We must protect the elderly as we move to virtual care
In the words of the late, great, Sam Cooke “Change is gonna come.” In the words of my great but relatively unknown 70+-year-old husband, “Honey, it’s already come!”
And so it has. What back in 2019 was a slowly advancing trial for the few, virtual care is now a reality for the majority of seniors in Canada.
The challenges for healthcare professionals have been enormous during this COVID-19 pandemic. Staff at my family practice clinic, for example, have done an outstanding job of responding to this change while at times being almost overwhelmed by the stress and workload they could never have foreseen as 2020 began.
They have gone the extra mile to maintain as close to full service as possible while also recognizing that the large number of seniors in their cohort must not be left behind. Endless phone calls and emails to be received and responded to, in-house appointments and virtual clinics from home and office, flu clinics to arrange, at-risk patients to check on, on-line communications and mail-outs to attend to … the list can seem to be endless. It’s a new world order for everyone on both sides of the virus.
But what is happening from the patient perspective, more specifically elderly seniors? How are they coping and how are their interests best served by the rapidly and unavoidable changes that are happening? How will the tsunami of “baby-boomers” (born 1946-1965) cope with this changing healthcare landscape?
As of July, there were more than 6.8 million Canadians over 65. By 2041, it is estimated that 24.5 per cent of the total population will be over 65 and of those, 5.8 per cent over 85. Many seniors have comorbidities and likely are the largest users of primary health care. You get old, you get sick, you need help.
Most of today’s seniors grew up in a culture of “hands-on” medicine. Their GPs likely served the whole family, possibly for generations. GPs listened to problems, examined patients in their offices and conducted annual physicals that were an integral part of the equation. GPs knew their patients well enough to recognise changes in body and mind when they saw them. And they made house calls.
That form of primary care already had been slowly changing and COVID has put an immediate circuit-breaker on traditional healthcare. Seniors need and want to still feel medically safe. But depending on their age, location, technological and language skills, financial status and personal support system, this is now more difficult to achieve.
The expansion of virtual care and, thankfully, the trusty landline long abandoned by the younger generation, has allowed physicians to monitor seniors in these changing times. While some seniors have cell phones, the most elderly find them difficult to use. Cognitive and technical challenges with added hearing and vision issues make it difficult for elderly seniors to take advantage of smart phones.
So the landline becomes their lifeline. Early surveys show that seniors are comfortable talking with their healthcare teams on the telephone and the benefits of staying in situ are a great bonus.
But there are issues. The one-on-one, in person, human visit and that ability for a face-to-face conversation is lost. With telephones, hearing can be compromised, sensitive subjects too easily avoided. Difficulty framing questions or symptoms, language barriers – there are a multitude of problems that can arise.
Older patients are concerned that conditions will be missed or not fully understood without a physical exam. Perhaps blood pressure or breathing/heart changes are not caught, cues that something could be wrong such as movement and appearance difficulties, vision problems and other things that will never be noticed via the phone.
As a hospice- trained volunteer, during the pandemic, I am unable to visit palliative patients in their homes or hospital units as before, so I use the telephone.
It takes time to build up a relationship of trust using a landline alone and it is impossible to judge exactly what circumstances the client is living under and experiencing when all you hear is a disembodied voice. Listening skills are vitally important but cannot replace the touch of a hand or human closeness. Multi-generational homes (more common with immigrant families) relieve some of these problems; clients living alone are far more vulnerable.
Emails have become part of our modern culture and healthcare is no exception. But many elderly seniors do not have computers and are missing out on updates, appointment dates, portals. Some have family or friends to help but our oldest generation is losing its inability to keep up – those living alone (often older widows living on the poverty line) can slip through the cracks.
Computer screen appointments are the creme de la creme of the virtual healthcare movement. They have brought much needed aid to patients in remote areas or small urban settings that have no specialists. They are overwhelmingly valuable. But what of our seniors who have no computers or struggle to make them work?
We must continue to roll out new and exciting initiatives and innovations that will leave no senior behind. Our seniors deserve a future in which all senior households have a free tablet (perhaps via provincial/federal altruistic business partnerships) with a simple interface connecting directly to health teams; a TV that has a healthcare channel making these direct connections, too; students signing up for “Senior Tech” volunteer credit programs to give in-house assistance at private residences, senior buildings and retirement/long-term care homes. And free landlines and Internet services from telecommunication providers for all Canadian seniors country wide.
However, physical visits must remain an on-going necessary part of senior healthcare.
As Canadians, we must continue to change and move forward with virtual healthcare initiatives while protecting the elderly. Their needs are great and they must be kept safe. Change has come. Let’s embrace it without losing sight of those who need it the most but find it the hardest.