Researcher Yue Li, a biomedical engineer, right, and her research assistant, U of T masters student Oliver Chung, in the cold room, demonstrate the set-up they use to study the effects of the cold on the health of elderly patients at the Toronto Rehab Hospital on July 8, 2011.Peter Power/The Globe and Mail
Canada's largest rehabilitation centre is putting the finishing touches on a lab capable of measuring how the worst winter conditions - sub-zero temperatures, icy sidewalks, snow and winds up to 30 kilometres an hour - affect the elderly.
The WinterLab, which will be up and running in November, will help researchers at Toronto Rehabilitation Institute develop new clothing, footwear and mobility aids to help seniors cope better with cold weather, a season that typically leads to a spike in deaths for those with chronic health conditions.
The research at Toronto Rehab is oriented toward finding alternatives to warehousing patients in acute-care hospital beds so they can live independently and safely in the community for as long as possible, said Mark Rochon, chief executive officer of Toronto Rehab.
"That's where we all want to be," he said.
Acute-care beds are not designed to serve the needs of people who no longer require medical intervention. As a result, they end up deteriorating mentally, emotionally and physically very rapidly, said David Walker, a professor of emergency medicine at Queen's University and head of an Ontario government committee examining the challenges of providing care to seniors.
"Our health system is designed for what was in the past rather than what's coming in the future," Dr. Walker said. "We are a little behind the times."
Mr. Rochon sees first-hand how the growing ranks of the frail elderly in Canada languish not only in acute-care hospital beds but also in rehab because they have nowhere else to go. Seven per cent of Toronto Rehab's 230 beds are occupied by patients who should be somewhere else, he said.
But the situation is even bleaker in acute-care hospitals. In 2008, one in seven beds in Canada were occupied by patients who no longer needed acute care, according to the Canadian Institute for Health Information.
Toronto Rehab is on the leading edge of a trend to help ease the bottleneck. It has joined forces with University Health Network to help free up beds in Toronto's largest hospitals. Sunnybrook Health Sciences Centre is also in merger talks with St. John's Rehab Hospital.
Toronto Rehab formally became part of UHN on July 1. The integration will save about $5-million a year, about equal to 4 per cent of Toronto Rehab's budget, Mr. Rochon said.
But the biggest benefit will be the opportunity for the two research hospitals to work together on developing new programs to help patients move from acute care to rehab sooner. The integration will help all seven hospitals Toronto Rehab serves move patients more seamlessly and quickly. At the three hospitals that comprise UHN alone, 50 to 70 patients are waiting for rehab services at any one time.
The WinterLab will play a key role in this initiative. People who have been in the hospital need help easing back into everyday life, and making sure they do not become housebound during Canada's harsh winters.
Cold temperatures not only affect an elderly person's ability to deal with winter, deaths due to heart attacks and strokes increase dramatically. An average of 7,200 Americans died each day from December to March, compared with 6,400 during the rest of the year, according to 2008 data from the U.S. National Centre for Health Statistics. The toll was similar in this country, according to Statistics Canada. An average of 656 Canadians died each day in January, 2006, compared with 546 in August of the same year.
Yue Li, a biomedical engineer at Toronto Rehab, is testing how a face mask can help reduce stress on the heart caused by frigid temperatures. The mask contains a small pouch filled with copper wires that warm up the cold air before a person breaths it in. As a result, the air a person inhales is 20 degrees Celsius warmer than the temperature in the lab, Dr. Li said.
The WinterLab is providing invaluable information on how seniors cope with winter. In tests measuring people's heart rate, eye movements and muscle activity, study participants' blood pressure jumps when they are not wearing the mask.
The lab is also testing footwear, wheelchairs and walkers to determine which designs perform best on inclined and icy surfaces - anyone taking part in a study is strapped to a body harness attached to pulleys to prevent injuries.
Toronto Rehab has an annual research budget of $13-million, the second largest in North America after the Rehabilitation Institute of Chicago, Mr. Rochon said. But now that it is part of one of Canada's largest acute-care hospital networks, it will be able to devote more resources to research aimed at replicating the everyday experiences of patients.
"To me, this is all part of the objective to finding solutions that will keep people safely in their homes and their community environment as they age," he said.
Readers' comments
From dellaratcliffe, via globeandmail.com
This is a huge issue and one that definitely needs a voice. This silo approach to health care was devastating for our family last year when my father (already at end-stage Alzheimer's) was diagnosed with end-stage lymphoma.
Even though he was admitted to a palliative care ward in a major Toronto hospital for the lymphoma, the lack of care and understanding provided was appalling. He was basically ignored by medical staff who did not know how to manage the combination of Alzheimer's and lymphoma. It was the non-medical staff (room cleaners and the folks who delivered the meals) who actually showed the most compassion and care! It was left to the family to provide around-the-clock personal care and administer the majority of medication, not the medical staff.
It was only through relentless advocacy across several institutions (including the hospital, a supportive care facility and the CCAC) that we were able to eventually find a health-care solution that provided both quality of life as well as quality of health care in his final weeks (which in his last days included hospice care, another institution that deserves more support).
For those without an advocate who can speak for them - or provide the personal care - the prognosis is shockingly bleak.
Karen Howlett