Dr. Jo-Anne Clarke forges new paths

Dr. Jo-Anne Clarke forges new paths

Dr. Jo-Anne Clarke is forging new paths in geriatric care across northeastern Ontario as she establishes the North East Specialized Geriatric Services team.

Based in Sudbury, Clarke works under the banner of the North East Centre of Excellence for Seniors Health within a newly built office beside Pioneer Manor, a long-term care facility.

She approaches her work with a passion and drive rarely seen in a region suffering from chronic shortages of health-care professionals, long waiting lists for specialized care and overcrowded hospitals.

Born and raised in Lively (now part of Sudbury), Clarke is no stranger to the North and its issues. After she spent 13 years studying medicine to become a geriatrician, the City of Sudbury was able to woo her “back home” by creating a position and a milieu in which to hire a multidisciplinary team of allied health professionals.

Clarke said municipal representatives worked with “incredible foresight” for the last three years to raise capital to build a centre for geriatric services with the knowledge that she was interested in practicing in the North.

The City was able to access funds through the Aging at Home Strategy, a 2007 Ministry of Health and Long-Term Care initiative targeting the aging boomer population, which is anticipated to double in the next 14 years. The Ministry distributed funds to the 14 Local Health Integrated Networks (LHINs) to help seniors live independently. The City acts as an administrator for the funding of the centre’s services.

North East Specialized Geriatric Services is using the Regional Geriatric Programs (RGPs) of Ontario as its model, providing clinical service delivery, education, research and program evaluation.

Other goals are to increase capacity in geriatric care throughout northeastern Ontario and be responsive to the needs of the geriatric community.

As the only geriatrician in a region that spans 400,000 square kilometres, Clarke appears undaunted by the solitary status that seems to accompany the profession. She loves her work and embraces the challenges encountered.

Assessment

“Caring for older people is very complex,”  said Clarke. The assessment process can take up to 75 minutes for an initial visit, not including a one-hour pre-assessment performed by a nurse. “In medicine, we’re taught that you get one disease and multiple symptoms from that disease, and once treated, it goes away. However, caring for an elder means you have multiple risk factors and impairments, whether it’s hearing, visual, cognition, muscle weakness, nutritional loss, and multiple chronic diseases all combined in a single presentation.”

Therefore, the focus in geriatrics is less on prolonging life and more on optimizing function.

“Our assessments focus on physical function, chronic disease management, nutrition, mood, cognition, medication, social situation and physical limitation at home,” Clarke said. A team approach is required, and there is no quick fix, she added.

The team

The specialized team is made up of a geriatrician, registered nurses, physiotherapist, occupational therapist, social worker, and a geriatric education resource co-ordinator, some of whom Clarke was in the process of hiring as of late August.

“The approach to geriatrics is very much multidisciplinary and interdisciplinary,” she said. “All of those areas are best targeted by other allied health professionals. Those components are important in maintaining someone’s independence in the community.”

Currently, Clarke and her team offer ambulatory clinic consultation; home visits for the housebound; telemedicine consultation; and regional outreach and education. A six-week rotation schedule was developed to carry out these services.

The team performs pre-assessments, new patient assessments or follow-up appointments in outpatient clinics, conducts dementia clinics via the Ontario Telemedicine Network and does home visits and long-term care consultations.

There are also outreach visits across the northeast.

The work is needs driven, and the services are in high demand. However, Clarke is hoping to meet the needs of the communities through capacity building.

“The more educational initiatives you can create across the northeast in geriatrics, the more capacity and expertise you build in those areas.”

As pockets of geriatric expertise grow, Clarke would like to establish within each community a first line-of-contact for assessment, help and intervention, which would be linked with the Centre and its support services. The type of support could include clinics within the communities, case conferences, and educational activities.

GiiC

Another initiative sponsored by the RPGs is the Geriatrics Interprofessional Interorganizational Collaboration (GiiC). The initiative has produced a geriatric toolbox to serve as a resource to assist in assessing and treating geriatric conditions.

“Over the last year, they’ve contacted family health teams and community health centres across Ontario and asked them to identify one or two people to be the geriatric resource person within those health teams,” Clarke said.

Conferences have been held to familiarize those appointed with the toolkit and provide information on frailty, comprehensive geriatric assessments and interdisciplinary collaboration.

“We’re also hoping to roll out those kinds of educational initiatives to long-term care facilities.”

Care-of-Elderly program

Clarke and her colleagues at the Northern Ontario School of Medicine are also interested in implementing a Care-of-the-Elderly program at the medical school, which is an additional year of training for family physicians.

As North East Specialized Geriatric Services continues to build its programs and reach out to communities, Clarke is encouraged by the gains she sees in her patients, as well as her team’s reactions to patient improvements.

“My goal is to be a resource, not a solution … to build capacity in geriatric care throughout the northeast, get more people training in geriatrics, and create excitement among trainees for geriatrics so we’ll have more geriatricians and care of elderly physicians to achieve all of these goals.”

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