Anthony P. Lombardo, MA, PhD(c) Network Manager Long Term Care Association of Manitoba

1. National Initiative for the Care of the ElderlyInitiative nationale pour le soin des personnes âgées Anthony P. Lombardo, MA, PhD(c) Network Manager Long Term Care Association of Manitoba October 2008

2. NICE: Context & Background • Unprecedented growth in number and proportion of elderly in Canada • 2005, 4.2 million seniors, 13.2% of population1 • 2036, 9.8 million seniors; 24.5% of population1 • Increasingly multicultural older population2 • Shortage of professionals and students specializing in the care of the elderly • Gaps in interdisciplinary care of the elderly • Gaps in evidence-based care of the elderly 1. Martin Turcotte and Grant Schellenberg, A Portrait of Seniors in Canada: 2006, Ottawa, ON: Statistics Canada, 2007, p. 12. 2. Ibid., p. 23; A. Bélanger and É. Caron Malenfant, Population Projections of Visible Minority Groups, Canada, Provinces and Regions: 2001 – 2017, Ottawa, ON: Statistics Canada, 2005.

3. How many Geriatricians? • 189 geriatricians in Canada – CMA 2003 • 1.25 geriatricians per 10,000 for elderly • 2000/01 only 7 physicians entered post- graduate training for all of Canada • 512 – 607 required geriatricians

4. How Many Nurses? • There are 251,675 nurses in Canada • 26,619 work in geriatric care (10 percent) • 75.9 percent work in long term care • 11 percent in hospitals • Ave. age 47.8 years • 48.6 percent are eligible for retirement - Canadian Nurses Association, 2006

5. How Many Social Workers? • Who knows? • 4 to 5 percent of registered members in gerontology • Two MSW degrees in gerontology in Canada • As of last year, graduate about 15 students a year

6. NICE: A short history… • Funded through Networks of Centres of Excellence – New Initiative Grant • One of only 5 “New Initiative” networks funded • Incorporated non-profit, 2006 • Housed at Institute for Life Course and Aging, University of Toronto • One of only 3 networks awarded International Partnership Initiative grant (2007) • Over 200 members • Diverse disciplines and professions

7. NICE: Network Goals • Networking and Knowledge Transfer • Disseminate evidence-based research across university – community continuum • Foster interdisciplinary teams in the care of the elderly • Improve geriatric and gerontological curricula and enrolment • Address training shortages in the care of the elderly • Effect positive policy changes

8. Central Committees Knowledge Identification Program Development Researcher Training Curriculum Development Professional Development Communications Advisory Committees Business Advisory Seniors Advisory New Committees Policy, Planning and Protocol ICCE Advisory Theme Teams Caregiving Dementia Elder Abuse End-of-Life Mental Health NICE Structure

9. Committee Progress • Researcher Training • NICE Student Mentorship Program • Curriculum Development • Core competencies and accreditation • Knowledge Identification • Web resources on evidence-based practice and teaching tools

10. NICE “Theme Teams” • Action towards interdisciplinary care: Forging unique links • Interdisciplinary teams • Medicine, nursing, social work, and others • Bridging research and practice • Interdisciplinary environments for students • Seniors’ involvement in the teams • Develop user-friendly tools using evidence-based research, translate into practice

11. Theme Team Tools • Caregiving Theme Team • “Respect All” Poster • Designed for staff in long-term care facilities • Placed on facility walls for easy visibility • Suggestions are based upon research evidence • Distributed through Canadian Gerontological Nursing Association • Format & use are being evaluated

12. Theme Team Tools • Caregiving Theme Team • “Caring Calendar” • Designed for family members • Formatted with consideration of behaviour changes • One evidence-based support strategy per month • Distributed through Alzheimer Canada • Format & use are being evaluated

13. Theme Team Tools • Elder Abuse Theme Team • Elder Abuse Suspicion Index (EASI) • Developed by Dr. Mark Yaffe, McGill University • Tool to screen for potential cases of elder abuse • Adapting for use with different health practitioners • Adapting for use in different countries (Israel, England)

14. Theme Team Tools • Elder Abuse Theme Team • Developed by Drs. Myrna Reis and Daphne Nahmiash • Caregiver Abuse Screen (CASE) and Indicators of Abuse Screen (IOA) • CASE: Screen caregivers for potential signs of abuse • IOA: Training practitioners to recognize the signs of potential elder abuse

15. Theme Team Tools • Elder Abuse Theme Team • In Hand (En Main) • Developed by Dr. Marie Beaulieu, University of Sherbrooke (Quebec) • A framework to guide health care professionals in decision-making around suspected/confirmed cases of elder abuse • Original devised in French, being translated/adapted for use with English audiences

16. Theme Team Tools • End-of-Life Theme Team • “What to Expect” Brochure • Includes sections that describe • Physical Changes • Pain Control and Opiate Use • Advance Care Planning and Substitute Health Care Decision-making • Written for friends and family members of the dying person in a respectful and matter-of-fact tone • Could also comfort the dying • Will be placed in palliative care facilities across the country

17. Theme Team Tools • End-of-Life Theme Team • “Capacity & Consent” Tool • Quick reference tool to help health practitioners in understanding law and respecting seniors’ rights • First tool geared to Ontario • Additional tools in development for other provinces and territories

18. Theme Team Tools • Mental Health Theme Team • Depression Assessment Screen • Based on guidelines of the Canadian Coalition for Seniors Mental Health • Tool for family physicians to increase screening of older patients for symptoms of depression

19. Tools in Process • Dementia Theme Team • Assessment and diagnosis tool for family practitioners • Based on Guidelines of the Registered Nurses’ Association of Ontario

20. International Collaboration for the Care of the Elderly (ICCE) • Only NCE-NI to be awarded additional funding through International Partnership Initiative of NCE and International Development and Research Centre (IDRC) • New partnerships with researchers and organizations in:

21. ICCE: Context and Goals • Global aging • Economy of scale in world-wide knowledge on the care of the elderly • Canada’s growing older population • Collaborate with countries with longer histories of meeting the challenges of an aging population • Canada’s growing ethnically-diverse older population • Collaborate with countries with experience in the cultural issues of aging • Critical shortage of geriatric/gerontological professionals • Forum for interdisciplinary collaboration and training

22. ICCE: Partner Responsibilities • Tool Development • Make tools sensitive/relevant to home regions • Knowledge Transfer • Participate in NICE events • Coordinate and conduct KT events in home region • Student Involvement

23. Research Funding Received • Homeless to Home: A Knowledge Exchange • Homelessness Partnering Initiative, HRSDC • Older Women and Domestic Abuse • Status of Women Canada

24. Research Funding Under Review • Recruiting Students into the Field of Aging • Health Human Resources Strategy, Health Canada • Intergenerational Outreach to Improve Recruitment • New Horizons for Seniors Community Participation and Leadership, HRSDC • Improving Older Women’s Financial Literacy • Status of Women Canada • Palliative Care for Older Adults in Institutional Settings • CIHR: Knowledge Synthesis

25. NICE Knowledge Transfer • Website • www.nicenet.ca • NICENews • Available online • Workshops and Symposia • Annual NICE Knowledge Exchange • June 5 – 6, 2008: Toronto, Ontario • www.niceke.ca