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Monday December 18 2017

Bracing ourselves for the “grey tsunami”

A surprising volunteer experience

At first, I did not know what I was signing up for. It was the first year of university, and I had decided to volunteer for the Hospital Elder Life Program (HELP), a program that aims to prevent delirium in hospitalized elderly patients through daily orientation, at the Juravinski Hospital in Hamilton. Having rarely spoken to or even met three of my four grandparents, I had never gotten an opportunity to properly interact with the elderly. What sorts of things could an ignorant and inexperienced undergrad have in common with an older and wiser individual?

Surprisingly, the kindness and enthusiasm that emanated from almost every individual I visited made my volunteering experience a lot less intimidating then I had initially imagined. During each shift, I am constantly immersed in enriching and inspiring tales of the hard work these people have done to get to this point in their lives, the love they have for their family and friends, and the life-long goals they have achieved. They also frequently tell me how much they appreciate the volunteers, as often they do not know what is going on and have not seen a doctor for days. That was another big surprise for me – why are these patients feeling so neglected?

Insufficiency of elderly care

Unfortunately, this is the current reality of elderly care in Canada. It is without a doubt that the Canadian population is aging at an unprecedented rate. Presently, 1 in 7 Canadians are aged 65 years or older, and by 2036, it is expected that nearly 1 in 4 Canadians will be in this age group (1). Despite this fact, in Ontario, there are currently only 129 active Ontario physicians holding subspecialty training in geriatric medicine (2), serving a population of 2.0 million seniors (3). This means that there are 0.65 geriatricians per 10,000 Ontarian seniors. To put it into perspective, there are 7.5 paediatricians per 10,000 Ontarian children (2, 3). The insufficiency of elderly care in Canada has been aptly named the “grey tsunami”, which is defined as the on-going demographic shift that if left accounted for, will lead to serious consequences for the health care system (4).

Second-class doctors

In 2011, 15 of the 31 spots to train doctors in geriatrics across Canada were unfilled (5). Why are so few individuals willing to become geriatricians or specialize in geriatric care? One reason may be because few medical students see the elderly at their best – which would be at home (5). Instead, the students often see the elderly confused, anxious, or delirious in the emergency room or chronic care ward (5). Unfortunately for the elderly, our health-care system is so built around hospitals, to the extent that it sometimes takes twice as long to discharge patients back home or to another facility than to admit them (5). As a result, very few trainees get the opportunity to do house calls, which are very appreciated by elderly patients who often have trouble getting transportation to the hospital. House calls also enable the troubleshooting of specific problems, such as falls prevention or tracking errors in medications (5).

Being a geriatrician also requires significant training – 3 years of internal medicine training plus two years in geriatrics (5). Family physicians who wish to gain additional training from care of elderly (COE) programs are also deterred by the extra time and the substantial decrease in income which often results from this training (6). Departments of family medicine also do not always stress hiring physicians with COE training, and potential for this sort of work within the division of geriatrics is limited by competition with internist geriatricians (6). To put it bluntly, Angela Juby, former president of the Canadian Geriatrics Society, states, “Geriatrics doesn’t have status. If doctors think they will be doing a job and always be second-class citizens, they will be less likely to want to do it” (6).

“Geriatrics doesn’t have status. If doctors think they will be doing a job and always be second-class citizens, they will be less likely to want to do it.”

— Angela Juby, Former Canadian Geriatrics Society President

A silver lining

Although the geriatrician-to-elderly ratio in Canada is quite appalling, there is in fact a silver lining in the midst of this oncoming storm. Public awareness towards Canada’s aging population has increased receptiveness of all levels of government. There is also a move in Canada towards elder-friendly hospitals and increased use of Acute Care of Elders units (4). Moreover, the Geriatric Education and Recruitment Initiative has been established to lobby governments, so that barriers to additional COE training are decreased (4). Even from my own experience, HELP has expanded tremendously over the years as hospital staff increasingly recognize the importance and usefulness of the program.

Challenge yourself today

If you are interested in helping the elderly, even at the slightest, I challenge you to do something to assist the elderly today – whether it is volunteering at a nursing home for a day or even considering a career in geriatrics. Before you know it, in just a couple of years, many of your parents will join this subset of the population. It has been a long and arduous journey for the elderly to have arrived to this milestone in their lives, and for that, they should be respected and cared for, not neglected and abandoned.

By Bonnie Cheung

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References:

1) Statistics Canada. National Seniors Day…by the Numbers [Internet]. [Ottawa]: Statistics Canada; 2013 [cited 2013 17 Nov]. Available from: http://www42.statcan.gc.ca/smr08/2013/smr08_178_2013-eng.htm

2) College of Physicians and Surgeons of Ontario [Internet]. [Toronto]: College of Physicians and Surgeons of Ontario, 2013 [cited 2013 17 Nov. Available from: http://www.cpso.on.ca

3) Ontario Ministry of Finance. Ontario Population Projections Update [document on the Internet]. Ontario Ministry of Finance; 2013 [cited 2013 Nov 17]. Available from: http://www.fin.gov.on.ca/en/economy/demographics/projections/projections2012-2036.pdf

4) Madden KM, Wong RY. The Health of Geriatrics in Canada —More Than Meets the Eye. Canadian Geriatrics Journal [Internet]. 2013 Mar 7 [cited 2013 Nov 17];16(1). Available from: http://www.cgjonline.ca/index.php/cgj/article/view/75

5) Priest L. Canada’s seniors: The doctor will see you now. The Globe and Mail [Internet]. 2011 April 11 [cited 2013 Nov 17]. Available from: http://www.theglobeandmail.com/life/health-and-fitness/canadas-seniors-the-doctor-will-see-you-now/article576256/

6) Frank C. Challenges and achievements in caring for the elderly. Can Fam Physician. 2010 Nov;56(11):1101–5.

Image source: http://www.saintkatharinedrexelparish.org/Parish-Ministries.html

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The Meducator is McMaster University’s undergraduate Health Sciences Journal. It publishes pieces that critically address current issues with a high degree of scientific rigor, but in a way that is accessible to a broad audience.

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