Dr. John Muscedere, MD, FRCPC, is an intensivist at Kingston General Hospital (KGH), and Professor of Critical Care Medicine at Queen’s University. He serves as the Research Director of the Critical Care Program at Queen’s and KGH, and Co-Chair of the Canadian Critical Care Trials Group Knowledge Translation Committee. John is an accomplished critical care researcher whose primary research interests include nosocomial infections, clinical practice guidelines, knowledge translation and critical care outcomes. In addition to his clinical and academic posts, John is Scientific Director and Chief Executive Officer of the Canadian Frailty Network (CFN), funded by Canada’s Networks of Centres of Excellence. CFN is improving care of older adults living with frailty by: increasing frailty recognition and assessment, increasing evidence for decision-making, mobilizing evidence into policy and practice, and advocating for change in the healthcare system.
Addressing Inequalities in Older Populations Living with Frailty
Dr. Melissa K. Andrew, MD, MSc, is Associate Professor of Medicine and a consultant in Geriatric Medicine at the QEII Health Sciences Centre in Halifax. She did a Masters of Public Health at the London School of Hygiene and Tropical Medicine and completed her PhD in Interdisciplinary Studies at Dalhousie University on the subject of frailty and social vulnerability among older adults. She is engaged in research on frailty in relation to dementia, vaccine effectiveness & outcomes of infectious diseases, and how to improve care for frail older adults in our health care systems.
Dr. Cara Tannenbaum, MD, MSc, is a practicing geriatrician, and professor of medicine and pharmacy at the Université de Montréal. Her research focuses on older women’s health and priorities for healthy aging. She was appointed Scientific Director of the Institute of Gender and Health for the Canadian Institutes of Health Research (CIHR) in 2015. In this capacity she promotes the application of evidence-based solutions for improving the health of men, women and gender-diverse persons. She has published over 100 peer-reviewed manuscripts and book chapters on women and aging. Her contributions have been recognized with the Betty Havens Award for Knowledge Translation in Aging. She leads a CIHR-funded Partnership for Health System Improvement award and is the founder and director of the Canadian Deprescribing Network.
Gloria Gutman, PhD, LLD (hon.), FCAHS, CM, OBC, developed the Gerontology Research Centre and Department of Gerontology at Simon Fraser University (SFU) and was director of both from 1982-2005. She is currently a Research Associate and Professor Emerita at SFU. Dr. Gutman is author/editor of 23 books, the most recent (with Andrew Sixsmith), Technologies for Active Aging (Springer, 2013). Her research interests are wide-ranging; including seniors’ housing, long term care, health promotion, seniors and emergency preparedness, gerontechnology, prevention of elder abuse and neglect and most recently, increasing access to advance care planning among marginalized groups. During her career Dr. Gutman has held a number of high profile roles including two terms as President of the Canadian Association on Gerontology, President of the International Association of Gerontology and Geriatrics, and President of the International Network for Prevention of Elder Abuse. Currently, she is President of the North American chapter of the International Society for Gerontechnology, and a member of the Research Management Committee of the Canadian Frailty Network (CFN-NCE). In 2007 she was awarded the Order of British Columbia, in 2010 an LLD (honoris causa) by the University of Western Ontario for her work “as an international authority in the field of gerontology” and was named one of Canada’s “best 45 over 45” by Zoomer magazine, in 2012 she was awarded a Queen.
Jennifer Walker, PhD, is a health services researcher and epidemiologist. She has Indigenous (Haudenosaunee) family roots and is a member of the Six Nations of the Grand River. She has a PhD in Community Health Sciences (Epidemiology specialization) from the University of Calgary. Her work focuses on Indigenous use of Indigenous health and health services data across the life course, with a focus on older adults. She collaborates closely with Indigenous organizations and communities to address health information needs. Jennifer holds a Canada Research Chair in Indigenous Health at Laurentian University in the School of Rural and Northern Health. She is a Core Scientist and Indigenous Health Lead at the Institute for Clinical Evaluative Sciences. She also holds appointments at the Centre for Rural and Northern Health Research, the Northern Ontario School of Medicine and the Dalla Lana School of Public Health.
Frailty is a common, yet under-recognized health state associated with functional decline, chronic multiple health problems and poor health outcomes in late life. The risk of becoming frail increases with age, although frailty isn’t simply a function of getting older. Older adults living with frailty are over-represented in all sectors of the healthcare system, and frailty is associated with increased healthcare resource consumption. The Canadian Frailty Network (CFN) was funded by the Networks of Centres of Excellence recognizing the growing prevalence of frailty in Canada and the need for more evidence to improve the complex care needs of older Canadians living with frailty. Over one million older Canadians are medically frail and in 10 years it is estimated that over two million Canadians will be living with frailty. However, the burden of living with frailty is not equal among our population. Social inequalities faced by older adults living with frailty present challenges to receiving appropriate and timely health care. The prevalence of frailty in older women is higher than in men and because of their longevity older women are more likely to be living with frailty for a longer period of time, into late life. The older LGBTQI community living with frailty face unique health care issues in late life since they’re more likely to live alone and less likely to have a partner or children and thus more likely to be reliant on care from close friends and formal care services. In addition, LGBTQI older persons are more likely to experience discrimination by residents and staff within long-term care facilities which increases their chances of poor health outcomes due to isolation and neglect. Indigenous people have been shown to have poorer health and social outcomes than non-Indigenous people, with markedly higher frailty levels at younger ages. Seriously ill older Indigenous adults living with frailty also experience poorer health care services, some of which may be a function of being remotely located. For instance, palliative care services in northern Nunavik communities in Canada are essentially non-existent. As a result, Inuit patients that are frail and terminally ill often require transfer to larger urban health centres, which jeopardizes their well being by stripping away the social supports that are essential to their social and spiritual well-being. This symposium, presented by CFN’s Network of researchers will present the inequalities and challenges faced by these groups and provide potential solutions.
Overview of frailty and the current healthcare system, John Muscedere
Frailty is defined as a state of increased vulnerability resulting from reduced physiological reserve and loss of function across multiple systems reducing the ability to cope with minor stressors that can cause rapid and dramatic changes in health. Canada’s healthcare system, like many others was originally designed to address acute care needs of younger populations; thus there’s an urgent need to restructure the healthcare system to chronically care for older adults living with frailty in a holistic manner. To address this, CFN is supporting research and knowledge translation efforts to bring about frailty screening and assessment in all care settings using appropriate tools while supporting research to provide better evidence for their care. Identifying frailty in older adults will support the development of appropriate care plans, leading to better quality of life for all citizens impacted by frailty.
Older Canadian living with frailty and social inequalities, Melissa Andrew
Frailty has many social and societal implications. Social circumstances, including socioeconomic status, social supports, social engagement, and social isolation, are important in two broad ways, especially in the face of frailty. First, they contribute to older adults’ resilience or vulnerability to adverse health outcomes. Second, on a practical level, they are facilitators or barriers to independence and access to supports/interventions. Frailty also has important societal implications for health systems and social care policy. In this presentation, a social ecology framework will be used to consider social and societal implications of frailty at each level from the individual, through to impact on relationships with family and friend caregivers, institutions, health systems, neighbourhoods and communities, and society at large.
Older women living with frailty and social inequalities, Cara Tannenbaum
Women outlive men, and by age 85 there are 2.5 women for every man left in this age group in Canada. As the prevalence of frailty increases with age, so too does women’s overrepresentation among frail older Canadians. Both sex (biological) and gender (sociocultural) factors differentiate frail older women from frail older men, pointing to targeted and modifiable areas for intervention. Evidence-based solutions include de-stigmatization of conditions such as urinary incontinence in order to promote self-management and/or help-seeking. Reducing polypharmacy and the harms associated with a high prevalence of sedative-hypnotic use in frail older women is of priority. Tackling the issue of falls self-efficacy, which has been shown to restrict women’s activities more than men’s, and responding to women’s self-reported preferences for engaging in physical activity promise additional improvements. A higher proportion of women than men reside below the poverty threshold in Canada, further exacerbating inequities, and opening the door for policy remediation. Applying a sex and gender lens to rectify inequities in frail older adults aligns with international efforts in the realm of personalized health and gendered innovations.
Older LGBTQI living with frailty and social inequalities, Gloria Gutman
Older LGBTQI adults experience same health challenges as heterosexual age-peers. Living with chronic conditions is more problematic however, because of differences in availability of social supports. LGBTQI older adults are more likely to grow old without children, without partners, and to live alone; as a result, they express great concern about “nobody being there” for them in late life and fear having to “go back into the closet” to get the care needed. Differences also exist in experiences of the subpopulations included under the LGBTQI umbrella: HIV/AIDS is more prominent among older gay men; economic issues more frequent among older lesbians; transgender persons speak of experiencing disrespect from care providers and from within the LGBTQI community. Care providers need to understand unique issues confronting frail LGBTQI older adults and make them feel more welcome in health and social service settings. Many have faced stigma and discrimination from the professionals who most often assist in end-of-life preparations and care. They’re reluctant to confide in these individuals or utilize formal facilities and services. They express difficulty in identifying replacements for those who traditionally provide care and in identifying LGBTQI affirmative facilities and services related to late/end of life planning.
Older Indigenous persons living with frailty and social inequalities, Jennifer Walker
Few studies have looked at frailty in First Nations populations. In a joint research project with the Chiefs of Ontario, we applied a Frailty Index to the First Nations Regional Health Survey as a first step in understanding age-related frailty and wellness. We found that frailty is occurring at substantially younger ages in First Nations communities compared with the general Canadian population. Sixteen percent of Canadians aged 65-74 are classified as living with frailty and this level of frailty is reached at ages 35-44 in First Nations communities in Ontario. By age 75 and older, almost half of those living in First Nations communities are living with frailty. Together, we have created a positive profile of those who are aging in robust health without frailty, and this is helping to provide First Nations with potential keys to healthy aging. Likewise, a profile of those who are living with frailty is helping to prioritize new initiatives and highlight areas where more health and supportive care resources are needed. This has prompted discussions about what frailty means from First Nations perspectives so that First Nations communities, organizations and health care providers can better measure how “well” the population is aging.