Transforming Primary Care for Older Adults Living with Frailty: Dr. Paul Stolee

December 2, 2020

Dr. Paul Stolee is a Professor in the School of Public Health and Health Systems at the University of Waterloo. At Waterloo, he leads the Geriatric Health Systems Research Group, and is the Director of the University of Waterloo Network for Aging Research. Paul has been involved with CFN since its early days both as a funded researcher, a member of the Scientific Review Committee and as a Supervisor of trainees in the Summer Student and Interdisciplinary Fellowship Program. We asked Paul to give us an overview of how he came to focus his research on older adults living with frailty and some lessons learned along the way. Here is Paul’s story:

I’ve been involved in research on older people, particularly older people living with frailty and complex health conditions, for (checks notes) nearly 40 years (four decades, really? that can’t be right, can it?). My first geriatric research experience was at the University of Saskatchewan, where I was fortunate to work with two outstanding colleagues, Dr. Duncan Robertson and Dr. Kenneth Rockwood (this was just before Ken went off to medical school, so he wasn’t actually “Dr.” yet). We were conducting a provincial health survey of older people, both those living at home and those living in long-term care. We had a number of aims, including estimating the prevalence of cognitive impairment in persons aged 65 and older (our resulting estimate was 7.8%[1]). A major interest was to understand frailty in older people, to define and measure it, and to identify those who are frail. I won’t say that we fully succeeded in those aims, but I believe we made some headway. And we kept working on those goals after the study was done,[2] Ken Rockwood most notably.

After leaving Saskatchewan, my career took me to the Alberta Department of Health, where my attention was necessarily drawn to health policies, health services and health systems, and how they serve, or do not serve, older people. I left government to go back to university to do graduate work on epidemiology and health studies. With my interest in health services and systems for older people in mind, I considered geriatric assessment programs, and came to the conclusion that a major barrier to determining their effectiveness was the outcome measures being used. This led to the investigation of the potential of an individualized outcome measure in geriatric care settings.[3] Continued interest in outcome measures and assessment tools in a later role with the Regional Geriatric Program in London pointed me toward looking at how health assessment information was being used and shared in the care of older people.

I started a faculty position at the University of Waterloo in 2004, and pursued this interest in health information use in several CIHR-funded projects, with particular emphasis on the experiences of older persons living with frailty as they transitioned from one care setting to another[4]. Some of the lessons from this work: older patients and caregivers often have limited involvement in health care decision-making, health information is often inadequately shared across health settings, and primary care – which is seen as having a key gatekeeper and care coordination role – lacks the resources to do so.[5]

Among the projects that arose from these findings was our CFN-funded Transformative Project on Primary Care for Older Canadians Living with Frailty. We have learned a great deal through this project to date, but it has been seriously disrupted by COVID-19, which put a halt to recruitment of new study participants. We did, however, have ethics clearance to follow-up with older patients and caregivers who we had previously interviewed. With support from the CFN COVID-19 research funding initiative, we are recontacting these persons to understand their health care needs and experiences during the pandemic, including their experiences and needs as a result of physical distancing, support during self-isolation, and access to testing. We are also looking at how primary care clinics, and provincial health systems, have responded to the needs of older Canadians living with frailty.

Older people are high users of the health care system, but the health care system has many shortcomings in how it has responded to their needs. The COVID-19 pandemic has brought these limitations into sharp focus.[6] With our CFN  COVID-19 grant, we can take advantage of this research opportunity to learn more about how to strengthen our health care system for older persons, particularly those living with frailty.



[1] Robertson, D., Rockwood, K., & Stolee, P. (1989). The prevalence of cognitive impairment in and elderly Canadian population. Acta Psychiatrica Scandinavica, 80, 303-309.

[2] Rockwood, K., Fox, R.A., Stolee, P., Robertson, D., & Beattie, B.L. (1994). Frailty in elderly people: An evolving concept. Canadian Medical Association Journal, 150(4), 489-495.

[3] Stolee, P., Rockwood, K., Fox, R. A., & Streiner, D. L. (1992). The use of goal attainment scaling in a geriatric care setting. Journal of the American Geriatrics Society40(6), 574–578.

[4][4] Stolee, P., Elliott, J., Byrne, K., Sims-Gould, J., Tong, C., Chesworth, B., Egan, M., Ceci, C., & Forbes, D. (2019). A Framework for Supporting Post-acute Care Transitions of Older Patients With Hip Fracture. Journal of the American Medical Directors Association20(4), 414–419.e1.

[5] Elliott, J., Stolee, P., Boscart, V., Giangregorio, L., & Heckman, G. (2018). Coordinating care for older adults in primary care settings: understanding the current context. BMC family practice19(1), 137.

[6] Meisner, B. A., Boscart, V., Gaudreau, P., Stolee, P., Ebert, P., Heyer, M., Kadowaki, L., Kelly, C., Levasseur, M., Massie, A. S., Menec, V., Middleton, L., Sheiban Taucar, L., Thornton, W. L., Tong, C., van den Hoonaard, D. K., & Wilson, K. (2020). Interdisciplinary and Collaborative Approaches Needed to Determine Impact of COVID-19 on Older Adults and Aging: CAG/ACG and CJA/RCV Joint Statement. Canadian journal on aging = La revue canadienne du vieillissement39(3), 333–343.