Aging & Health
Aging, Health & Well-being and the Concept of Knowledge Translation:
Though research is often fuelled by the motivation to make positive changes in society, this goal is sometimes prevented by a large gap that exists between research findings and implementation.
In medicine, the significance of this gap should not be underestimated. The purpose of knowledge translation is to address such issues, by making evidence-based knowledge more accessible and enabling its application. In Canada, knowledge translation is most commonly defined as “as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.” (CIHR, 2009)
- Synthesis of knowledge involves integrating and contextualizing the findings of individual studies within the general framework of research in that area.
- Dissemination refers to identifying the various stakeholders that would benefit from the research and presenting the information in a way that caters to their needs.
- Exchange is the integral aspect of involving and acquiring information from all parties, including but not limited to researchers, physicians, pharmacists and patients.
- Ethically sound application refers to strict guidelines by which any knowledge can be applied to health care settings and translated into policies. (CIHR, 2009)
Enhanced technology and more rigorous research methods continue to yield findings that have the potential to improve lives. Knowledge translation can ensure that this potential is not wasted. Here we discuss the concept of Knowledge Translation as it relates to Geriatric Health. Enjoy!
(Written by Zainab Furqan, 2011)
Knowledge Translation Topics for Geriatric Health:
This list of seniors' health care topics was developed by Magda Lenartowicz and Andrew Robertson, in partnership with Schlegel Research Chairs in the areas of Neuroscience, Geriatric Pharmacy, Vascular Health, Geriatric Medicine and Seniors' Care. This is a collaboration between research students at the University of Waterloo and Canadian medical students (through NGIG). The topics below will be developed over time. If you are interested in participating in this work, please contact us.
What constitutes a "geriatric syndrome"?
Physicians are trained to understand the concept of syndrome as a constellation of signs and symptoms that, together, indicate some physiologic deficit. For example, a smoker with shortness of breath, wheezing, and enlarged lungs likely has COPD. A person with shortness of breath, edema, and extra heart sounds has heart failure, etc.
A "geriatric syndrome" is a clinical entity that results from a constellation of accumulated age-related deficits (and not symptoms or signs). For example, cognitive impairment, visual impairment, orthostatic hypotension, peripheral neuropathy, sarcopenia and foot pain can lead to the syndrome of falls.
Clinically, the former has a relatively limited differential diagnosis and is thus (theoretically) easier to diagnose. Once diagnosed, there is usually a single entity to treat. The latter requires the identification of potentially several conditions, each of which can be treated, resulting in a reduced chance of falls. Additionally, we recognize frailty as an accumulation of age-related deficits in multiple areas. This subsumes that the deficits are clinically evident. There are two that are often missed - cognitive impairment and osteoporosis.
The diagnosis and complexity of dementia (e.g. multiple dementias or persons having dementia with other health issues) are still areas of great concern and good research on diagnosis and treatment options are not getting trickled down to the front line. Cognitive impairment often results from and complicates a variety of chronic diseases. Clinicians still have difficulty with diagnosis and decisions are not usually made until after a significant event (e.g. car accident).
Diagnosis: Diagnosis of dementia is undermined by the reluctance of the family to recognize the problem (attributed to “normal aging”), which might be public health concern, as well as the overreliance on imperfect screening tests (e.g. MMSE) to come to a conclusion. Knowledge towards the recognition and diagnosis of dementia is an important area for trainees.
Treatment: Often, patients with dementia have multiple medical issues that contribute to the dementia, but that also require a high level of cognitive ability to manage (e.g. multiple, time-sensitive medications). It’s a ‘catch-22’. Also, cognitively impaired patients are more likely to find themselves in acute care facilities, where discharge planning needs to consider their cognitive state in the decision-making process. Furthermore, these folks have multiple care providers, each focusing on their area of specialty, and as a result everyone ignores the cognitive problems. In the end, everyone wonders why the person's diabetes or heart failure is poorly controlled and why the are subject to multiple admissions, leading to ALC, LTC, etc.
Quality of life of older adults in acute care and long-term care facilities
There has been growing interest in this area as clinicians and researchers are looking at subjective measures (to supplement objective measures) in evaluating outcomes of care. For example, the hospital bed environment, and how it impacts on quality of life, might have a role in the progression of incontinence, delirium, and functional decline in inpatient acute care.
Alternate level of care patients in inpatient acute care
Alternate level of care patients are those placed in a hospital bed while waiting for a more appropriate setting to meet their needs such as a long-term care bed, supportive housing unit or home. These patients often ‘fall through the cracks’ between the priorities of acute care and long-term care. Renewed focus on advocacy, care pathways, and best practice research regarding this patient group needs to be brought forward.
Biomedical vs. Person-centric Approaches to Care
Another branch of the quality of care theme concerns an urgent need to move beyond strictly biomedical approaches in care and support to person and relationship-centered models. Practitioners have a hard time understanding what it means to put these philosophies into practice or how to incorporate these approaches. Physicians diagnose dementias based on deficits - what a person can no longer do. Privileges are removed, and, often subconsciously, future discussions on health care involve only caregivers instead of the patients. Family meetings occur where the person's input is downplayed (if they happen to be invited). E.g. from local physician – “I was just at a family meeting to discuss the pros and cons of bypass surgery in a man with mild-moderate dementia. He was not present. I had to point out that the man still had insight and could provide input into the decision - in fact, he had told me just before the meeting that preserving his brain was important to him (the family was leaning towards surgery).”
Depression is one of the most common psychiatric disorders among the elderly population, yet it is often under-diagnosed and undertreated. The majority of older adults with depressive symptoms will be seen by their family physician in primary care; however a significant amount of seniors will not meet the standard diagnostic criteria for major depression or dysthymic disorder due to somatic comorbidity or cognitive decline. Some primary care physicians believe depression is ‘understandable’ and ‘justifiable’ given an older adults’ reduction in function and social networks. These barriers are among many that make instances of depression among the older population go undetected and untreated in primary care. Yet even minor depression among older adults increases the risk for disability and suicidal ideation. On a global scale, men and women over 74 years of age have the highest rates of completed suicide; however, men over 84 have the highest rate of suicide across all age groups.
There are a number of validated screening tools for detecting late-life depression in primary care, as well as several psychological, psychosocial and pharmaceutical treatments for depression among older adults. As late-life depression is generally amenable to treatment, low detection and recognition among primary care physicians represent a significant barrier to healthy aging. Despite initiatives to improve the recognition of late-life depression and suicidal ideation in primary care, the number of undetected cases of depression among elderly patients remains quite high (up to 67% of patients).