Using a digital version of the popular whack-a-mole carnival game, participants are measured on how fast they use their fingers to tap certain furry critters – and avoid tapping others – on a tablet screen.

“In the current prototype, we have a ‘go or no-go’ task, where the player tries to hit targets that pop up – for example, raccoons, but not the butterflies,” says Dr. Jacques Lee, a scientist at Sunnybrook Research Institute and a physician in the hospital’s Emergency Department.

According to Dr. Lee, measuring changes in patients’ reaction times to the game-based activities could be a potential predictor of delirium onset.

“We want to find out how long it takes people to do this, if they find it easy to complete and how many errors are made.”

Delirium, characterized by acute confusion and inability to concentrate, is a common occurrence in seniors, especially in an emergency department setting and regardless of the reason that sent them there.

Delirium is a serious condition that may persist for weeks or months and is associated with several negative outcomes, including risk of death, complications after surgery, and problems with memory.

“The key is prevention,” according to Dr. Lee. “Once an older person becomes delirious, it’s difficult to treat or reverse.”

Working with Mark Chignell, a professor of mechanical and industrial engineering at the University of Toronto, Dr. Lee is conducting two innovative studies aimed at better predicting the onset of delirium in seniors in the emergency room, so health-care teams can prevent it.

They’re using video-game-like technology in both research projects.

“The primary objective,” explains Dr. Lee, “is that by better understanding the early course of delirium, we hope to design targeted interventions to prevent it and the many life-altering complications that can follow an episode.”

Informed consent is obtained from elderly patients who fit the profile of someone who might be susceptible to delirium, and then they are asked if they would like to participate in the studies, which use tablet-based apps that measure reaction time and act as potential delirium-screening tools.

Many more versions of the game could be created – say, a timed bingo game – but Dr. Lee also notes that this is just another tool to spot the early signs of delirium. “A lot of clinical experience, judgment and training [are] required to make the diagnosis, [which uses] the standard Confusion Assessment Method (CAM) test.”

The CAM test is a brief, standardized and evidence-based clinical tool that allows health-care professionals who are not trained in psychiatry to quickly diagnose the presence or absence of delirium. The test is considered by many to be the gold standard of delirium detection in both clinical and research settings.

The research is funded by the Canadian Frailty Network (CFN) – a cross-Canada alliance of 45 universities, hospitals and research institutes. CFN supports original research and trains the next generation of health-care professionals and scientists to improve health outcomes for older Canadians across all settings of care.

Delirium can be challenging for health-care providers to diagnose, says Dr. Barbara Liu, executive director of Sunnybrook’s Regional Geriatric Program of Toronto, as well as director of the geriatric medicine postgraduate program at the University of Toronto. A proper diagnosis of delirium requires knowledge of the patient’s baseline or usual cognitive status and there may not be a person available who can provide that background information when the patient is admitted to hospital.

“When delirium occurs in the context of underlying dementia, it can sometimes be challenging for clinicians to tease out whether the patient’s level of confusion is different from their baseline,” Dr. Liu explains.

“Delirium can also present in different ways – the hypoactive [less than normally active] form of delirium may be missed by clinicians when the patient is drowsy and quiet. And delirium, by definition, is fluctuating, so the diagnosis needs to reflect the patient’s symptoms over a period of time. [The patient] may seem fine at one point during the day, but later be more confused.”

So if you see a senior playing a video game at the hospital, it may not be just for fun, it could be part of research to improve future health outcomes for an aging population.

Delirium vs. dementia: what’s the difference?

Onset: The onset of delirium occurs within a short time, while dementia usually begins with relatively minor symptoms that gradually worsen over time.

Attention: The ability to stay focused or maintain attention is significantly impaired with delirium. a person in the early stages of dementia remains generally alert.

Fluctuation: The appearance of delirium symptoms can fluctuate significantly and frequently throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.

Delirium is frequently overlooked or underdiagnosed.

The post Researchers explore using video games as a way to reduce delirium in seniors appeared first on Your Health Matters.

For Teresa Kowalczyk, Sunnybrook’s approach to caring for seniors is not an abstract concept. It’s something that helped save her life.

In April 2009, she was rushed to the emergency department of her local hospital where she was diagnosed with bacterial meningitis, a disease that affects the membranes surrounding the brain and spinal cord. Left untreated, the disease can be fatal in a matter of hours. Patients can suffer damage to the brain after recovery, and speech and mobility can be permanently affected.

Teresa, now 79, was in the Intensive Care Unit (ICU) for six weeks, either unconscious or sedated. She then spent four months recovering at another facility before she entered Sunnybrook’s W. P. Scott Geriatric Day Hospital.

“When I came to Sunnybrook, I was shaking. I didn’t know what to expect, but they were very friendly and had patience with my disability,” says Teresa, who is still relearning some speech skills following her illness. “They paid attention to my needs. After a few visits, I felt like I was at home. There were many activities like physiotherapy and painting. Everyone has a smile on their faces, and they treated me with respect, as a normal person.”

For Teresa’s husband, Victor, it was a turning point. “Sunnybrook’s Day Hospital was the missing link,” he says. “That’s where Teresa started to be an independent person again. She can take Wheel-Trans by herself. She is gardening, she can walk to the hairdresser. I couldn’t imagine it when she could only move one finger [in the ICU]. The program is tremendous.”

As a senior citizen who spent many months under Sunnybrook’s care, Teresa’s case is typical of the demographic shift that is happening at hospitals across Canada.

Senior citizens are the fastest-growing age group in Canada, which means health-care professionals have to pay attention to the unique needs, opportunities and challenges presented by this bulging population cohort.

How significant is the greying of Canada? According to Statistics Canada, about five million Canadians were aged 65 or older in 2011. This number is now expected to double in the next 20 years, reaching 10.4 million seniors by 2036. From a health-care perspective, the aging of the baby boom generation, combined with an increase in life expectancy, means taking a different approach to patient care.

[mks_pullquote align=”left” width=”300″ size=”24″ bg_color=”#2f56a5″ txt_color=”#ffffff”]
“Sunnybrook’s Day Hospital was the missing link. That’s where Teresa started to be an independent person again.”
– Victor, Teresa Kowalczyk’s husband [/mks_pullquote]

In 2011, the most recent date for which statistics are available, 52 per cent of the patients served by Sunnybrook’s programs (excluding women and babies, and veterans) were over 65 years of age. Although seniors made up 14 per cent of the population in 2011, they accounted for 63 per cent of all in-patient days in Ontario.

Sunnybrook, which has a distinguished history of caring for seniors, recognized the population shift early and made senior-friendly care a priority almost a decade ago.

“It’s not just about being nice to older people,” says Dr. Barbara Liu, a geriatrician at Sunnybrook and executive director of the Regional Geriatric Program of Toronto. “Senior-friendly care requires a comprehensive approach to implementing best practices, providing an accessible environment, overcoming systemic barriers and addressing all aspects of care delivery, from attitudes to the emotional and behavioural side. Seniors often have the greatest needs, yet they are the most reluctant to ask for help.”

One of the challenging areas where Sunnybrook and other hospitals are making strides is with elderly patients who have delirium, an acute and fluctuating state of confusion characterized by inattention, disorganized thinking and changes to level of consciousness. New ways of treating delirium and reassessing current methods with an eye toward less reliance on drugs are aimed at improving outcomes for patients. This grew out of a concern that seniors, particularly those in long-term care facilities, are being overprescribed powerful medications that can have major side effects. A February 2016 report from the Canadian Institute for Health Information found that 39 per cent of long-term care residents were prescribed an anti-psychotic drug at least once in 2014.

The Sunnybrook senior-friendly team addressed the problem with a grant from the hospital’s Alternate Funding Plan (AFP) Innovation Fund to start its Anti-psychotic Stewardship Program.

“The program is a second look at elderly patients who are prescribed anti-psychotic medications, a class of drugs used to reduce or relieve symptoms of psychosis such as delusions or hallucinations,” says Deborah Brown, a nurse practitioner. “We’re piloting an anti-psychotic stewardship program which is the first of its kind in an acute care setting.”

Deborah Brown discusses delirium with a patient. (Photography by Doug Nicholson)

Brown says delirium is preventable, but barriers persist, including gaps in understanding its root causes. She says simple things like speaking to community care providers and engaging more with family members of patients are critical to more person-centred care, rather than seeing someone solely as a patient.

“Using validated screening tools such as the Confusion Assessment Method [CAM], we can get a better idea if there has been changes to a patient’s baseline, which is how they were before they came to the hospital,” says Brown. CAM is a screening tool that allows clinicians to efficiently assess for the presence of delirium.

Another key area of focus is mobilizing patients early in their hospital stay. The act of walking or even moving from a hospital bed to a chair is better than bed rest and this has shown to reduce the incidence of delirium, as well as a reduced length of stay.

Keeping patients moving is especially important considering up to one-third of older patients experience a decline in their function as a result of being immobile during their hospital stay.

“Patients can lose 5 per cent of their muscle strength per day of bed rest, so the early mobilization strategy is critical, whether it’s a simple exercise or walking. It gets patients moving three times a day,” says Jocelyn Denomme, a physiotherapist and mobility lead for the Senior Friendly Strategy at Sunnybrook.

One of the keys to mobilizing elderly patients at Sunnybrook was the introduction of Healthy Stay Volunteers five years ago. Young people accompany patients on walks and help them navigate the hospital’s often busy corridors or help elderly patients stay oriented by paying friendly visits. What started out as a small program of about 40 to 50 people has grown into a major network of more than 600 volunteers.

Sunnybrook is also the co-lead site for Mobilization of Vulnerable Elders in Ontario (MOVE ON). The program promotes early and consistent mobilization of hospital patients throughout their hospital stay. MOVE ON grew from a joint initiative of Sunnybrook and St. Michael’s Hospital, to a 14-site provincial collaboration funded by the Council of Academic Hospitals of Ontario (CAHO). It has now reached beyond these 14 hospitals to include over 40 hospitals in Ontario.

Outside the hospital, Sunnybrook has formed partnerships with Emergency Medical Services (EMS) services in Toronto, and Halton and Peel regions to have hospital clinicians shadow paramedics during their calls in the community.

“This is a collaborative effort, to determine how we can better understand the person and how they were functioning prior to hospitalization, which is essential information for  care providers,” says Beth O’Leary, program manager, Senior Friendly Strategy & Best Practice Implementation. “This helps to guide the delivery of appropriate care and best practice.”

Dr. Liu says one of the keys to changing how health-care professionals deliver care to an aging population is changing our language and attitudes. “Ageism is one of the last accepted forms of discrimination, but I’m hopeful this will change because of the progress in other domains for example, how we talk about and view mental health and disability,” she says. “Hopefully, society will catch up on this issue, too.”

Looking after the health-care needs of seniors is a complex process with many challenges. Through innovative best practices, knowledge sharing and a return to some basic care approaches, Sunnybrook is helping to make an aging population’s golden years live up to their promise.

Growing old gracefully

Veterans have fought in war, now they are facing new battles of deteriorating health and dementia.

That’s where Sunnybrook’s Veterans Centre plays an important role. Nestled on the hospital’s leafy grounds, it is the largest veterans’ care facility in Canada. Working in partnership with Veterans Affairs Canada, the Veterans Centre provides long-term care to 475 veterans from the Second World War and Korea.

Opened in 1948 by Prime Minister William Lyon Mackenzie King, Sunnybrook was originally founded as a hospital for war veterans, a place for the courageous men and women who served our country to heal and readjust to life at home.

Sunnybrook pioneered new procedures in the diagnosis of musculoskeletal problems, spinal cord injuries, cardiovascular conditions, plastic surgery and rehabilitation medicine for soldiers returning home with devastating injuries.

Today, residents live as independently as possible in the Kilgour wing, George Hees wing and the Dorothy Macham Home. Care is divided into four main categories: physical support, cognitive support, mental health support and palliative care (for veterans, as well as community patients). With the generous support of Veterans Affairs Canada, myriad unique recreation, music and art therapy programs and outings are an integral part of daily life and are designed to maximize quality of life for the residents.

Along with specialized cognitive support care units, the Dorothy Macham Home provides a therapeutic, home-like setting for 10 veteran residents who have aggressive behaviours related to dementia, and sometimes complicated by post-traumatic stress disorder. The unique design of the home was the result of extensive consultation with both national and international experts in dementia care.

Sunnybrook is committed to the welfare of Canada’s war veterans. If you would like more information about the Veterans Centre, visit sunnybrook.ca/veterans.

For eligibility and admission inquiries, please contact Veterans Affairs Canada directly at 1-866-522-2122.

The post Making strides in health-care approaches for seniors appeared first on Your Health Matters.

Daphne, now 93, is a volunteer and watercolour artist whose artwork appears throughout the hospital, including on the ceiling tiles. These tiles are installed in patient care areas such as emergency, X-ray, chemotherapy and radiation rooms.

“They’re in every room possible,” says Daphne, who has painted about 30 tiles. She’s been around long enough to see in practice what science has now established − that there’s a connection between visual art and the brain’s ability to alleviate stress, anxiety and pain. Art provides a chance for patients to go to another place − a respite on the often long road to recovery following a life-changing event, such as a cancer diagnosis or a traumatic injury. And ceilings and bare hospital walls have proven to be prime real estate for helping improve the patient experience.

Daphne’s art doesn’t just make life brighter for patients, employees and visitors. It has also become an important part of the fundraising mix at Sunnybrook. She has been selling cards featuring her watercolours since 2008. Last year alone, Daphne sold about 200 packs. Over the years there have also been corporate requests for large purchases. One organization ordered 1,000 cards.

For Christmas, cards are printed from paintings by local artists entered in a competition every year organized by Daphne. These are sold in packets of 10 in the gift shop and around the hospital for the holidays. Daphne’s watercolours of Mclean House, Vaughan Estate, the historic Kilgour House, the hospital and the Odette Cancer Centre are sold in packets of 10 year round in the gift shop.

“It’s very gratifying when people buy the cards,” says Daphne. “I’m very pleased to help. It’s a constant thing; the hospital can use the cards for fundraising forever. It’s very, very special.”

Through the Sunnybrook Volunteer Association, ceiling tiles can be sponsored by donors and come with a plaque, complete with the artist’s name and information about the work. With a $125 donation, one of the four-feet-by-two-feet ceiling tiles can be customized and hung in the hospital.

Daphne hasn’t always been a painter, but after hearing a CBC radio interview with famed Hungarian-Canadian-American watercolourist Zoltan Szabo one day in the early 1970s, she resolved to pick up a brush and take a course. She says painting in oil or acrylic is fine, but watercolours present a unique challenge because they move. “Sometimes,” she says, “they go where you don’t want them to go.”

“A lot of people get discouraged if they don’t paint a masterpiece after the first class,” says Daphne, whose kitchen acts as her studio. “I’m a very determined person, and I was fortunate to take one or two workshops with Szabo. He said most people have it quite wrong when it comes to painting. He said anyone can do it. You just have to keep at it.”

Determination defines Daphne’s extraordinary volunteer journey at Sunnybrook. Her first role, long before the age of smartphones, tablets and on-demand video, was working on a pilot project to help patients access television service during their stay.

She remembers first being approached to volunteer at the hospital.

“A very good friend asked, ‘Can you start this afternoon?’ I said, ‘No, but I can come in tomorrow,’” she says. It’s been a great match ever since.

[mks_pullquote align=”right” width=”300″ size=”24″ bg_color=”#2f56a5″ txt_color=”#ffffff”]“Daphne’s caring and commitment to Sunnybrook exemplify the true spirit of volunteerism.”[/mks_pullquote]Daphne, who was a bookkeeper in her working days, then became treasurer of the Sunnybrook Volunteer Association before overseeing the hospital’s Fine Arts Program, which invites local artists to submit their work to be displayed on Sunnybrook’s walls. She not only led the program, but was also one of its artists.

It was around that time that Daphne convinced her husband, Stan, to join her as a Sunnybrook volunteer. The two of them logged a remarkable 60-plus years of volunteer service, including 25 years together. Sadly, Stan passed away in February 2015. They had been married for 65 years.

“Daphne’s caring, creativity and commitment to Sunnybrook exemplify the true spirit of volunteerism,” says Katherine Alexopoulos, director of volunteer resources at Sunnybrook. “She and Stan initiated and led numerous projects that have had so many positive impacts at the hospital. If it’s about helping to improve the patient experience in some way, Daphne’s attitude has always been, ‘We can do this!’ She is well-loved, well-known and admired for her many contributions and accomplishments.”

A hospital can be a sterile and imposing place. The painted ceiling tiles offer warmth and colour, and there are now almost 600 of them to help Sunnybrook patients on the road to recovery.

One patient in particular had a lasting impression on Daphne. “She had been in a car accident and could not move,” recalls Daphne.

“She could only move her eyes. She said, ‘I really love dolphins.’ I had never drawn a dolphin in my life, but she was absolutely delighted with the ceiling tile. She took it with her when she left, and I will always have that connection with her.”

During the SARS outbreak in Toronto in 2003, there were extensive restrictions on family and friends visiting patients, and everyone was under stress.

“We were the only volunteers,” she says. “The nurses, staff and patients really appreciated looking at the art at that time.”

Whether it’s painting old stone houses or recreating van Gogh’s The Starry Night, Daphne says she loves to help bring colour into patients’ lives – and critical fundraising dollars to Sunnybrook.

“It’s such a worthwhile thing to do,” she says. “It has made such a difference in my life to have the chance to help the hospital and help the patients.”

Watch a video featuring Daphne and her artwork (filmed in 2011):

Photograph at top by Doug Nicholson

The post Meet the volunteer whose artwork brightens patients’ stays appeared first on Your Health Matters.