Rurality and frailty: What are the impacts, benefits and outcomes of paramedic palliative support at home?

Anticipated Findings

The results of this study should lead to improvements in paramedic care for older adults living with frailty in rural communities, and beyond.

About the Project

Paramedics often provide care to older adults with palliative, or comfort, goals of care. Patients are commonly treated and then transported to emergency departments by ambulance. This type of care might not align with the patient’s goals of care where their wish may be to receive symptom relief and to remain at home. In 2015, Nova Scotia launched a program to provide paramedics with the information and tools to treat patients within their own home without the need to go to the hospital. Our research has shown paramedics feel more prepared and comfortable providing palliative support to people with advanced cancer and less prepared to meet the needs of older adults living with frailty.

Most research on palliative care has focused on cancer; few have looked at how palliative care should be provided to older adults living with frailty. Paramedics have had little training on frailty identification, addressing patients and caregiver’s needs, and treating symptoms in the presence of frailty. This issue may be more prominent in rural communities where frailty and access to care may be barriers.  There is also a lack of information on the costs of receiving care at home. The economics of supporting people to stay home through paramedic-based systems are unknown, and likely impacted by rurality.  As the population ages, it will be important to understand the impact of rurality on the economics of new models of care.

We will study whether awareness of frailty and a different approach to care address unmet care needs for rural older adults living with frailty. By the end of this study, we will understand the reasons why older adults living with frailty call 911. We will describe whether this new model of paramedic care is meeting the patient’s needs as documented in care plans. Paramedics will be provided with education on frailty and we will assess whether this changes how they identify and care for older adults with frailty. Finally, we will describe the costs associated with receiving this type of care.

Project Team

Principal Investigator:

Alix Carter, MD, MPH, FRCPC – Nova Scotia Health Authority


Marianne Arab, MSW, RSW – Nova Scotia Health Authority

Michelle Harrison, BSc, AHN, MA – Nova Scotia Health Authority

Laurie Mallery, MD, FRCPC, MSM – Nova Scotia Health Authority

Paige Moorhouse, MD, FRCPC – Nova Scotia Health Authority

Grace Warner, PhD – Dalhousie University

Patient Advisor:

Joyce Murray

Project Contact: Dr. Alix Carter –

Key words: frailty; palliative; paramedic; EMS; Clinical Frailty Scale; rural; community


We think there are differences in the way paramedics manage patients with cancer and other “typical” palliative conditions, compared to those with frailty. We suspect that the emergencies or crises older adults with frailty experience may cause differences in how often they call for paramedic support, and this might be particularly in rural areas where people might have less access to health care providers and services.

Research Plan

We will use a couple different approaches to this study:

We will use electronic patient care data to identify why and how often older adults living with frailty call paramedics. We will also look to see how often paramedics use a tool designed to figure out if a person is considered frail or not. Using this information, we will set up education for the paramedics to help them understand more about frailty and how they can best help these people.

Interviews: We will talk to paramedics and managers to seek their input on how care provision differs for older adults living with frailty. We will also explore challenges in providing care. We will ask them what they think needs to change to help these patients, particularly in rural (country) areas of Nova Scotia.