Urban senior: A Vancouver doctor in the house

Part one of a two-part series

John Sloan is a Vancouver-based doctor who has worked for decades to devise a way of practising medicine that is better adapted to the special needs of the fragile elderly than the methodologies he was taught in medical school — the methods still employed by most B.C. doctors. He believes his home-visit based approach is better for the patient and better for the health system’s bottom line. The Courier met with Sloan recently at a West End coffee shop to learn more.

Sloan is a lean, energetic, open-faced and affable man in his late sixties. He decided 20 years ago to close his office and work with fragile elderly patients entirely through home visits, reduction of unnecessary overmedication and promotion of better quality of life. He is currently associated with a Vancouver Coastal Health program called Home VIVE that provides home-visit care for nearly 400 fragile elderly patients.

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“If you listen to my patients,” Sloan said, “you find out what they want and need is fairly simple. They want to be comfortable, they want to stay at home and they do not want to be abandoned. Once we get them off unnecessary medications and figure out how to support their ongoing functioning at home, consultation and help available 24/7 and the prior discussions done with patients and caregivers about what options we’ll have when there is a crisis mean that we’re better prepared to respond without panic.”

So what does it mean to talk about the “fragile elderly? They are older patients who suffer from multiple pathologies and are dependent on others for activities of daily living. According to Dr. Martha Donnelly, director of the community geriatrics division at UBC Medical School’s department of family practice, who spoke to the Courier in 2010 for an earlier story, approximately 10 per cent of those over 65 are among the frail elderly. By the time Canadians reach 90, she said, as many as 30 per cent fall into that category.

Hollywood icon Bette Davis said it best: “Old age is not for sissies.” And if you are old enough to remember her movies, you probably have some painful personal data to support her position. The bad news is that there are going to be more and more Canadians living with the multiple diseases and failing capacities of old age.

Canadians over 65, who numbered 3.92 million in 2001, will amount to more than nine million in 2041. Close to a quarter of the population will be on social insurance then, and many of us will be very ill. The costs of health care spike upward dramatically as we age, and are very high indeed for the fragile. The good news is that Sloan and his colleagues at Home VIVE are implementing an approach designed to keep the fragile elderly at home, minimally medicated and able to enjoy a better quality of life

In the next installment of this coverage, we’ll look in more detail at how this approach plays out in practice, and what its implications might be for the ongoing health care needs of B.C. seniors.

Tom Sandborn is aging in place in Vancouver, where he has lived and worked since 1967. He welcomes feedback and story tips at tos65@telus.net

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