utilizing community partnerships with a rural and remote memory clinic to develop assessment...
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Utilizing Community Partnerships with a Utilizing Community Partnerships with a Rural and Remote Memory Clinic to Develop Rural and Remote Memory Clinic to Develop Assessment Instruments and Protocols Assessment Instruments and Protocols Appropriate for Aboriginal SeniorsAppropriate for Aboriginal Seniors
UNIVERSITY OF SASKATCHEWANUNIVERSITY OF SASKATCHEWANSaskatoon, Saskatchewan, Canada. www.usask.ca
Aboriginal Experiences in AgingSaskatoon, SKSeptember 17-19, 2008
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Debra Morgan Associate Professor, Canadian Centre for
Health & Safety in Agriculture Margaret Crossley
Associate Professor, Department of Psychology
Shawnda Lanting Doctoral Student, Department of Psychology Travel support: Northern Scientific Training
Program, Northern Medical Services
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Canadian Institutes of Health Research Canadian Institutes of Health Research CIHR New Emerging Team (2003-2009)CIHR New Emerging Team (2003-2009)
Strategies to Improve the Care of Persons with Dementia in Rural and Remote Areas Interdisciplinary research Interprofessional training Capacity development
Rural and Remote Memory ClinicRural and Remote Memory Clinic
CIHR New Emerging Team Co-Investigators
Norma Stewart, PhD, RNProfessorAssociate Dean Graduate Studies & ResearchCollege of Nursing
Margaret Crossley, PhDAssociate Professor Director, Aging Research & Memory ClinicDepartment of Psychology
Carl D’Arcy, PhDProfessor & DirectorApplied Research/Psychiatry
Jay Biem, MD, MSc, FRCPLakeshore General Hospital, Montreal
Andrew Kirk, MD, FRCPC Professor & Head, Division of NeurologyDepartment of Medicine
Dorothy Forbes, PhD, RN Associate Professor, School of NursingUniversity of Western Ontario
Lesley McBain, PhDAssistant Professor, First Nations University of Canada
Sheri Harder, MD, FRCPCAssociate Professor, Department of Medical Imaging
Jenny Basran, MD, FRCPCAssistant Professor & Head, Department of Geriatrics
Vanina Dal Bello-Haas, PhD, PTAssociate ProfessorSchool of Physical Therapy
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Funding Partners: Funding Partners:
-CIHR Institute of Aging-CIHR Institute of Health Services &
Policy Research-CIHR Rural & Northern Health Initiative-University of Saskatchewan-Saskatchewan Health Research Foundation -Alzheimer Society of Saskatchewan-Telehealth Saskatchewan (in-kind support)
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Objectives of this presentation Objectives of this presentation To describe the development & implementation
of a telehealth-supported interdisciplinary Rural and Remote Memory Clinic
To describe the community partnerships that were essential to the development of instruments and protocols for assessing cognitive impairment in Aboriginal seniors.
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What is Dementia?What is Dementia?
A progressive and typically irreversible loss of intellectual abilities, including memory, due to brain-based changes that are severe enough to interfere with daily functioning
Alzheimer’s disease is the most common form of dementia, accounting for up to 70% of all cases
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What do we know?What do we know? seniors are over-represented in rural
areas 22% of towns vs. 15 % of cities
47% of seniors live in rural areas with moderate to no metropolitan influence
Estimated prevalence of dementia in SK is 18,000 and growing
Limited access to specialized dementia care services in rural and remote areas
Rural and Remote Memory ClinicRural and Remote Memory Clinichttp://www.hc-sc.gc.ca/seniors-aines/pubs/fpt_docs/fed_paper/index_e.htm
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Prevalence of Dementia (Percentage) Prevalence of Dementia (Percentage) in Canada by Age Groupin Canada by Age Group
8
2.4
11.1
34.5
0
5
10
15
20
25
30
35
Age Group
65+65-7475-8485+
CSHA. 1994
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““It was like climbing a It was like climbing a mountain to get a diagnosis”mountain to get a diagnosis”
“Strategy for AD and Related Dementias in Saskatchewan”
(2004), focus group comment.
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Importance of Early DiagnosisImportance of Early Diagnosis
Reduced stress and burden to patient and family/caregivers
Treatment initiated early; implications for quality of life & cost to healthcare system
Decision making and planning for the future, prevent crisis events
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Rural & Remote Memory Clinic Rural & Remote Memory Clinic
Research goals:
1) Development & evaluation of streamlined, integrated, 1-stop clinic for assessment, differential diagnosis, and management of early stage dementia
2) Evaluation of telehealth delivery format
3) One focus is on Aboriginal seniors
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Importance of Investigating Dementia Importance of Investigating Dementia in Aboriginal Seniorsin Aboriginal Seniors
Aboriginal persons (First Nations, Inuit, Metis) make up approximately 4% of Canadian population
13% of population in Saskatchewan is Aboriginal
Aboriginal seniors are one of the most rapidly growing demographic group in Canada
Little research has been conducted regarding dementia in Aboriginal seniors
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Barriers for Aboriginal and other Barriers for Aboriginal and other Remote or Minority Culture SeniorsRemote or Minority Culture Seniors
Language and cultural differences
Extremely high cost of travel
Lack of awareness of dementia as an illness
Assessment protocols have been developed with majority culture adults
Telehealth Sites Telehealth Sites in Saskatchewan in Saskatchewan
(September 2008)(September 2008)
2001000
kilometres
Kelsey Trail
Prince AlbertParkland
ReginaQu'Appelle
Five Hills
Sun Country
PrairieNorth
KeewatinYatthé
MamawetanChurchill River
Heartland
SwiftCurrent
Tisdale (2)
Porcupine Plain
Kelvington
Spiritwood
NorthBattleford (4)
Goodsoil
Meadow Lake
PrinceAlbert (7)
Hudson Bay
Fort Qu'Appelle (3)
Regina (12)
Outlook
Moose Jaw
Kipling
Weyburn (2)
Redvers
Estevan (2)
Arcola
Wawota
Broadview
Balcarres
Ile a la Crosse
Saskatoon (15)
Lloydminster
La Ronge (2)
Cumberland House
Creighton
Sandy Bay
GrenfellWolseley
Moosomin
Maple Creek
Leader
Gainsborough
Stony Rapids
Athabasca Health Authority
Cypress
Sunrise
Saskatoon
Oxbow
Assiniboia
Melville
Yorkton
Humboldt
KindersleyRosetown
Unity
Melfort
Nipawin
Big River
Pinehouse Lake
Beauval
Buffalo Narrows
La Loche
Bengough
Gravelbourg
PA VictoriaHospital(3)
MentalHealthInpatient
Addictions Office
Mental Health Outpatient
CityHospital (2)
RoyalUniversityHospital(5)
St Paul'sHospital
College of Medicine (5)
Saskatoon Cancer Centre
KinsmenChildren'sCentre
ParkridgeCentre
Wascana RehabilitationCentre (WRC) (2)
RQHR 2110 Hamilton Street
HISC Service Desk
TC Douglas
GeneralHospital
Pasqua Hospital
Allan BlairCancerCentre
Healthline
Regina Child & Youth
Telehealth locations in Saskatoon
Telehealth locations in Regina
Telehealth locations in Prince Albert
Current Telehealth Location
Planned Expansions for 2008
All communities have only one endpoint unless otherwise noted
Eligible patients must live >100 kms. from a tertiary care centre
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1
8
11
3332
21
1511
33
15 3
2
3
NET Telehealth Community Visits Prior to Clinic Implementation:
Northern Communities Visited in Year 1 La RongePinehouse LakePelican NarrowsIle a la CrosseBeauvalLa Loche
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REFERRALREFERRAL
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CONTACTCONTACT
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INITIAL TELEHEALTH VISITINITIAL TELEHEALTH VISIT
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CLINIC DAYCLINIC DAY
RRMC Clinic Day RRMC Clinic Day AssessmentAssessment
1. Interprofessional clinical interview with patient and family
2. Assessment by:1. Neuropsychology2. Nursing3. Neurology4. Physical Therapy 5. Geriatric Medicine6. Neuroradiology (Brain Imaging)
3. End-of-day Team Conference and Teaching Rounds
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CLINIC DAYCLINIC DAY
Interprofessional Clinical Interview
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CLINIC DAYCLINIC DAY
Physical Therapy Assessment
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CLINIC DAYCLINIC DAY
CT scan
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CLINIC DAYCLINIC DAY
Neuropsychological Assessment
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The challenge for clinical The challenge for clinical neuropsychology was to prepare a neuropsychology was to prepare a test battery for the RRMC that test battery for the RRMC that was…was…
1. Brief enough to accommodate the time constraints of an IP same-day clinic
2. Sensitive to early-stage dementia
3. Adequate for differential diagnosis
4. Appropriate for cross-cultural assessment of rural and remote residents
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Interdisciplinary research Interdisciplinary research combining methods from combining methods from neuropsychology, human neuropsychology, human geography, and cultural geography, and cultural anthropologyanthropology
1. Focus groups with Aboriginal seniors at the Saskatoon Community clinic
2. Travel to Northern communities for consultation, and protocol and test development
Rural and Remote Memory ClinicRural and Remote Memory Clinic
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Community Screening Interview for Dementia (CSI’D)
Cross-cultural instrument provides an alternate assessment protocol for patients from non-majority cultures including non-English speaking patients
Modified in consultation with the Aboriginal grandmothers & northern healthcare providers
Hall et al., 1993
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Original Buschke Cued Recall Test Original Buschke Cued Recall Test
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Pictorial Prairie Buschke Pictorial Prairie Buschke
National Geographic Magazine
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“ “Grasshoppers & Geese”Grasshoppers & Geese”
Modification of Pyramids and Palm Trees based on harmonization approach
Culturally and geographically appropriate for older adults residing in rural and remote areas
Some examples…..
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Rural and Remote Memory ClinicRural and Remote Memory Clinic
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What we’ve learned so far about What we’ve learned so far about our modified assessment protocolsour modified assessment protocols
Modified neuropsychological tests (e.g., Grasshoppers and Geese) are extremely well received by all patients in our clinic
The modified screening protocols (CSI’D) still require some adjustment and ongoing work with our northern healthcare partners to ensure acceptability and sensitivity
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What we’ve learned so far about What we’ve learned so far about our Interprofessional Clinic Modelour Interprofessional Clinic Model
Satisfaction ratings are high for telehealth and the streamlined 1-stop clinic model despite ongoing challenges related to cost and time of travel for remote northern patients and their families
We strongly promote this model of care for use with other chronic health concerns regardless of place of residence
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Thank-you