CP@clinic: A Community Paramedicine Program for Indigenous older adults
We anticipate that through CP@clinic, Community Paramedics will apply their skills beyond emergency call response, and proactively provide community-based healthcare to this remote northern community.
About the Project
CP@clinic is a community health program for older adults running in many parts of Canada. During a session, community paramedics perform one-on-one health assessments. They measure older adults’ risk for heart disease, diabetes and falls. They also assess their quality of life, social isolation, and poverty. The results of each session are sent to the older adult’s family doctor so that they are up to date with their health. The program has improved quality of life, decreased risk factors for chronic diseases and reduced the need for emergency health services.
The health of older adults in the Northern Indigenous community of Moosonee, Ontario is poor. The community does not have many resources to support older adults at home. There are a high number of 911 calls, and a lack of care programs and long-term care facilities for older adults. In partnership with the Weeneebayko Area Health Authority Paramedic Services (WAHA-PS), we propose to implement CP@clinic in Moosonee. However, it needs to be adapted to their unique setting, cultural practices and to the resources of their community.
We predict that the adapted program will be successful in reducing the frailty of older adults. We also predict the overall health and quality of life will be improved with long term impact.
- Gina Agarwal — McMaster University
- Jeff Gunner — Weeneebayko Area Health Authority Paramedic Services
- JD Heffern — Government of Canada
Keywords: indigenous; older adults; community paramedicine; CP@clinic; frailty; quality of life; cardiovascular disease; diabetes; falls; qualitative and quantitative evaluation
The Weeneebayko Area Health Authority (WAHA) is a health-care network that provides healthcare services to remote Northern Indigeneous communities in Moosonee, Fort Albany, Attawapiskat, and Moose Factory along the James Bay and Hudson Bay coasts in Northern Ontario, Canada. Moosonee has a population of 3,500 with 85% being of Cree origin. Existing data shows that the majority speak English, although they may speak Cree at home. Around 14% of the population are aged 55 years and older. Locally available data from WAHA Paramedic Service shows an increasing rate of 911 calls in the past 5 years. In 2018, the 911 call volume was 2152, with 32% originating from older adults and 32% coming from Moosonee.
There are many reasons for the increasing use of 911 by older adults. Poverty rates are high, diet is poor, and there is lack of food security in these Northern Communities. Evidence also suggests that there is a higher prevalence of diabetes (6-10%) among the Cree population in Western James Bay compared to the general Canadian population (5%). For older adults in particular, the community of Moosonee is poorly resourced and there are only two providers to support WAHA Aging at Home: Home Care (formerly Community Care Access Centre) and the Canadian Red Cross. This combination of poor health status and lack of community health resources leads to older adults using 911 more frequently.
Another factor is the absence of a geriatric care program or long term care facility. Older adults who become chronically ill are more likely to be transitioned to another community, contradicting the cultural custom to keep elders at home. Based on the current healthcare needs of the population, emergency department and primary healthcare workers report being overwhelmed and unable to provide health services to older adults in the community.
In partnership with local Indigenous leaders, we will adapt the CP@clinic program to:
- Decrease frailty as measured by the Clinical Frailty Scale
- Improve health and quality of life
This program will be adapted for older adults living in Moosonee but it is anticipated that this could also be applied to Fort Albany, Attawapiskat, and Moose Factory.
Our main deliverable is a version of the CP@clinic program that is acceptable to community-dwelling Indigenous older adults, and able to be implemented and sustained by existing WAHA healthcare workers.
This study will have 3 phases:
Phase 1: An initial qualitative phase will gather information on how to adapt the delivery and different elements of CP@clinic to an Indigenous community.
Phases 2 and 3: Quantitative; where CP@clinic will be implemented and tested, measuring acceptability, feasibility and effectiveness in improving participant outcomes.