Geriatrics

Division of Geriatrics

Key Publications

Wilding L, DiMillo AM, Gilsenan R, Dalziel B, Milne K. Promising Best Practice: The Champlain Geriatric Emergency Management Plus (GEM Plus) Program. CGS J CME 2015; Vol 5(1):6–8.

Byszewski A, Gill J, Lochnan H. Socialization to professionalism in medical schools: a Canadian experience. BMC Med Educ 2015;15:204.

Rapoport MJ, Weegar K, Kadulina Y, Bédard M, Carr D, Charlton JL, Dow J, Gillespie IA, Hawley CA, Koppel S, McCullagh S, Molnar F, Murie-Fernández M, Naglie G, O’Neill D, Shortt S, Simpson C, Tuokko HA, Vrkljan BH, Marshall S. An international study of the quality of national-level guidelines on driving with medical illness. QJM 2015;108(11):859–69.

Huang, A.R., Redpath, C.J., van Walraven, C. The influence of cholinesterase inhibitor therapy for dementia on risk of cardiac pacemaker insertion: a retrospective population-based health administrative databases study in Ontario, Canada. BMC Neurol 2015; 15:66.

Huang, A.R., Mallet, L. (Eds). Medication-related falls in older people. Causative factors and management strategies. Springer, New York, 2016. 261 pages. ISBN 978-3-319-32304-6.

  1. Huang, A.R., Mallet, L. Chapter 1. Introduction
  2. Horsley, P., Huang, A.R. Chapter 2. The Ageing Population and Falls
  3. Huang, S.C.C., Forster, A. Chapter 7. Adverse Events and Falls
  4. Lemay, G. Chapter 11. Drugs for Degenerative Neurologic Conditions: Antiparkinson Medications, Cholinesterase Inhibitors and Memantine.
  5. Huang, A.R. Chapter 19. The Role of Information and Communication Technologies.
  6. Huang, A.R. Chapter 21. Future Directions.

 Key Grants

McIsaac D, Wijeysundera D, Huang A, Kendall C, Corsi D, van Walraven C. Optimizing the Care of Frail Elderly Patients in the Perioperative Period (Phase 1): A Population-Based Analysis of Structures and Processes of Care to Inform the Design of a Perioperative Surgical Home for Frail Elderly Patients. Canadian Anesthesiologists’ Society New Investigator Award.

Hudson J, Momtahan K, Chan J, Huang AR, et al. eHandover: Improving the quality and safety of patient care handover with an electronic tool. TOHAMO Innovation fund

Lee TC, Macdonald EG, Downar J, Tamblyn R, Pilote L, Forster A, Huang AR et al. Reducing post-discharge potentially inappropriate medications amongst the elderly: a multicenter electronic deprescribing intervention. TVN Catalyst Grant 2015.

 

 

Mission: To provide each older adult and their families with the world-class care, exceptional service and compassion that we would want for our loved ones.

Overview

Geriatric Medicine is a branch of Internal Medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life.

The Division of Geriatric Medicine and the Regional Geriatric Program of Eastern Ontario (RGPEO) are based at the Civic Campus of The Ottawa Hospital. A well-coordinated and comprehensive range of specialized Geriatric services is provided throughout the region. The Division is considered a leader in medical education targeted at the Undergraduate, Postgraduate and CME levels with a particular focus on assessment tools for Dementia and Delirium. This expertise is also linked to clinical research activities focused on the assessment of Driving in the Older Person and Dementia Care.

Our Division recently underwent a Strategic Planning Exercise. This resulted in a 5-Year Plan, which will allow us to be pro-active in the face of future patient needs, hospital budgetary pressures and to be amongst the leaders in the changing landscape of the health care system. Geriatric Services are a vital part of the Ottawa Hospital as it strives to implement a Senior-Friendly Hospital Initiative. Current Geriatric Services at The Ottawa Hospital include the Inpatient Geriatric Medicine Unit, the Geriatric Medicine Ambulatory Services and Day Hospital, and the Enhanced Geriatrics Consult Service.

Currently, ten Geriatricians work at the Ottawa Hospital. Our physicians’ clinical expertise and focus fall in four main categories or  M4, which represent drivers that lead to becoming HIGH RISK seniors:

  • Mind (delirium, dementia, depression and behavioural problems): Dementia is the NUMBER ONE disease driving up ALC rates and accounts for 1/3 of hospital ALC days
  • Mobility (falls): MOST COMMON cause of injury, 6th leading cause of death, accounts for $6.2B costs, is a large contributor to ALC
  • Medications: 15-30% of all admissions have medication side-effects as a causative or contributing factor
  • Multicomplexity: Multiple interacting chronic diseases contribute to a loss of function which often leads to long-term care institutionalization

These areas capture the WHY our physicians choose Geriatric Medicine: To ensure that older people, especially those who are frail and vulnerable get the best possible health care in order to give them a chance to live their remaining lives to the fullest.

Clinical Services

The Division of Geriatric Medicine provides a well coordinated comprehensive range of specialized Geriatric Interdisciplinary assessment services. Patient care settings include inpatient and outpatient care at The Ottawa Hospital, rural and regional clinics and the GEM (Geriatric Emergency Management) Program. The Civic Campus is the major Eastern Ontario Referral Center for the outpatient assessment of elderly individuals with complex medical problems associated with common Geriatric issues such as cognitive and functional decline, falls, and polypharmacy.   A holistic assessment and management is done with a multidisciplinary approach to care.

Our Division specializes in the clinical care and development of programs for High Risk Seniors (those at high risk for admissions, readmission, ALC, ED presentation, return to ED) in the Champlain Local Health Integration Network (LHIN). The clinical care portfolio of the Division involves several critical roles:

1. Keeping hundreds of high risk seniors out of hospital every year by

    • assessing and implementing services for the 1200 seniors seen in the Geriatric Medicine Ambulatory Services and Day Hospital
    • reviewing and recommending management plans for the 1800 seniors reviewed with the RGPEO Geriatric Assessment Outreach Teams (GAOT)
    • assessing and implementing services for the 3500 seniors seen in the EDs by members of the RGPEO Geriatric Emergency Management (GEM) Program before returning back to the community

2. Helping discharge high risk seniors back to the community by

    • assessing and planning services for the 350 seniors discharged from the geriatric inpatient unit annually
    • assessing the 1380 seniors seen by the consult team annually
    • developing and assisting in the care plans of the 150 seniors seen in follow-up

3. Providing leadership for innovative TOH Seniors’ initiatives

    • MOVE-ON*
    • Delirium programs **
    • Senior Friendly Hospital Initiatives

* The MOVE-ON project (Mobilization Of Vulnerable Elders – ONtario) involves the early mobilization of hospitalized older adults to avoid complications of deconditioning. This project is part of the Senior Friendly Hospital Initiative at The Ottawa Hospital, and currently being deployed across TOH thanks to continued MOH funding.

** Delirium Programs. We started with identification, assessment and management of delirium in patients older than 75-years in the post-operative period following a hip fracture. Early identification of delirium will result in improved patient outcomes, and decreased LOS and ALC numbers. This program will be moving to the Vascular Surgery Service in 2014-2015.

Faculty of Medicine Educational Activities

The Division of Geriatrics provides outstanding Undergraduate, Postgraduate and Continuing Professional Medical Education. The Ottawa Program is considered a leader in Geriatric education in Canada with a particular emphasis on the assessment of Dementia, Delirium, and Driving safety in those with Cognitive Impairment. Members of the Division also provide leadership at the University of Ottawa in the areas of Professionalism, Clinical Skills and in Gender Related Health Issues. Members participate on a regular basis as tutors for Physical Examination Skills Development, Case Based Learning, Integration Block, Professionalism Small Group Sessions and coaching E-Portfolio groups. They also take part in Undergraduate and Postgraduate OSCE and Academic Half Days. Clinical supervision and teaching is provided to an average of 10 trainees during each four week rotation.

View “What kind of doctor do you want to be? Podcast on Geriatric Medicine”

  • Our video is a compilation of testimonials from Canadian physicians and trainees in geriatric medicine, describing geriatric medicine and the advantages of pursuing the specialty as a career. Our hopes are to inform students about geriatrics, promote postgraduate training in the field and change trainee perspectives and attitudes toward the specialty.
  • All participants have signed consent forms and there are no conflicts of interest.

Examples of Leadership in Medical Education

Dr. Anna Byszewski is the Anglophone Director of the Undergraduate Professionalism Curriculum for at the University of Ottawa where she piloted the P-Mex tool for the evaluation of student professionalism. She is also the Content Expert for the Faculty Development for the “E-Portfolio” Program and the Geriatrics Rotation Coordinator for all External Medical Students and Residents rotating through Geriatrics. She is actively involved in several educational research projects, including Evaluation of the Learning Environment and Evaluation of the E-Portfolio Program.

Dr. Barbara Power is the Anglophone Director of the Undergraduate Clinical Skills Program at the University of Ottawa and she is the Program Director for the Geriatric Medicine Training Program. She is actively involved in several education research projects including evaluation of the community preceptor program and the interviewing skills curriculum.

Dr. Ruth Ellen serves as the content expert for the core teaching of Geriatric Medicine during the Integration Block.

Dr. Nahid Azad continues to lead the Integration of Gender and Health Education in the U.O. undergraduate curriculum. She is also an Editorial Board Member of the Journal of Geriatric Cardiology.

The members of the Geriatric Division actively participate in the training of CCAC Assessors serving the local LHIN as well rural LHINs throughout Ontario. Our members regularly participate in a variety of educational activities including: the Department of Medicine Grand Rounds, RGPEO rounds, local service multi-disciplinary educational rounds, and national and international conferences and meetings.

Honours and Awards

Our division is extremely proud to have the following members in Departmental, University and National leadership positions. These include:

  • Dr. Anna Byszewski—Anglophone Director of Professionalism in the Faculty of Medicine; assistant Anglophone Co-Chair of the “e-Portfolio” Program and the Geriatrics rotation coordinator for all medical students and residents.
  • Dr. Lara Khoury—Geriatric Medicine residency training Program Director, University of Ottawa.
  • Dr. Frank Molnar—Vice-President of the Canadian Geriatrics Society; the Editor-in-Chief of the Canadian Geriatrics Society CME journal.
  • Dr. Barb Power—Anglophone Director of the Clinical Skills Program and the Physical Skills Development in the Faculty of Medicine, University of Ottawa; Department of Medicine Vice-Chair for Education.
  • Dr. Ed Spilg—Department of Medicine Vice-Chair for Physician Health and Wellness.