One of the major challenges to improving the care of older patients is the availability of health human resources trained in providing appropriate care to the elderly. With only about 250 geriatricians currently available to support 5 million older Canadians, there are not enough geriatricians – let alone other types of Canadian physicians and other health care professionals – with the appropriate knowledge and skills to provide holistic, person-centred care to our rapidly ageing population.
We therefore established the Savlov/Schmidt Geriatrics Summer Scholars Program to address this health human resource challenge. The Savlov/Schmidt Geriatrics Summer Scholars Program provides a unique and structured learning opportunity for students to gain valuable research or project experience in a health care setting and encourages them to consider a future career in the fields of ageing and geriatrics. In the program, students are assigned a mentor that supervises them as they work on individual research projects. Students also have the opportunity to shadow physicians, geriatricians, nurses and other allied health professionals in both hospital and community-based clinical settings.
This year, seven students from a variety of disciplines were selected out of dozens of applications received to work with our clinical faculty on projects that investigate a variety of topics related to the care of older adults. Adrian Chan, Asma Hasan, Shionne Hitchman, Wuqi (Qiqi) Lin, Nishila Mehta, Alfiya Mukharyamova, and Lavan Sivarajah were selected to be the 2018 cohort of the Savlov/Schmidt Geriatrics Summer Scholars. We invited the Scholars to share how their project and experience will benefit their own career, as well as the care of older patients in general.
Adrian Chan, MD Candidate, University of Toronto
Mentors: Dr. Shabbir Alibhai (Staff Geriatrician, Sinai Health System) and Dr. Vicky Chau (Staff Geriatrician and Geriatrics Education Director, Sinai Health System)
I worked on a retrospective chart review measuring the frequency and quality of delirium documentation in medical and surgical discharge summaries. Delirium is a disturbance in attention and orientation that fluctuates in nature. It is more common in older adults, and can be caused by infections, medication side effects, dehydration, malnutrition, or being in an unfamiliar environment. When health care providers do not appropriately document delirium in patient charts, the lack of information can lead to adverse medical events and hospital readmissions once the patient has returned to the community. Through this experience, I was able to develop my clinical and statistical knowledge, as well as gain a deeper appreciation for the unique challenges older adults face in the hospital. The results from this study highlight the importance of providing more education about proper delirium documentation for physicians and allied health professionals.
Asma Hasan, DDS Candidate, Western University
Mentor: Dr. Howard Tenenbaum (Dentist-in-Chief, Sinai Health System)
This summer, I was involved in patient recruitment and screening for a study investigating the use of mandibular implant retained overdentures (IODs) in older adults who are missing teeth. Researchers have previously demonstrated that implant retained overdentures in the lower jaw are less painful, more stable and have improved oral health-related quality of life compared to conventional dentures. However, dentists have no established criteria to recommend this treatment for older patients. Our study will use neuropsychological and cognitive testing as potential predictors of patient satisfaction with IODs. With results from this study, we hope to establish guidelines to recommend IODs for older patients that can be based on cognitive function cut-off values and then used a priori to determine the likelihood as to whether a patient might or might not respond well to treatment.
Shionne Hitchman, BNsc Candidate, Queen’s University
Mentors: Dr. Samir Sinha (Director of Geriatrics, Sinai Health System) and Ms. Nicoda Foster (Sinai Health System Healthy Ageing and Geriatrics Program Project Manager)
For my summer project, I developed evidence-informed recommendations to improve the outcomes of older adults following manmade and natural disasters, which were endorsed by members of the American Red Cross and the American Academy of Nursing. With the support of my supervisors, Dr. Samir Sinha and Nicoda Foster, I conducted a systematic review of the factors that make older adults more vulnerable to adverse outcomes during disasters, existing gaps in disaster management and successful interventions. After reviewing the evidence, I created a list of recommendations that were assessed by a panel of experts from various professional fields related to disaster management. Through a consensus-building process, I gathered the opinions of experts to finalize a list of 25 recommendations. I am currently in the process of finalizing a white paper that will present the results of the systematic review and contextualize the recommendations that were developed across six emergency management domains:
- Older adults and caregivers
- Community services and programs
- Health care professionals and emergency response personnel
- Care institutions and organizations
- Policy/legislative reforms
- Research
We hope that this project will go on to better prepare the nation to respond to disasters more effectively, while keeping the goal of protecting the safety of older adults in mind.
Wuqi (Qiqi) Lin, PharmD Candidate, University of Toronto
Mentors: Dr. Samir Sinha (Director of Geriatrics, Sinai Health System), Ms. Sabrina Haq (Geriatrics Community Outreach Team Pharmacist, Sinai Health System) and Mr. Chris Fan-Lun (Geriatric Medicine Consult Service Pharmacist, Sinai Health System)
My project was a descriptive analysis of the Independence at Home Community Outreach Team (IAHCOT) Pharmacist-Driven Medication Reviews. While working on this project, I experienced every aspect of research from literature review, research ethics board application, data collection and analysis to presentation, report writing, and now preparing conference submissions. We found that amongst 171 patients who received a home medication review from the IAHCOT Pharmacist, 76% used at least one high-risk medication as per Beer’s Criteria, which is an evidence-based list of inappropriate medications for older adults. The pharmacist identified 827 drug therapy problems, and made 1,088 recommendations – 74% of which were implemented! This goes to show that a home-visiting pharmacist does have the potential to identify large number of drug therapy problems, and make recommendations that are well accepted.
Nishila Mehta, MD Candidate, University of Toronto
Mentor: Dr. Sangeeta Mehta (Staff Intensivist, Sinai Health System)
This summer, I had the opportunity to lead a quality improvement study looking at reducing inappropriate use of Proton Pump Inhibitors, a class of medications that are often prescribed without indication, or for longer durations than recommended. This is important because polypharmacy amongst older adults can result in adverse drug events, drug interactions, and non-compliance. As such, health care providers should de-prescribe medications where they are not needed. I collected and analyzed patient data from five hospital divisions, and prepared a manuscript and presentations. We hope that this study will help to promote an institutional focus on de-prescribing in the elderly.
Alfiya Mukharyamova, MD Candidate, McGill University
Mentors: Dr. Samir Sinha (Director of Geriatrics, Sinai Health System), Ms. Nicoda Foster (Sinai Health System Healthy Ageing and Geriatrics Program Project Manager) and Ms. Vicki Lau (MAUVE+ Program Elder Life Specialist, Sinai Health System)
The Maximizing Ageing Using Volunteer Engagement Plus (MAUVE+) Program is designed to provide specialized training to hospital volunteers to allow them to engage with at-risk frail older patients in order to help these patients improve their experience and minimize functional loss and risk of delirium. As part of my summer project, I conducted a retrospective data analysis of the MAUVE+ database and staff and volunteer surveys. I looked at the demographic and clinical characteristics of patients that have been enrolled in the MAUVE+ program, the types of interventions that have been carried out by the program’s volunteers, and the levels of staff and volunteer satisfaction with the program. The results from this study will be used to inform a second phase of evaluation, which will assess relevant clinical outcomes associated with exposure to the MAUVE+ program.
Lavan Sivarajah, MD Candidate, University of Toronto
Mentors: Dr. Asenath Steiman (Staff Geriatrician, Sinai Health System) and Dr. Alice Kam (Staff Physiatrist, Toronto Rehabilitation Institute)
This summer, I worked on a geriatric curriculum research project. Specifically, we wanted to see what residents think about implementing a blended learning curriculum for the didactic components of their geriatric rotations. To support this project, I conducted a literature review, which found that there is very limited research in blended learning in medical residency, and in geriatrics. The few studies examining blended learning in geriatrics show that it leads residents to have higher self-efficacy in treating older adults, improved attitudes towards the elderly and improved knowledge. I also assisted in ethics applications, and will be involved in recruitment and interviewing of residents. We are hoping this project will lead to a revamped curriculum that can be introduced in the near future.
Date modified: 2018-09-13
