Improving Emergency Care of Indigenous Elders Living with Frailty in Interior Health Authority
About the Project
We know from early conversations, interviews and talking circles with Indigenous communities and Elders in BC that many Indigenous Elders are not going to hospital for emergency medical care when they need to, because of being treated badly in healthcare services and in other institutions, such as residential schools, over many generations. We hope that this project will help us to better understand how community input can lead to better local community health care interventions for aging Elders that are frail.
We have formed a research team that includes researchers at Royal Roads University, people who work for Interior Health (who deliver healthcare services in the region), and Indigenous people from the community. This team will work together with the hospital staff to help the hospital to understand how they can provide care to Indigenous Elders in ways that feel safe and supportive to Elders, so Elders will feel able to come for medical care when they need it. This is helping to improve the healthcare system in ways that have been needed for a long time, but have not been put into practice across hospitals in Canada, because Indigenous people have not been included in conducting the research. We will be holding discussion sessions which are designed to help people in the health system to change the way they work. By doing this work in departments within local hospitals, we are providing a community intervention, as successful treatment and discharge will result in more Elders with frailty remaining in their own homes.
- Elizabeth Hartney, PhD — Royal Roads University
- Katrina Plamondon, PhD, RN — University of British Columbia
- Leslie Bryant, MSc, CSEP-CEP — Interior Health Authority
Knowledge Users & Stakeholders:
- David Archie — Williams Lake Indian Band
- Chris Marchand
- Eric Mitchell
- Vanessa Mitchell, MA — Interior Health Authority
This project concerns what has been identified as the most important topic for Canada (Trudeau, 2019) and the most important topic for Canadian health leadership (Dagnone, 2016): the health of Canada’s Indigenous peoples, specifically Elders. Indigenous Elders attending the emergency department meet the provincial definition of frailty: “Frailty is broadly seen as a state of increased vulnerability and functional impairment caused by cumulative declines across multiple systems. Frailty has multiple causes and contributors and may be physical, psychological, social, or a combination of these” (BC Ministry of Health, 2017). Through our consultations and preliminary research with Indigenous communities and Elders, it has become clear that many Elders are not accessing necessary emergency medical care due to issues of past traumatization and current re-traumatization in the healthcare system (Hartney & the DESTINED Project Team, 2020). This is impacting their ability to remain in their homes or communities as long as possible; while some pass away in hospital when their deaths could have been prevented from earlier intervention, many pass away without medical intervention; others receive sub-standard care and refuse to attend hospital again; and yet others are unable to remain at home after a serious injury or illness that could be treated sooner. Recent literature indicates systemic changes are needed to meet the needs of Indigenous patients in hospital emergency departments (Berg et al, 2019). Extensive research has identified the healthcare needs of seniors (Faul et al, 2016; Choi, DiNitto, Marti, & Choi, 2016), the importance of emergency departments to provide essential, often life-saving care to older adults (di Bari et al, 2015), and their role in providing prevention and education interventions to address future needs, such as risk screening for functional decline (Sirois et al, 2017). However, this body of literature fails to identify how to meet the specific trauma-informed emergency healthcare needs of Elders today, given their collective historical trauma (Yellow Horse Brave Heart, 2004; Truth and Reconciliation Commission of Canada, 2015; Grayshield, Rutherford, Salazar, Mihecoby, & Luna 2015).
Life expectancy is substantially and consistently shorter for Indigenous household populations compared with the non-Indigenous household population. In 2011, life expectancy was 72.5 years for First Nations males, compared to 81.4 for non-Indigenous males, and life expectancy was 77.7 years for First Nations females, compared to 87.3 for non-Indigenous females (Tjepkema, Bushnik, & Bougie, 2019). The rate of violent victimization of Indigenous people, which often requires emergency care, is more than double that of non-Indigenous people; furthermore, nearly three times as many Indigenous women are victims of violence than non-Indigenous women (Boyce, 2014). These issues were raised in our preliminary research (Hartney & the DESTINED Project Team, 2020). Indigenous people living off reserve have rates of injury over twice that of the general population, while those living on reserve have rates nearly six times greater (Brussoni, George, Jin, Lalonde, & McCormick, 2016). While the need for urgent care for Indigenous Elders is clearly reflected in these statistics, the trauma-informed practices required to create a culturally safe and welcoming environment that will adequately attend to the needs of Elders require culturally and psychologically sensitive implementation.
This gap in knowledge urgently needs to be addressed. As the Canadian population ages, the healthcare needs of Elders will continue to multiply. Without adequate knowledge of how to meet these growing healthcare needs, health inequities, along with preventable suffering and loss of life, will continue. The proposed project will use a culturally appropriate knowledge translation approach, deliberative dialogue (Plamondon, Bottorff, & Cole, 2015; Plamondon & Caxaj, 2017) to implement the findings of our research with Elders.
The main objective of the research is to implement the findings and recommendations emerging from original research conducted with Elders in Indigenous communities (Joe, 2019; Hartney & the DESTINED Project Team, 2020), within 16 hospital emergency departments in Interior Health Authority.
We will address the following question:
How can community input lead to better local community health care interventions for aging elders that are frail?
In this context, we are recognizing that by developing trauma-informed hospital emergency departments within local hospitals, we are providing a community intervention as successful treatment and discharge will result in Elders with frailty remaining in their own homes. We have conducted original research with Elders which form the basis of our knowledge translation (Joe, 2019; Hartney & the DESTINED Project Team, 2020).