Exploring the care needs of Canadians living with frailty and the role of primary care during the COVID-19 pandemic

Anticipated Findings

Leveraging existing relationships with primary care sites across three provinces, this project aims to answer the following questions: i) What are the health care needs and experiences of older Canadians living with frailty, and their family caregivers, during the COVID-19 pandemic (including experiences and needs as a result of physical distancing, support during self-isolation, and access to testing)? Ii) How are primary care clinics responding to the needs of older Canadians and their family caregivers during the COVID-19 pandemic in the three provinces? and, iii)How have these provincial health systems responded to the needs of older adults living with frailty? To answer these questions, we will conduct in-depth individual and group interviews with patients, family caregivers and health care providers, as well as conduct a policy analysis.

About the Project

On March 11, the World Health Organization declared coronavirus disease (COVID-19) a global pandemic. Over 10M people world-wide have been infected, with 502,947 cases resulting in death (as of 06/29/20; Johns Hopkins University, 2020). COVID-19 can infect anyone, however, older adults with underlying health conditions are at higher risk for developing serious complications from the illness (CDC, 2020). COVID-19 and the associated changes to policy and society are impacting the health care of older adults in unprecedented and profound ways. As a result of COVID-19, many primary care providers have cancelled clinic appointments, home visits, and chronic disease management clinics. Although virtual care has been encouraged in many provinces (RCPSC, 2020), the rate of uptake by the primary care sector, and access by older adults is unclear. Many older adults may not be getting the care they need to manage and protect their health.

Project Significance

This project will result in learnings during, and beyond, the pandemic answering questions such as: How do we address the needs of patients during pandemics, and as health care and communities ‘return to a new  normal’? This work will have implications for future pandemic responses, and for other scenarios in which older adults may have to self-isolate and receive care remotely. We will also be able to understand how each province reacted to the pandemic and the resulting health care and patient impacts.

Project Team

Principal Investigator:

Co-Investigators:

  • Jacobi Elliott PhD — University of Waterloo
  • Anik Giguère, PhD — Université Laval
  • Justine Giosa PhD — University of Waterloo
  • Donald Juzwishin, PhD, MHSA — University of Victoria
  • Margaret MacNeil, PhD — McMaster University
  • Sara Mallinson, PhD — University of Calgary
  • Kenneth Rockwood, MD, FRCPC, FRCP — Nova Scotia Health Authority
  • Joanie Sims-Gould, PhD, MSW — University of British Columbia
  • Catherine Tong PhD — University of Waterloo

Keywords:

Background

On March 11, the World Health Organization declared Coronavirus disease (COVID-19) a global pandemic. Over 2.1M people world-wide have been infected, with 146,000 cases resulting in death (as of 04/17/20; Johns Hopkins University, 2020). Across Canada, measures have been taken to decrease the spread of COVID-19 including school closures, closure of non-essential businesses and public parks, and recommendations of physical distancing and self-isolation. COVID-19 can infect anyone, however, older adults with underlying health conditions are at higher risk for developing serious complications from the illness (CDC, 2020). Over 1.5 million Canadians are currently living with frailty; many of these individuals are living with multiple chronic conditions and are at high risk for complications from COVID-19 (CFN, 2019; CDC, 2020). COVID-19 and the associated changes to policy and society are impacting the health care of older adults in unprecedented and profound ways. These changes will impact the health and care of older adults for years to come. The health care impacts of COVID-19 include significant impacts for primary care. Older adults look to their primary care providers to assess their needs, coordinate their care, and manage their health conditions (CIHI, 2011; Elliott et al., 2018). As a result of COVID-19, many primary care providers have cancelled clinic appointments, home visits, and chronic disease management clinics. Although virtual care has been encouraged in many provinces (RCPSC, 2020), the rate of uptake by the primary care sector, and access by older adults is unclear. Many older adults may not be getting the care they need to manage and protect their health.

Our group has been funded by CFN to undertake a Transformative Project on Primary Care for Older Canadians Living with Frailty (Stolee et al., 2015; Stolee, 2017). While on-site primary data collection [with older (70+) patients, health care providers and administrators (HCPs)] is on hold as a result of the pandemic, our team has ethics clearance to follow-up with previously recruited participants. We are thus in a unique position to investigate the health care experiences of older adults who are living with, or are at risk of frailty, during a pandemic. It is important that the voices and experiences of older adults and their family caregivers, as well as those of HCPs, inform health system and policy responses to pandemics and other emergencies. Monitoring and capturing provincial health system responses (evolving rapidly in real time) will put these experiences in a comparative policy context (Mallinson et al., 2018).

Research Questions & Methods

Research Questions (RQs)

  1. What are the health care needs and experiences of older Canadians living with frailty, and their family caregivers, during the COVID-19 pandemic (including experiences and needs as a result of physical distancing, support during self-isolation, and access to testing)?
  2. How are primary care clinics responding to the needs of older Canadians and their family caregivers during the COVID-19 pandemic in the three provinces?
  3. How have these provincial health systems responded to the needs of older adults living with frailty?

Methods

We will conduct in-depth individual and focus group interviews (RQs 1 & 2) (Creswell & Poth, 2017) as well as a policy analysis (RQ3), in the 3 CFN Transformative Project provinces (Alberta, Ontario, Québec). Data collection will occur both during the pandemic, and retrospectively to reflect on experiences.

Significance & Impact

This project will result in learnings during the pandemic and its aftermath, answering questions such as: How do we address the needs of patients during pandemics, and as health care and communities ‘return to normal’? This work will have implications for future pandemic responses, and for other scenarios in which older adults may have to self-isolate and receive care remotely (e.g., flu outbreaks in LTC and retirement homes, natural disasters/events such as ice storms, people who are undergoing treatments that require isolation). We will also be able to understand how each province reacted to the pandemic and the resulting health care and patient impacts. Our team has a rare, important, and time-limited opportunity to capture real-time experiences of patients and family caregivers during a pandemic, and to link these experiences to health care provider and policy responses. It is vital that we take this research and learning opportunity to help in strengthening our health system capacity to respond to future pandemics and emergencies.