Caring for patients who are very old 80 and older, yet still living independently can take a great deal of time and effort by the family physician. At Memorial’s Primary Healthcare Research Unit (PHRU), a team of researchers is looking at delivering a nurse-based program of home-delivered care to provide a variety of benefits for the old elderly including improved quality of life, improved symptom management and better utilization of community resources.
The ElderCare project will help determine if older patients who receive contact from a district nurse require fewer visits to their family doctor than others of a comparable age group.
Those aged 80 and older are the fastest growing age subset of the population. Dr. Marshall Godwin, director of the PHRU, explained that care of the elderly poses a central challenge to health care systems.
“They are more likely to have chronic illness, to be on multiple medications, and to visit their physician,” said Dr. Godwin. “But a physician is not always necessary or the most appropriate health care provider to address the many concerns of the elderly.”
Dr. Wanda Parsons is a faculty member in the Discipline of Family Medicine who knows from first-hand experience that some of her elderly patients have concerns for which they frequently visit their family doctor. “In conversations with Marshall (Godwin), I wondered if there was a way to provide a service in their homes, linked with the family physician, that would cover a lot of these issues and improve their quality of life. This was the seed of the project and Marshall assembled a skilled team with experience in geriatrics and aging and we went from there.”
Heather Pitcher is the nurse who is doing the patient assessments for the ElderCare project. “We are looking at enrolling 320 elderly patients in the study group half will have the nurse intervention and half will be the control group. With the intervention group I start with a two-hour assessment and do eight follow-up visits over a year. I’m looking at issues like how lonely they are, medications, medical problems, relationships, family dynamics, diet and exercise.”
Ms. Pitcher assesses the patient’s needs and develops a plan to match their needs. In her talks with patients, she is often able to prompt thought about issues concerning end-of-life, such as planning for long-term care and wills.
Dr. Parsons is enthusiastic about the project. “As family physicians, we want to ensure the elderly remain independent and stay in their own homes as long as possible and have the best quality of life possible. With the out-migration of young people, there is often not the family support that used to be common in this province with Nanny and Poppy living either in the same house or garden as their children and grandchildren. This lack of family support, or where there is support, over-extension of social support networks, leads to increased dependence on the primary health care system.”
Dr. Parsons said it is advantageous that family physicians be involved in any care plan due to their long term knowledge of their patients. “In the ElderCare study, the nurse will meet with the family physician and the patient after her interviews to review and adapt the goals and overall plan based on physician and patient input. The family physician is still a key player and will continue to see the patient for medical care, but the nurse and the family physician will work together with the patient on the individual plan.”
Dr. Anne Sclater, chair of the Discipline of Medicine and an expert in gerontology, is a member of the research team for the ElderCare project. “This project identifies a gap in health care; it is so exciting to see it roll out. The findings of this project will have a great impact on health care planning.”
The research team for the ElderCare project includes Dr. Godwin, principle investigator; Dr. Sclater; Dr. Parsons; Farah McCrate, a consultant on aging and seniors for the Department of Health and Community Services; Karen Parsons, School of Nursing; Drs. Sharon Buehler and Vereesh Gadag with the Division of Community Health and Humanities; and Dr. Bob Miller, chair of the Discipline of Family Medicine. Research staff include Ms. Pitcher, research nurse; Andrea Pike, project co-ordinator; and Angelique Myles, research assistant.
The ElderCare project is one of four major research projects of the PHRU, which was established in November 2005 with Dr. Godwin as director. The unit is a resource within the Discipline of Family Medicine for the conduct of clinical and health services research in the area of primary care and primary healthcare. The PHRU has spearheaded the development of the Atlantic Practice Based Research Network (APBRN) a network of nearly 90 primary care providers who have agreed to become involved with the PHRU in conducting research in the primary care setting.