Tuesday, January 17, 2017

Why we can't dismiss caring for the old

The health-care system must do better at addressing conditions that restrict how we live as we get old

By Kenneth Rockwood
Troy Media
Kenneth Rockwood
Click image for Hi-res
HALIFAX, N.S. /Troy Media/ - Should medicine be ageist?
A young trainee doctor recently proposed to me that it should. Health care is overstretched, she argued. "We can't do everything for everyone, so why spend money on old people, who have little chance of benefit?"
For her, ageism is not all that bad - in fact, it's a practical response to limited resources.
I'm unpersuaded. Ageism is not benign. We fail older people when we treat them, as typically we do, in ways that are at odds with how ageing works. Ageism masks our need to do better.
The challenge is the complexity of ageing. With age, almost all diseases become more common.
Health care has become pretty good at assembling teams that specialize in specific problems, creating focused, subspecialized care.
And patients do best when their single illness, no matter how complicated and no matter what their age, is their main problem. Subspecialized care may work very well for them.
But as we age, we're more likely to have more than one illness and to take more than one medication. And as we age, the illnesses that we have are more likely to restrict how we live - not just outright disability, but in our moving more slowly or taking care in where we walk, or what we wear or where we go.
Not everyone of the same age has the same number of health problems. Those with the most health problems are frail. And when they're frail, they do worse. Often, those with frailty do worse because health care remains focused on single illness. Our success with a single-illness approach has biased us to think that this is the approach we should always take.
When frail people show up with all their health and social problems, we see them as illegitimate or unsuited for what we do.
So would the young doctor be right if instead of restricting care in old people, she simply opted for restricting care for frail people? Should frailism be the new ageism?
For health care, such a notion would be self-defeating. If frail patients are unsuited to the care that doctors provide, we must provide more suitable care.
Frail older adults consume a lot of care. Far better that those of us in the health system treat them as our very best customers. That would improve care for everyone.
No one admitted to hospital benefits from poor sleep, but (mostly) we get away with it in our fitter patients. Not so in the frail, in whom it leads to worse outcomes: longer stays, more confusion, more medications, more falls and a higher death rate.
No one benefits from being immobilized too long. No one benefits from not having medications reviewed, or from poor nutrition, or inadequate pain control, or getting admitted when care at home would be better or in not clearly discussing goals of care. Just because the health system mostly gets away with it in fitter patients is no reason to forego change.
Changing routines to improve care will benefit everyone. But it won't happen if we see frailty as an acceptable form of ageism. We need to invest in better care and in better understanding how to design, test and implement it.
As important as subspecialties are, by definition each subspecialty group benefits a small fraction of people. The skills required to provide expert general care, particularly for frail older adults, have been less celebrated. Compared to disease research, ageing and frailty are barely on the funding radar screen.
In any guise, ageism can be insidious. We don't have to go far to find it. I find it in myself when I'm in a long line. It's not the science of how movement becomes slow that saves me then - it's realizing that slowness is not a moral failing, much less one directed at my busyness.
What we do in our health system now fails older people who might benefit if we provided better care. In that way, it fails us all.
Attitudes must change. Medicine should not be ageist. It shouldn't even be frailest. We must work to provide better care for frail older adults, especially when they are ill.
Kenneth Rockwood is a geriatrician in Halifax, N.S., and a researcher with Canadian Frailty Network (CFN), a not-for-profit organization dedicated to improving care for older Canadians living with frailty.
© 2016 Distributed by Troy Media

Monday, January 16, 2017

Move health research out of the academy and into the community
Health changes require greater input by people trained to create a difference - and that's not happening in Canada

By Stephen Bornstein
with Adalsteinn Brown
TORONTO, Ont./Troy Media/ - Canada has a mismatch between the world-class health research we produce and how that research is implemented into our health-care system.
Our doctoral graduates are among the most productive and respected researchers in health services, health policy and health economics - and Canadian universities are often in the global top 10 for these areas of study. Yet our health system continues to underperform.
Where's the disconnect?
Stephen Bornstein
Click image for Hi-Res
The Commonwealth Fund ranks comparable health systems around the world on a number of performance indicators. It continually places Canada as one of the worst performers across a number of categories, such as timeliness, safety and efficiency of care. Only the United States routinely performs worse, sitting at last place overall.
It would be easy to point to health-care funding as the culprit but that's largely not the case.
Canada spends roughly 10.4 per cent of its gross domestic product on health, more than the United Kingdom, New Zealand and Australia.
The truth is, we often don't manage our health system well.
But much can be done to lift Canadian health care out of its poor standing.
Over the last several decades, a number of studies from experts inside and outside of Canada have pointed out the gap between the performance of our system and the level we should expect.
Adalsteinn Brown
Click image for Hi-Res
Landmark reports from Manitoba and Ontario show that a patient's likelihood of getting needed surgery depends heavily on where they live. Studies also show a huge gap between what we know to be effective and appropriate care and what people actually receive. And a study from over a decade ago shows that nearly one in 13 hospital visits resulted in adverse health events with nearly nine per cent of these ending in preventable death; a follow-up study last year shows that little has changed.
We can do better, but how?
Health system changes require greater input by people trained to create and use evidence to design, implement and evaluate them. That's not happening in Canada.
Every year, more than $3.5 million is invested in the training of health-care-related PhDs in Canada. But for the majority of them, the likelihood of academic employment is low and declining. In fact, the vast majority will work in health services and management fields, not academia. Yet our doctoral programs in health sciences don't prepare them for such work.
An extensive interview-based study found that our recent health PhDs are not having the impact they could have on Canada's health system - the sort of impact that many of our most advanced graduates with PhDs see as the goal of their careers and the reason for their training. While well prepared in academic terms, they lack preparation in the managerial and leadership skills necessary to make tough decisions based on evidence with a relentless commitment to evaluation and improvement across the system.
We can change this - and we've started to.
Over the past two years, the Canadian Health Services and Policy Research Alliance has worked with experts to improve the impact of Canadian PhDs on the quality and sustainability of our health system - by changing the training and preparation they receive.
It's time to move health research out of the academy and into the community.
We now provide experiential learning opportunities during and after PhD training, where individuals get the opportunity to work with hospitals, government agencies and other health-care providers in the community - to apply their skills and findings directly in the service of health system improvement.
We're building an open source curriculum to teach health PhDs essential managerial and leadership skills they need to make sure their expertise gets translated into better decisions across our health system.
Discussions about health funding will always be important, but we need to make sure we have the personnel to make the system better, regardless of the dollars transferred between levels of government.
We have a great resource in Canada's university-based training programs in health services and PhD graduates who want to make a difference. Now we need to make sure they have the opportunity.
Adalsteinn Brown is an expert advisor with EvidenceNetwork.ca, the director of the Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair in Public Health Policy at the University of Toronto. Prior roles include senior positions in the Ontario government. Stephen Bornstein is director of the Centre for Applied Health Research and a professor at Memorial University. Prior roles include senior positions in the Ontario government.
© 2016 Distributed by Troy Media

Monday, January 9, 2017


  Here are a few other 2016-2017 holiday hits:
  • The alpine touring craze is confirmed: sales of rando-ski passes are up, and so are equipment sales at the Boutique Expérience SUTTON, which had counted on the trend and acquired an even more specialized back country equipment this year.
  • The boutique has also experienced a 140 % increase in helmet sales, and a 150 % increase in goggle sales, in comparison to an average year, mostly in response to its even wider selection and improved layout.
  • New skiers were also three times as many to pick up a new winter sport this holiday season with our initiation packages.
  • Monday pass and Friday pass sales (168 $) are still increasing, making this year their best since their introduction.

More activities to come

Even though the holiday excitement is over, Mont SUTTON is not slowing down. From January 10th to February 16th, those 50 and over, men, and women are all celebrated on their own 25 $ ski days: 50+ Club Tuesdays, Suits and Ties Wednesdays, and Divas on Skis Thursdays. What’s more, every weekend, skiers are encouraged to take a pair of new skis out for a run for free from our demo deck. An ideal way to try before you buy from the Boutique Expérience SUTTON! For all upcoming activities at Mont SUTTON: www.montsutton.com/activities.  

Friday, January 6, 2017

Potato and Greens Frittata

An easy, tasty meal—for breakfast or any time.


Recipe: Potato and Greens FrittataYou can use sliced Canadian bacon for a lower-fat version of this hearty egg dish.
Serves: 6
Prep:  5 min
Cook: 30 min
Total: 40 min
  • 1½ tablespoons olive oil
  • 2 large sweet onions, thickly sliced
  • 1 teaspoon coarse salt
  • ¼ teaspoon pepper
  • 2 teaspoons balsamic vinegar
  • 1¼ cups cubed (½ inch) cooked potatoes
  • ¾ cup cooked greens, such as mustard or kale, chopped
  • 2 slices bacon, cooked and crumbled (optional)
  • 8 large eggs, beaten
1. Preheat the oven to 350°F.
2. In a 10-inch ovenproof skillet, heat the oil over medium heat. Add the onion slices, 1/2 teaspoon of the salt, and 1/8 teaspoon of the pepper. Cook, turning with tongs, until well browned, about 10 minutes. Sprinkle with the vinegar and cook 1 minute longer.
3. Add the potatoes, greens, bacon (if using), and remaining 1/2 teaspoon salt and 1/8 teaspoon pepper. Pour the eggs over the vegetables and stir to blend. Cook over medium heat until the mixture begins to set, about 3 minutes.
4. Place the skillet in the oven and bake for 15 minutes, or until set. Let stand 5 minutes, then invert onto a platter. Cut into wedges to serve.
Nutritional Facts per serving
Calories     213.8 cal
Fat     11.3 g
Saturated fat     2.9 g
Cholesterol     284.9 mg
Sodium     557.5 mg
Carbohydrates     17.7 g
Total sugars     6.8 g
Dietary fiber     2 g
Protein     11.2 g
Courtesy of the Rodale Healthy Recipe Finder.

Thursday, January 5, 2017




To expedite the review and approval process for over-the-counter sun care, the US Food and Drug Administration issued new guidelines this week, outlining the data required to demonstrate that sun care ingredients are generally recognized as safe and effective...