When older adults have complex health needs, Dr. Nicole Didyk enjoys being a detective of sorts.
Dr. Didyk is a geriatrician at Grand River Hospital and St. Mary’s General Hospital. She completed her medical degree as well as fellowships in internal medicine and geriatrics at McMaster University.
Dr. Didyk recognizes how a wide variety of factors can contribute to a patient’s overall health. She has to sort through a number of clues to develop a care plan that will work best for a patient’s individual needs.
Dr. Didyk is passionate about team work both in the community and inside the hospital to help people with complex medical needs.
What interested you most in care for the elderly?
What interested me most was the conditions that people presented with in the second half of life. Older people have more complex needs, and a lot of diseases are associated with aging. I liked that there were lots of brain conditions, as well as physical and psychiatric conditions.
When you have that much complexity, you can’t just look at the disease or the person, you have to look at their environment and their family, and their life experience.
When you encounter patients, what are their needs?
We talk about those geriatric giants, those syndromes that most often come up in older people: falls, medication complexity. A lot of it is dementia and cognitive impairment. People seem to be confused, they might even be delirious which is the sudden worsening of cognition and alertness.
We collaborate a lot with the psychiatry team because a lot of conditions are associated with depression and anxiety. Pain is another very challenging area where geriatrics is asked to consult.
It’s unusual for us to see someone with one of those; it’s usually a number of things interacting.
Since you started in geriatric medicine 15 years ago, what has changed?
The common thread we see is frailty. As people are living longer which is a good thing, it allows people to become more medically complex. Medical complexity and frailty are very close to one another, and frailty is basically an individual who doesn’t have a lot of reserve. It doesn’t take much for a person with frailty to go from barely managing OK with some supports to falling off the edge and suffering a decline in day-to-day function.
The people who do get admitted to hospital are much more frail, sicker and complex than they used to be.
There have been certain adaptations that are good. Things like the geriatric emergency management nurses, which are in every emergency department across the local health integration networks. I think those are exceptional roles. We know 25 per cent of emergency department visits are from seniors, so to have a specialized nurse with geriatric expertise there is a very senior friendly thing.
We also have integrated geriatric services workers. They can visit people in the hospital but they work mostly in the community. They help with another concept that nobody really talked about when I started training, and that’s system navigation.
I think we know now that for a frail person, just having the right medicine or the right equipment is not enough. You have to deliver that in a way that’s acceptable to the patient
What stresses do caregivers of older adults face?
When I think of my own family responsibilities, they’re pretty heavy. Thankfully my own parents are in good health, but if in addition to doing all the things I do for my kids, if I had to also check on an older family once a day or once a week, and buy them groceries, and take them to medical appointments, it wouldn’t take much for that system to become really frail.
A lot of caregivers have that kind of sandwich, they have their own young families, and they have an aging parent.
How can people age better?
We know that physical exercise is very important. We know that exercise helps with almost every single health condition. And we know that people who exercise will age more successfully.
It doesn’t have to be a lot of exercise. We know that as little as 150 minutes a week of fairly vigorous exercise is going to improve lifespan and reduce disability.
Social connectivity is important. People who have friendships or relationships with others, or get out and socialize with others tend to be healthier and live longer. That’s true with dementia as well. They will not progress or be institutionalized as much.
What can make the difference in care for the elderly in a health care setting?
We need to integrate the care across different sites. There needs to be a team approach every step of the way. That’s something I’m looking forward to in the future more integration between places like community and the hospital, and how can we get a team that goes into both of these sites.