Originally published in the Toronto Star on July 22, 2011. To go to the Toronto Star website please click here
The most telling thing about Dr. Samir Sinha is that he has a mahogany dining set in his small office. The director of geriatrics at Mount Sinai Hospital thinks it makes his elderly patients feel more at home.
On it sits a Dr. Seuss book: You’re Only Old Once! A Book for Obsolete Children.
But this isn’t your classic kids’ fare. It was penned when Dr. Seuss was 82, five years before his death, as a wry warning to adults that the medical system — “the Golden Years Clinic” — can be strange and scary as you age.
Few people are as aware of that as Sinha, at 34 one of the youngest geriatricians in Canada and a man who is determined to help revolutionize the way in which we care for seniors.
“I joke that the hospital is better than the Four Seasons because you can be served all your meals — breakfast, lunch and dinner — in bed. But we’re learning that all that bed rest can be deadly for old people.”
It’s also recognition that hospitals can, in fact, be dangerous places for frail seniors.
Confining them to beds, hooked up to intravenous tubes and catheters, can actually do more harm than good to their aged bodies. About 35 per cent of seniors end up more immobile at discharge than they were when admitted and, as a result, often end up in long-term-care facilities.
There are other challenges:
“The patients have changed but the system hasn’t,” says Sinha. “We need medical care that is more tailored to these complex patients.”
For almost a year now, Sinha has been overseeing precisely that kind of transformation at Mount Sinai.
Last April, the hospital opened its 28-bed Acute Care for Elders (ACE) Unit as part of a comprehensive new strategy aimed at improving care and quality of life for seniors, who fill about 60 per cent of Sinai’s hospital beds.
It has also created specialized medical teams that include nurses, social workers, pharmacists, occupational therapists and physiotherapists who work with geriatricians to assess and provide highly customized treatment to frail elderly patients. These efforts are supported by emergency-room staff, who often constitute the first contact when elderly people arrive at the hospital.
The idea isn’t new — there are dozens of Acute Care for Elders units across the United States, and there’s one in Vancouver.
But Sinai is the first acute-care hospital in Canada to make better care of the elderly a stated priority across the whole facility.
“We all went into medicine to help people and geriatrics is, to me, the ultimate way that I can help a vulnerable population that doesn’t have a lot of people advocating for them,” says Sinha, who oversees the program.
“These are not easy patients. They can be very complex medically, very complex socially and a lot of people shy away from that complexity.
“For me, it’s an exciting intellectual challenge. It’s like a puzzle.”
Sinai’s interdisciplinary approach comes at a good time. In the years ahead, there will be a tsunami of seniors requiring comprehensive medical care.
Currently 14 per cent of the Canadian population is 65 or older. That is expected to double over the next two decades.
Almost half — 44 per cent — of total health-care spending now goes to older adults.
Even so, there aren’t enough hospital beds or long-term care facilities to keep up with growing demand.
Mount Sinai’s aim is simple: To get vulnerable seniors, many of whom are so housebound they can’t even get to a doctor’s office, back on their feet and back into their homes, with the necessary supports, as quickly as possible.
The team approach is also intended to focus better care on the so-called “frequent-fliers” — the frail elderly with four or more chronic conditions that land them in the emergency department on a regular basis.
To better help them manage their illnesses, the hospital has partnered with House Calls, a multidisciplinary team headed by Dr. Mark Nowaczynski, as well as the province’s Community Care Access Centre, to ensure they get both the medical care and support they need at home.
“This is a very low-tech, high-touch solution,” says Sinha.
“We don’t need fancy instruments. The most important part is the team,” he stresses. “It’s about bringing professionals together (who understand the special needs of the elderly) and deploying their expertise.”
Some of the changes are obvious the minute you walk onto the 10th floor ACE unit.
The walls are a cheery yellow (studies have shown the colour can be a real mood booster for patients) and oversized clocks hang in each room to keep elderly patients oriented to time and day.
Most patients are helped to the bathroom so they don’t have to be fitted with catheters, and they eat their meals in comfortable high-back chairs, not beds.
As a result, catheter use dropped from 53.2 per cent last September to just 14.7 per cent by March.
Readmissions dropped almost five per cent (from 14.4 to 9.7 per cent) and the average length of stay dropped from eight to 7.5 days during the same period. There was a more than two per-cent increase in the number of patients able to return to their homes.
“Hospitals tend to be very hostile environments for seniors,” says Sinha. “We’re trying to make sure that we maintain as much normalcy and routine as possible.”
You just have to meet 101-year-old Janusz to see some of the benefits in real life. The retired architect and artist (his last name can’t be used so as to protect his privacy) had been managing with the help of a walker in his downtown apartment before a fall sent him to Mount Sinai one Friday night last September.
By the time Sinha saw Janusz the following Monday, he was attached to a catheter and unable to get out of bed.
Sinha had it removed and called in an occupational therapist to work on getting Janusz back on his feet.
He’s understandably cranky — “I think old age as I’m living it now is a waste of time” — but grateful not to be in a nursing home: “I call them prefuneral homes,” says Janusz.
“I can guarantee you that, without the ACE strategy, he would never have gone home again,” says Nowaczynski, who stops in on him regularly.
Sinha comes along on the most complex cases four half-days a month.
“It takes a different mindset to look at these elderly patients in this way, and it takes a little more manpower because it’s high touch,” says Nowaczynski.
The results speak for themselves.
“The costs are far outweighed by the benefits to the health-care system and it has a huge impact on the quality of life of these seniors.”