Care of acutely ill older persons living with frailty: Making health care work like a system

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This project aimed to better understand the trajectory of care (what makes older persons vulnerable and what are risk factors for them ending up in hospital and intensive care units) and once admitted, what determined their long term function and how they recovered from acute illness. We then developed several strategies to provide evidence-informed information for nursing home, home care and hospital professionals to assist them in discussing treatment choices and plans of care for older persons living with frailty. The many studies in this program of research aimed to develop and conduct early feasibility studies of information tools kits, with electronic platforms to make them easy to use, with up-to-date information at the point-of-care.

This research also provides all of the foundational elements to initiate widespread implementation and evaluation of decision support tools. These tools were designed to provide health professionals with useful information about the patient’s trajectory in order to facilitate evidence-informed discussions with families or patients while in nursing homes or once they arrive in the acute care setting.

John Hirdes, PhD, FCAHS is a Professor in the School of Public Health and Health Systems, University of Waterloo. He is the Senior Canadian Fellow and a Board Member of interRAI, an international consortium of researchers from 35 countries. He chairs interRAI’s Network for Mental Health and the interRAI Network of Canada.

Dr. Hirdes has 230+ publications in peer reviewed journals and academic book chapters. His primary areas of interest include assessment, mental health, aging, health care and service delivery, case mix systems, quality measurement, health information management, and quantitative research methods.

Dr. Hirdes led development of several interRAI instruments and related applications, which are used across Canada and internationally. Examples include interRAI’s Mental Health, Community Mental Health, Brief Mental Health Screener, Emergency Screener for Psychiatry, and Contact Assessment. He is also co-author of interRAI’s Home Care, Community Health Assessment, Palliative Care and Acute Care – Comprehensive Geriatric Assessment instruments. In addition, he is lead/senior author of numerous interRAI scales, algorithms, and decision-support tools (e.g., Home Care Quality Indicators, suicide risk appraisal).

In 2012, Dr. Hirdes received the Queen Elizabeth II Diamond Jubilee Medal for his work on long term care through the Canadian Home Care Association and the Canadian Association on Gerontology.

George Heckman, MD, FRCP(C) holds an undergraduate degree in Engineering Physics from Laval University (1988) and a Master of Mathematics in Computer Science from the University of Waterloo (1991). He graduated in 1995 with a Doctor of Medicine from the University of Toronto, Ontario. He completed residency training in internal medicine at the University of Toronto (1999) and geriatric medicine at McMaster University (2000), and is a Fellow of the Royal College of Physicians and Surgeons of Canada. He completed a Master of Science Degree in Health Research Methodology at McMaster University in 2006. His most recent academic achievement was passing the OMHA Hockey Trainer Certification Program (Level 1 – he is not allowed to perform CPR).

He holds the Schlegel Research Chair for Geriatric Medicine at the University of Waterloo Research Institute for Aging, and is presently an Associate Professor with the School of Public Health and Health Systems at the University of Waterloo. He is also an Assistant Clinical Professor of Medicine at McMaster University. He provides knowledge translation support for the Waterloo Wellington Local Health Integration Network.  He has been Primary Panelist for the Canadian Cardiovascular Society Consensus Conference on Heart Failure since 2005, Vice Chair of the Quality Indicators for Heart Failure Working Group of the Canadian Cardiovascular Society until 2018, led the Quality Indicators for Heart Failure Sub-theme group for Palliative Care/End of Life Planning 2011-2012 of the Canadian Cardiovascular Society, and was a member of the Heart Failure Management Working Group of the Cardiac Care Network of Ontario. He is a Fellow of interRAI, an international not-for-profit consortium of researchers and clinicians from over 35 countries and which develops, tests and implements standardized assessment systems for vulnerable individuals across several care settings.

Research interests include management of heart failure in long term care and other frail seniors, chronic disease management of frailty in various care settings, and vascular aging.