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.

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