I'm pleased to be here.
I would like to begin by saying that I have long been a fan of the veterans independence program. In one of my capacities, which is that of immediate past president of the International Association of Gerontology and Geriatrics, on numerous occasions and in numerous countries I have spoken with considerable pride about our continuing care activities in this country, drawing particular attention to the VIP program, which has played a leadership role over the years.
I'm here wearing a number of hats, but in respect of my research, I'm probably best known as an environmental gerontologist. My speciality has been in seniors housing, shelter and care for persons with dementia, and in the built-environment side of things, extending as well to WHO projects on cities that are age-friendly.
Today I'd like to speak a bit about some recent research of mine on how to make hospitals more age-friendly. This is particularly important. We need to remember that the bulk of veterans are able to stay in their communities because when they are ill or have an accident they are able to go to a hospital and get the care they need. To a lesser extent, this also applies to those who look after these veterans, the older wives, daughters, and so on.
What many people don't know is that, unfortunately, sizable numbers of older people who go into hospital because of congestive heart failure, a heart attack, or a fall lose functional status and independence while they're in the hospital. The resultant condition can be far more severe than the one they were admitted for. One reason for this has to do with iatrogenic illnesses—in particular illnesses that come about because of some treatment or procedure. Often it's a medication interaction or medication misprescription. But there are also other causes. Some of them lie in outdated beliefs and stereotypes about what you can and cannot repair in older people, what treatments and procedures they can successfully survive and thrive on.
What we're learning more and more is that age per se is not a good predictor of who should qualify to be a recipient of a heart transplant or a bypass surgery. If you think back 10, 20, 30 years, many of the procedures that today are commonplace—knee replacement, hip replacement, triple and quadruple bypass surgery—were thought to be far beyond what any older person could survive. They were considered too risky for older people. We now know that in fact many of these procedures can be successfully performed and can provide a better quality of life to older people. There are still some people in the medical field, some nurses and doctors, who are not as aware as they should be of the resilience of older people. So we need to increase our supply of geriatricians, geriatric nurses, all of the allied health professionals that work with older people.
Some of the blame for the deconditioning that happens when older people go into hospital resides with the seniors themselves. They think they need to remain in bed, whereas in fact the opposite is true. The sooner they can get back on their feet and start to resume the activities of daily living, the greater the possibility that they can go home and continue to live independently.
It's also important to recognize that the physical environments of hospitals can act either as barriers or as facilitators for older people. We did some studies in British Columbia in acute care hospitals, and we looked at the design of the hospitals. We talked to staff, and they told us what they thought were the problems. Then we brought in groups of older people who were all over the age of 75 and still living at home. They weren't sick, but they were older people somewhat on the frail side.
We exposed the older people to two different rooms. One was a traditional hospital room. The second one had started out the same as the first but we adapted it, and we found that it did make a difference in terms of their ability to understand and remember post-discharge instructions and in terms of their being safely mobile as they moved about the room. They got out of the bed, walked towards the washroom, sat themselves down on the toilet, got up from the toilet, went over to the sink, and pretended to wash their hands, brush their teeth, and comb their hair--all of the things that many of us take for granted and that people who go into hospital need to resume doing as soon as they possibly can.
The design alterations we made were all done in stages. The first thing was to drop the ceiling and to add some acoustical tiles to act as sound barriers. The second thing was to put in a rubberized flooring. The third thing was to make it possible for the patient to control the lighting. Many times when an older person--or anybody, for that matter--goes into hospital and they're in a bed, to reach the light, which is way behind the bed, they have to have considerable manual dexterity to grasp and pull the string. We realized that this was beyond what people could do, and that they were falling out of bed and breaking their hips for reasons like that. But if you go into a Home Hardware, you can buy--off the shelf, for a very minimal cost--a remote control that allows you to turn lights on and off.
We also found that by making it possible for the older persons themselves to control the bed going up and down, it was much easier for them to get out of the bed and to do so without tripping and without injury.
Another kind of simple adaptation we did was to put an automatic light, a movement-activated light, in the bathroom. When the door opened and they entered the bathroom with a walker, they didn't have to take their hands off the walker in order to turn on the light.
So there are a lot of simple solutions that can be done to make hospitals much safer and to make it easier for older people to be able to be independent during the period while they are convalescing, which has a great impact on what will happen when they go home. These are small illustrations.
The study was done in a community hospital, but I draw it to your attention because I know that many veterans who become frail end up in veterans hospitals. I would bet your hospitals are no better than the community hospitals in terms of the physical design. And these things can be done. These are adaptations that need to be done.
A set of studies we have not yet done, but which needs to be done, has to do with making hospitals safer for people with dementia. The good news is that more and more people are living to be old. The bad news is that over the age of 85, the probability of having a dementing illness goes up considerably. But those people, if they get physically ill, still need to go into hospital and need to be safe.
Many of these same kinds of adaptations can be done to the homes of older people for relatively minimal cost. When you think what it costs if a person falls and has a serious injury from that fall, the adaptation is well worth the kinds of costs that might be involved. Canada Mortgage and Housing Corporation, through the various programs it has had over the years, has made it possible for some of these kinds of adaptations to be funded. Those programs need to be expanded, continued, and improved and enhanced, both for veterans and for other people.
In terms of seniors housing, we talk about the six As. Again, I know that in the veterans program many units have gone up. They tend to meet the first A, which is affordable. We think about accessibility, tend to think about it as wheelchair accessible, but with normal aging what many more people experience is sensory fading, so you need to be concerned about lighting and sound and those kinds of things. They need to be attractive. They need to be acceptable, to be the kinds of homes people want to go into. And people need to be able to age in place, which is the catchword these days, meaning that people can stay in a familiar environment for an extended period of time.
One of the things that makes that happen is the availability of some alternatives, so that if they cannot manage in the family home or in conventional housing without some help, they can move into an assisted living facility. As there is further change, those who do require it should be able to get into a care facility.
In many parts of the country, care facilities are now restricted to only those who are very, very fragile, so there is a gap between independent living and assisted living, and then the care facility over here. What happens to those people in the middle? We need to be sensitive to those kinds of challenges. Those are the primary things.
The other issue, which has to do with design, is making it possible for people to be very much a part of the community in which they live. This means being able to get out of their home and to navigate to get to the store, to get to the bank, to get to the doctor, and to be independent for as long as possible, which has implications in terms of how you design your streets—the traffic signals, traffic patterns, and so on.
The World Health Organization, in conjunction with the Public Health Agency of Canada, has just finished a project that was done in 33 cities around the world. That now has a rural and remote component in Canada, where they're looking at how to improve communities to make them more friendly and to keep our senior citizens functioning. These apply to veterans; they apply to other seniors.
I guess the unique feature for veterans is the experiences they have had in the past and how those translate in terms of current changes in behaviour. We know that some seniors are at risk because of their previous experience; some seem to have greater resilience because of their previous experience.
Certainly the message that comes through loud and clear is the heterogeneity, both of your veterans community and your general community. There is not a one-size-fits-all. Gerontologists are very much talking about options, alternatives, and a range of different kinds of living, working, and recreational spaces for our senior population.
Those were the main issues I wanted to bring to the table.