Insights (Essays)

Insights (Essays) October 2020

Supporting Canadian Seniors Through Improved Care Systems

Chelsea Smallwood

Seniors 

The COVID-19 pandemic has dramatically changed our lives and highlighted the importance of our healthcare system. It has also brought to light the substantial need to improve care for continuing care residents (long-term care, nursing homes, supportive living facilities) across Canada. The rapid and severe impact of this virus has shown us that the complexity of elderly care compels us to revisit the tools and practices in many continuing care facilities. Ensuring that these facilities are well-equipped to care for our elderly citizens’ physical and emotional health is especially important during these trying times (Junker 2020).

Among the challenges highlighted in a recent military report regarding long-term care practices, staffing and supplies shortages were prevalent, and issues regarding infectious disease management and medication safety were particularly concerning (Fox 2020).

While the management of patients with COVID-19 infections has prompted a more in-depth assessment of the provision of continuing care, infectious disease management and medication safety have been long-standing challenges. Residents of long-term care homes have a high incidence of infections due to their age, comorbidities, use of invasive devices and exposure to infection within the institution (Nicolle 2014). Furthermore, experts have indicated that widespread antimicrobial use in long-term care promotes the emergence and persistence of drug-resistant organisms and leads to adverse effects (Nicolle 2014).

Drug-resistant infections pose a particular risk to older adults (Neergaard 2020). While seniors may be more susceptible to the impacts of COVID-19, other infections – especially those resistant to antimicrobial treatments – can also be life-threatening (Cox et. al 2020). In order to enhance current practices on the management of infections, long-term care facilities can look to adapt the best practices employed by hospitals, and consider the policies and systems designed to protect patients.

Some of the shortfalls, that have been described recently with regard to our ability to respond to COVID-19 and other infectious diseases, have been caused by the gaps related to diagnostic capacity and surveillance (Burrows 2020). Effective diagnostic tools can help ensure patients are put on the best treatment pathway, as well as provide data that is essential for understanding population trends and designing interventions. Diagnostic tools can prevent the use of antibiotics when they are not needed, an important element in the fight against antimicrobial resistance (Clancy and Nguyen 2020).

Our healthcare system can also benefit from more a robust surveillance to track infections. A more sophisticated automated surveillance can provide near real-time data and facilitate timely interventions.

The elderly often require more complex medication regimens; continuing care facilities, therefore, must be equipped with tools to enable safer medication management. By partnering with their acute-care hospitals, they can help promote standardization and transparency of medication dispensing and delivery. Continuing care facilities could also benefit from innovation designed with safety guardrails to manage and dispense medications such as those found in hospital settings (Wang et. al 2020).

"As we advocate for quality care for older adults, we need to look at the opportunity in a holistic manner,” explains John Llaguno, MD (personal communication, September 2, 2020). “We need to promote professional development of all practitioners in long-term care – specifically providing opportunities to continue gerontological education. We also need to nurture a culture of patient-centered care by enhancing communication and professional collaboration amongst all healthcare team members, the resident and family. Finally, family members and residents need to be provided [with] an understanding of issues and expectations of aging. We need to do this together”, concludes Llaguno (personal communication, September 2, 2020).

While continuing care facilities face many unique challenges, lessons learned from hospital care can equip continuing care providers with tools to help deliver safer care. Our aging population deserves the highest quality of care and protection we can provide. It is essential that we continue to evolve our healthcare system to exceed expectations and for Canada to become a global leader in the provision of long-term care.

About the Author(s)

Chelsea Smallwood is associate director for Health Economics and Outcomes Research at BD–Canada in Mississauga, ON. Follow Chelsea on Twitter at @smallwo4.

References

Burrows, L. L. 2020, April 20. Drug-Resistant Superbugs: A Global Threat Intensified by the Fight Against Coronavirus. The Conversation. Retrieved September 2, 2020. <https://theconversation.com/drug-resistant-superbugs-a-global-threat-intensified-by-the-fight-against-coronavirus-135790>.

Clancy C.J., and M. H. Nguyen. 2020. Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect? Clinical Infectious Diseases. doi:10.1093/cid/ciaa524.

Cox, J. M., N. Loman, D. Bogaert and J. O’Grady. 2020. Co-infections: Potentially Lethal and Unexplored in Covid-19. The Lancet 1(1): e11. doi: 10.1016/S2666-5247(20)30009-4.

Fox, C. 2020, May 26. 'I think It is disgusting' Ford Says as Military Details Dozens of Issues at Five Ontario Long-Term Care Homes. CP24. Retrieved September 2, 2020. <https://www.cp24.com/news/i-think-it-is-disgusting-ford-says-as-military-details-dozens-of-issues-at-five-ontario-long-term-care-homes-1.4954722>.

Junker, A. 2020, May 18. COVID-19: Problems in Senior Care During Pandemic were Predictable, Preventable Says Expert. Edmonton Journal. Retrieved May 19, 2020. <https://edmontonjournal.com/news/local-news/covid-19-problems-in-senior-care-during-pandemic-were-predictable-preventable-says-expert/>.

Nicolle L. E. 2014. Antimicrobial Stewardship in Long Term Care Facilities: What is Effective? Antimicrob Resist Infect Control3(1):6. doi: 10.1186/2047-2994-3-6.

Neergaard, L. 2020, March 29. Age is Not the Only Risk for Severe Coronavirus Disease. The Globe and Mail. Retrieved May 21, 2020. <https://www.theglobeandmail.com/life/article-age-is-not-the-only-risk-for-severe-coronavirus-disease-2/>.

Wang L., W. He, X. Yu, D. Hu, M. Bao, H. Liu, et al. 2020. Coronavirus Disease 2019 in Elderly Patients: Characteristics and Prognostic Factors Based on 4-Week Follow-Up. Journal of Infection 80(6): 639-45. doi: 10.1016/j.jinf.2020.03.019. 

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