid, there will be $1.6 million left for four years.

The centre has put together academicians and practitioners working with older people and is focusing on best practices, with the aim of providing community agencies and institutions across Canada the tools they need to work with them.

"That's turning out to be a big winner," she said. "People don't have that information in one spot."

The institute also has a mentorship program for students in gerontology from the three professions, and it pays their way to an annual knowledge exchange.

McDonald said one way to get people involved is to offer scholarships and money for students to do research.

"Once you start to do it you love it," she said. "People who are in gerontology and geriatric medicine love it.

"It really is a challenge; it is really exciting when you can make a difference for an older person and their family."

gshaw@png.canwest.com

GERIATRIC CRUNCH

- Adults 65 years of age and older are Canada's fastest-growing population group.

By 2021, Canada will have 6.7 million seniors; by 2041 it will be 9.2 million and nearly one in four Canadians.

- The fastest-growing numbers among seniors are those aged 85 and older.

- Life expectancy for Canadians is rising, now at 82.5 years for women, and 77.7 years for men.

- The median age of Canadians has been rising steadily since 1966. In 2006, it was 38.8, a record high, up from 37.2 in 2001.

- The proportion of people aged 80 and above increased by 25 per cent between 2001 and 2006 to reach one million, second only to the rate of increase of those aged 55 to 64.

- During the same time, there was a 22-per-cent increase in the proportion of centenarians in this country.

- Kelowna has the oldest population of any Canadian city, with 19 per cent being elderly.

- There are fewer than 200 geriatricians in Canada, but the estimated need is more than 600, a number that is expected to skyrocket as the number of people over age 65 doubles in the next 25 years.

- On average, four to nine residents enter a geriatric medicine specialty training program every year.

© The Vancouver Sun 2007