How can health care be improved for older Canadians? It's a question that Carole Estabrooks has been exploring for nearly a decade as scientific director of Translating Research in Elder Care (TREC).
Estabrooks-a Canada Research Chair in Knowledge Translation and professor in the Faculty of Nursing-and her TREC team are focused on developing solutions for improving the quality of care provided to nursing home residents, enriching the work life of their caregivers and enhancing system efficiency.
Already extremely decorated as a fellow of the Canadian Academy of Health Science and a fellow of the American Academy of Nursing, Estabrooks will travel to Ottawa this fall for the official ceremony at Rideau Hall. Established in 1967 by Her Majesty Queen Elizabeth II, this highly prestigious award recognizes Estabrooks' work translating research into health care improvements for older Canadians. She will be joined by three other University of Alberta alumni: Donald Brinton, Patricia Demers and Shar Levine.
With a research focus on knowledge translation in the health sciences, Estabrooks studies the influence of organizations on the research implementation behavior of health care providers and the effect of knowledge translation on patient/resident, provider and system outcomes.
Much of Estabrooks' early research was conducted in acute care hospitals and addressed staff use of 'best evidence'. But a major challenge of analysing the organizational influences on use of best practice was finding a source of relevant patient outcomes across an organization.
"What use is studying clinicians' use of best evidence if it doesn't matter to patient outcomes, or even if we are pretty sure it does, we can't measure it?" says Estabrooks. "I became increasingly frustrated with my own research and wondered if my work mattered or if it could really contribute to a difference in patient health related outcomes."
In 2006 Estabrooks shifted her program of research to its current focus and began to build in a new area that had the capacity to impact an enormous segment of the population.
The number of seniors continues to increase sharply and within five years, 19 per cent of Canadians will be over 65 years old. By 2041, nearly a quarter of the Canadian population will be over 65, with seniors over 75 the most rapidly growing group.
Motivated by the urgent needs of highly vulnerable and frail older adults who live in residential long term care (LTC) facilities, Estabrooks and her team now conduct the majority of their research in LTC settings-where half of the residents are aged 80 or older.
"The need to improve quality of care, quality of life and quality of end-of-life are dramatic," she says. "And at a time when these older adults most need strong advocacy, they may have the least amount available."
Estabrooks notes that while there are certainly some residents in LTC facilities who can advocate for themselves, almost all are frail and over 70 per cent have some form of dementia. "As our community and alternative living programs become more mainstream and plentiful, and as aging in place policies continue to be implemented, older adults will be admitted to LTC facilities later and later in the trajectory of their decline."
This translates to residents who are more physically, medically and socially complex; however, how LTC facilities are staffed hasn't changed significantly in some time. Staffed largely by care aides who provide about 90 per cent of direct care, this group is not regulated.
Isolation, which has a negative impact on health, is also an issue for this population-whether in the community or LTC facility. Estabrooks' research shows that women, who also have significantly higher rates of dementia, make up the majority of LTC facilities and are disproportionately low income and alone.
Estabrooks' adds that recently-and only in a small number of major cities-efforts begun in earnest to address the unique needs of the LBGTQ community. "This is a community that is often marginalized and upon admission to LTC facilities would likely be forced back into the closet, furthering worsening their social and psychological isolation."
The last decade of Estabrooks' research and seeing its impact has given her hope for a better future for the care and quality of life of seniors.
"It has certainly been worth the effort," she says. "The work is rewarding, the sector welcoming, the quality of our team makes it a pleasure to work with. We have been able to move from observational work to intervention studies, network studies, and to exploit our rich database."
One day at a time, and one research study at a time, is how Estabrooks and the TREC team are shaping the future of LTC facilities and impacting the lives of older Canadians.
Interested in studying with Dr. Estabrooks and the TREC team? There are many opportunities for postdoctoral fellows, graduate students from a wide variety of disciplines, as well as, undergraduate students at TREC. Visit http://www.trec.ualberta.ca for more information.