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Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist! 

If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact QMA. We would be pleased to showcase your achievements.

Is there a need to review the organization of elder care?

Stéphane LemireBy 2031, it is estimated that Québec will have more than 2 million people 65 years of age and older. If the Québec health care system wants to be able to manage the care of its elderly, it must change. While the federal government just created a Minister of Seniors and appointed Filomena Tassi to the position (read the article A new Minister of Seniors for Canada), in Québec the focus is on keeping seniors at home with the first government policy on aging: Aging and Living Together, At Home, in One’s Community, in Québec.

However, according to some, the way geriatric care is provided in Québec could be improved to offer seniors more appropriate health care services. Geriatrician and QMA member Dr. Stéphane Lemire, for instance, tried a new approach with social geriatrics for two years. He feels that there are gaps in the organization of elder care, namely a lack of nearby services in the communities.

Greater decision-making autonomy for seniors

With social geriatrics, Dr. Lemire feels that people’s independence can be maximized. It enables medical care to be integrated into a global approach to the health of seniors with components of prevention, diagnosis and establishing a rehabilitation plan as needed. While current services cover part of these aspects, they do not offer everything, and certainly not always with the unconditional respect for the wishes of seniors. Social geriatrics makes it possible to consider not only functional independence, but also decision-making autonomy.

“I saw several people who had iatrogenic problems, caused by a traditional biomedical approach whereby the aim was to bring about improvement by using medication without considering the quality of life,” explained Dr. Lemire.

Providing elder care is not just making them healthy again, either by reducing the symptoms of certain illnesses, or by improving their autonomy, but also by following up on their quality of life and social integration when they return home. In a community environment, patients will participate in activities, be in contact with people and be able to rebuild a network for themselves. “There is a lot of isolation and solitude among seniors, and taking care of them is not just adjusting their medication or calling an occupational therapist to assess them, but also sometimes giving meaning to their lives,” stated Dr. Lemire.

The importance of nearby care

One of the foundations of social geriatrics is how close stakeholders are to seniors and the support of an entire traditional interdisciplinary team, with physiotherapists, occupational therapists, social workers, etc., to provide follow-up. Too often, in our health care system, seniors are directed to resources based on their level of health, which forces them to adapt to new caregivers and teams whose functioning they do not always understand.

Community stakeholders know these people well and often have seen the patients develop chronic diseases, be hospitalized, return home, lose their independence, etc. All this knowledge is important and nothing can replace it: “When you don’t have a foothold in the community, as a physician, whether it is in geriatrics or social geriatrics, you lack all this knowledge,” pointed out Dr. Lemire.

For two years, this approach was used in a community centre in Québec City’s Lower Town (Basse-Ville), in the Saint-Roch neighbourhood, and it was very conclusive. But the experience was cut short because a way could not be found to tie the social geriatrics into an existing structure in the network.

“There are several financial obstacles for implementing social geriatrics. It cannot be sustained by the community alone, so there must be a degree of resource sharing with the public service, but without allowing the public system to take absolute control of these services,” clarified Élie Belley-Pelletier, executive director of Fondation AGES which participated in the project launched by Dr. Lemire.

Specific issues

So both men went back to the drawing board. “The idea is still to bring the geriatrics expertise into the community. Everyone agrees on the need to bring the care of seniors into the living environments,” stated Dr. Lemire. So, this time, the geriatrician wants to focus on a physician-nurse dyad to bring the geriatric expertise into the community.

For many reasons, namely the fear of catching a disease or being placed somewhere, but also sometimes because they received services that did not really correspond to their reality, vulnerable populations go to the physician later “when the situation is worse”. By being in their living environment, this dyad would be in contact with the stakeholders, a necessary proximity since “they are often the ones who inform them that a certain person has changed,” explained Dr. Lemire.

Other care issues for seniors: the number of geriatricians – there are not enough to work in both the hospitals and the community – but also the fact that this specialty is not always one that attracts the most students. Two related problems for Dr. Lemire, because geriatrics is “super interesting”, but also the way geriatric care is delivered right now is not “stimulating. [...] It is not normal, as a geriatrician to be a specialist in chronic disease and loss of autonomy, but also to take care of patients exclusively at the hospital while they are hospitalized,” he specified.

In short, medical students quickly realize the difference between the role of the geriatrician and what they are asked to do in the field. And that has nothing to do with a question of ageism. Dr. Lemire acknowledges that it exists in the system like everywhere in society, but does not think that “physicians do not like to care for elderly patients, and that’s a fortunate thing, because they represent 50% of patients in hospitals and 25% to 40% of a physician’s practice.”