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dr. nowak: aging at home shouldn't be seen as just a stroke of luck

staying in your home as you age is achievable with better use of technology, caring for caregivers and recognizing the value of access to social networks.

by dr. dominik nowak

nov 29 2022
read time 4 minute read
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we have to rethink how we take care of older adults
all older adults should be able to live healthy and fulfilling lives in their place of choice, for as long as possible. getty
i will never forget what gustavo* (fictitious name used for illustration purposes) taught me about graceful aging. at the time, gustavo was nearly 90. i was seeing him as part of a family practice home visit. he had significant challenges with his health, which meant that it took him over a minute to move from his armchair to a table just three meters away.
despite his medical and mobility issues, gustavo told me that he was thriving. he shared about the dogs he has had in his life, his family and social supports, and the tomatoes he planted by the sunny windowsill every spring.
like gustavo, nearly all canadians want to age at home near family and community, even as their care needs increase. however, there is already an enormous unmet need in home care. statistics canada expects the number of canadians over 85 to triple in the next 25 years, further accelerating this dire need. as a society, we have no choice but to rethink how we plan to take care of older adults.
every canadian deserves the same kind of opportunity to age at home as gustavo had. i learned three lessons from him about how we can make aging at home a reality for more canadians.

health, not just health care

gustavo was fortunate to have excellent medical care throughout his life. my visits allowed him to stay at home even as his medical needs progressed. especially for people with life-limiting illnesses, a home-based palliative approach to care leads to fewer emergency room visits and hospital admissions, as well as a lower chance of death in hospital. in other words, home-based care let gustavo age at home and with dignity, even as he neared the end of life.

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and yet, his medical needs were just one part of the picture. what helped him thrive at home was being close to family and community, social supports, and a sense of belonging and purpose. when it came to aging at home, social factors were just as crucial as his medical needs.
social prescribing — connecting health and social needs — is a practical approach to addressing the important parts of health that are beyond the clinic or hospital. as it turns out, health has as much to do with connection and community, as it does with any medication i can prescribe.

care for the 1 in 4 canadians who are caregivers

gustavo needed help with dressing, moving, eating, bathing and more, not to mention more advanced tasks like handling finances or grocery shopping. before i met him, gustavo’s daughter was spending hours every day doing it all.
one in four canadian adults are caregivers for loved ones, often providing more than 20 hours weekly of unpaid labour. for gustavo’s family, it had reached a crisis point, wanting to stay at home but finding the demands costly and unsustainable. that is, until we found the right supports for both him and his family caregivers. these supports seemed basic but were life-changing — a local program that delivered affordable and nutritious food, an older adult access centre that gave gustavo a safe place to be with others, a subsidized homemaking and nursing service for gustavo’s daily needs. for his family, a caregivers group for shared support and a care coordinator to help navigate our increasingly complex health system.
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organizations like carers canada and the canadian centre for caregiving excellence are leading the way in recognizing the importance of family caregivers. resources like 211 across canada or the caregiver 24/7 helpline in ontario can help people find local support for themselves and their loved ones.

rethinking the role of technology

for many people, tech-savvy and internet connectivity can be tremendous barriers to modern health care. rethinking technology means acknowledging that not everyone will be able to engage with care through a smartphone.
instead, it means being creative with how we put the technology to work behind the scenes. for example, how can a family member help keep track of gustavo’s medications digitally? how can we make sure that, if gustavo goes to a hospital, they already have his extensive medical history and can connect with his primary care team? can we use technology to detect a fall and get help, even if gustavo cannot reach his phone? it also means exploring what good care looks like amid profound physical barriers to getting to an in-person visit.
today, being able to age at home is seen as a stroke of luck. the complex and systemic hurdles to aging at home can seem insurmountable. with the unmet need expected to grow quickly, it is critical for policymakers, health professionals, patients, and caregivers to work together in co-designing solutions.

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all older adults should be able to live healthy and fulfilling lives in their place of choice, for as long as possible. as a society, it is time to commit to making this value a reality. together, we can create a world in which more people will have the choice to age at home, just like gustavo.
 
dr. dominik nowak is a family doctor and health leader. as chief medical advisor at telus, dr. nowak bridges disciplines with health, community, and business leaders toward a health system that is more kind, caring, and careful. he is also a faculty member in the dalla lana school of public health and the department of family and community medicine at the university of toronto.
*any of the stories shared in this column are rooted in clinical practice but fictitious composites, meant to illustrate themes in modern health.
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