Long term care

he University of Toronto (UofT) Centre for Design + Health Innovation has released a new, comprehensive study, “Reimagining LongTerm Care Architecture in Post-Pandemic Ontario – and Beyond.” The report, supported by the Ontario Association of Architects (OAA) and consulting firm Jacobs Canada, explores how the built environment can better support long-term care (LTC) communities.

The COVID-19 pandemic had disproportionate impacts within Ontario’s LTC sector, exposing many structural vulnerabilities within these congregate facilities. Unless steps are taken to update standards and modernize design guidelines to better align to current and emerging clinical approaches, such vulnerabilities will remain largely unresolved – even in newly built LTC homes.

The study’s author, Dr. Stephen Verderber of UofT’s John H. Daniels Faculty of Architecture, Landscape, and Design, emphasizes the urgency for re-examining Ontario’s approach to refurbishing existing homes and building new ones.

“We applaud the Government’s commitment to adding desperately needed capacity into the LTC sector, however, success cannot be measured solely by the number of additional beds being provided,” he says.

The scale of financial commitment announced by the provincial government has the potential to bring about the paradigm shift in the quality of care for which residents and their families have long advocated. However, this rush to build new facilities will be a missed opportunity if the government neglects to first update standards and design guidelines to support enhanced infection control. Best practices must align with modern clinical approaches to dealing with LTC residents, particularly those living with physical or cognitive impairments.

In the case of residents with cognitive impairments, traditional ap-

New report reimagines a better built-environment for long-term care T THIS RUSH TO BUILD NEW FACILITIES WILL BE A MISSED OPPORTUNITY IF THE GOVERNMENT NEGLECTS TO FIRST UPDATE STANDARDS AND proaches have used the built environment as a means of keeping residents’ movements carefully controlled. However, the effort to solve one critical DESIGN GUIDELINES TO SUPPORT ENHANCED INFECTION CONTROL. problem (resident safety) has unintentionally created new issues – increased isolation and reduced mobility. “The built environment must be considered as important a parameter of care as any other medical intervention,” says Dr. Diana Anderson, an Architect and Geriatrician with Jacobs Canada. “I hope the Government of Ontario takes this opportunity to move beyond bricks-and-mortar solutions to considering data-driven design ideas, such as those identified in the UofT study, to inform health-based solutions.” The report identifies a number of exemplary case studies that model design excellence in long-term care residences. It also suggests 50 design considerations for use by design professionals, healthcare providers, gov-

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ernments, and other decision-makers working in this sector.

“This research could not have come at a better time,” says Susan Speigel, president of the OAA, which regulates the province’s architecture profession to protect the public interest. “We’ve known for a long time there were issues of concern within Ontario’s LTC sector, but this is one of the first times we’ve been able to take such a comprehensive look at the situation and begin identifying practical, evidence-based solutions and next steps that the architecture profession can bring into its practices.”

The devastating impact of COVID-19 on Ontario’s LTC sector is heartbreaking, but also a call to action.

“The vulnerabilities within Ontario’s LTC homes that led to the rapid spread of COVID-19 developed over several decades; no single government or political party has sole-ownership of this failure,” says Dr. Verderber. “However, the current government does have the financial tools, and the support of LTC residents, caregivers, their families, and Ontarians, to finally take decisive action to begin fixing this urgent problem.” ■ H

AGE-WELL announces recipients of its 2022 Emerging Entrepreneur Award

By Melissa McDermott

The 2022 recipients of AGE-WELL’s Emerging Entrepreneur Award are Liam Maaskant, co-developer of a walker with an elevating seat to give older adults greater independence at home, and Anika Munn, co-creator of a smart monitoring system to help older adults feel safer and more comfortable in various living settings.

The AGE-WELL Emerging Entrepreneur Award supports the development of emerging entrepreneurs to create and grow an innovative startup with potential social and economic impact in Canada. The innovation must address one of AGE-WELL’s 8 Challenge Areas and have potential to make a positive real-world impact in the lives of older adults and caregivers.

The award is designed to give a new entrepreneur the financial resources, mentorship and training as they focus on making their ideas viable and rapidly deployable in service to older adults and caregivers. The Centre for Aging + Brain Health Innovation (CABHI) has provided a cash top-up of $5,000 for each recipient, bringing the total value of the salary award to $30,000 for each of the awardees.

Liam Maaskant recently graduated from Dalhousie University where he received his degree in mechanical engineering. As co-founder of Axtion Independence Mobility Inc., he is developing a solution that expands the functionality of the rollator walker to include a motorized seat that moves up and down. This device aims to decrease older adults’ risk of falls while they engage in everyday tasks like reaching a lower drawer in the kitchen, transferring to the sofa or gardening in the flower beds.

“We designed our solution to help older adults live longer, more dignified lives at home by having a tool to stay active and engaged in the activities they love to do,” said Maaskant. “As a new graduate, I could not be more honoured and happier to receive this award. This will allow me to work full time on getting our device to people who need it.”

Anika Munn is completing her master’s degree in public health at the University of Saskatchewan. She is a co-founder of LivingSafe, a startup developing a smart monitoring system designed to keep older adults safer by providing their caregivers with physical status data – such as vital signs – and alerts, for instance if a loved one wanders at night.

“I am honoured to receive this award and thrilled for the opportunity to collaborate within AGE-WELL’s national network, which will help our general growth,” said Munn.

Continued on page 28

Continued from page 27 Entrepreneur Award

“Our solution is aimed at taking away numerous health and safety fears so older adults can live life more comfortably and, in some cases, stay in their homes longer.”

“Empowering, mentoring and supporting emerging entrepreneurs is part of AGE-WELL’s commitment to drive the delivery of technology-based products that benefit older adults and their caregivers, and generate economic returns for Canadians,” said Dr. Alex Mihailidis, Scientific Director and CEO of AGE-WELL, Canada’s technology and aging network. “Congratulations to this year’s exceptional recipients who exemplify the passion to make a difference and the innovative spirit in Canada’s growing AgeTech sector. We welcome these emerging entrepreneurs to our network with all its expertise and resources, and are pleased to begin working in partnership with them to get their innovations into as many hands as possible, ensuring a real-world impact for Canadians.”

“CABHI’s overarching mission is to advance innovative solutions to help older adults live their best possible lives. This year’s AGE-WELL Emerging Entrepreneurs epitomize that mission, providing critical solutions to help people maintain their independence, and age well at home,” said Dr. Allison Sekuler, President & Chief Scientist, CABHI. “When companies like these succeed, older adults will thrive. So, in addition to our cash contribution, award recipients will receive access to CABHI’s vast array of innovation services and our national and international network of scientific officers and validation, investment, and distribution partners, all supporting these creative entrepreneurs to significantly accelerate the spread, scale, and success of their companies.” ■ H

Melissa McDermott is an Ottawabased writer. AGE-WELL is a federally-funded Network of Centres of Excellence that brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. www.agewell-nce.ca

LONG-TERM CARE NEWS Scientists want a new definition

for critical care medicine

By Ana Gajic Here’s how COVID-19 shaped their cause

In the wake of the COVID-19 pandemic, a group of critical care physicians from around the world are calling for a broader definition of critical care – one that looks beyond syndromes and the consequences of illness and addresses the biological make up that determines how a person responds to disease and its treatments.

“Independent of its many causes, acute life-threatening illness is just the start of a process,” says Dr. John Marshall, a critical care surgeon at St. Michael’s Hospital, a site of Unity Health Toronto, and scientist at the Keenan Research Centre for Biomedical Science. “Many things happen that can change its course. These are less a result of the initial disease, than of its treatment and the way a person responds to it. Those all become part of a process, which can be modified.”

With a team of experts in critical care, including Dr. David Maslove, a clinician-scientist at Queen’s University in Canada; Dr. Benjamin Tang, a physician and scientist at the University of Sydney in Australia; Dr. Manu Shankar-Hari, a clinician-scientist at the University of Edinburgh in the United Kingdom; and Dr. Patrick Lawler, a cardiologist and intensivist at University Health Network in Canada, Dr. Marshall co-authored a perspective piece on this topic that was published in Nature Medicine.

We spoke with Dr. Marshall to learn more about why now’s the time to redefine critical care and what led to this call to action.

HOW DO WE CURRENTLY DEFINE DISEASES IN CRITICAL CARE AND WHERE DID THAT APPROACH COME FROM?

Traditionally, we’ve defined diseases based on their clinical manifestations, meaning the physical result of these diseases or their common symptoms. Two hundred years ago, pneumonia caused a patient to have a fever and to cough up sputum; why this happened was unknown. With the identification of bacteria as the cause of these symptoms, and the discovery that antibiotics could kill bacteria, pneumonia was redefined as an infectious disease of the lung.

But even with effective antibiotics, some patients continue to deteriorate, and prior to the advent of intensive care units (ICUs), deterioration was followed by death. The ICU had an impact on the nature of disease: if you got pneumonia and you became really sick, we could support you with a ventilator. This support gave rise to new complications and we created new terms for those complications. If you were on a ventilator and there wasn’t as much oxygen in your blood and your chest x-ray looked poor but you weren’t in heart failure, we said this was acute respiratory distress syndrome (ARDS). Patients with pneumonia could develop ARDS but so could any patient on a ventilator.

WHY ARE YOU PROPOSING A CHANGE IN THE WAY WE DEFINE CRITICAL ILLNESS?

There are three key features of syndromes like ARDS that develop because of ICU care. First, they result from the consequences of support in the ICU – only if you survive to be put on a ventilator do you develop ARDS.

Second, they aren’t unique to a particular initiating cause, such as trauma or pneumonia, but are a final common pathway of a number of acute illnesses. Both the body’s response and the treatment provided by the ICU team contribute to their evolution.

Finally, and most importantly, these complications arise through the body’s complex biologic response to infection and injury – a response that’s biologically variable from one patient to the next. As we learn more about the biology, we’re opening the door to a new strategy of treatment – targeting the response of the host, rather than just the trigger that activated that response. This can be done if we know which treatment is most likely to help which individual patient but to do this, we need to think beyond the bacteria and beyond the syndromes we support and describe patients on the basis of the treatable processes that are responsible for the patients being critically ill.

What we’re proposing is to take one step further back and say, how do we find common biologic traits across multiple physiologic processes and diseases, and therefore target the biologic process, not the doctor’s picture of what the common result is?

WHY IS NOW THE TIME TO THINK DIFFERENTLY ABOUT CRITICAL ILLNESS?

We’ve seen this happen in other fields. In the 1940s, oncologists realized that ovarian cancer behaves differently from skin cancer, even though we use the word cancer to describe them both. Continued on page 30

Continued from page 29 New definition

They proposed that we stage cancers based on the cell type and based on how advanced they are. In doing so, they paved the way for effective chemotherapy, and more recently, effective immune therapy.

Studies of breast cancer showed that some breast cancers are responsive to estrogen and others responded to a protein called vascular endothelial growth factor. Patients who had those responsive cancers could be identified and so it was possible to target the particular biological pathway and improve their outcomes. This was one of the first examples of what we’ve come to call “precision medicine.”

In critical illness, we’ve conducted more than 100 clinical trials studying treatments that target biological processes that we know are involved in critical illnesses; none of these have led to effective treatments. Our perspective is that the inherent biologic heterogeneity of those patients – or differences between patients – means that we’re not targeting the right patient with the right drug. Our goal is to change this.

HOW CAN WE LEARN FROM COVID-19 IN THIS AREA?

COVID-19 became the proving ground for the hypothesis that resolving heterogeneity can aid in finding effective treatment. COVID-19 is a disease caused by a single virus but one that that has variable effects on those infected. We still have that problem of variability – not everybody responds the same way to treatments – but the fact that we’re looking at a single cause is making it easier to understand that variability. For example, we’ve been able to identify inherited genetic factors that make a patient more susceptible to severe disease. Knowing what these are suggests that there are ways of identifying those patients in whom they’re present, and targeting the abnormality specifically.

We also learned through COVID-19 that we can work together and put aside competition to respond to a common threat. We’ve learned that it doesn’t cost anything to do that: progress is made much more quickly and everyone benefits, especially patients.

Photo credit: Yuri Markarov

WHAT DO WE NEED TO DO NOW AND WHAT ARE THE NEXT STEPS?

We’ve brought together many people who’ve been doing studies and coming up with models to differentiate more homogeneous subpopulations within a larger population of ICU patients. The long-term aspirational goal is to meld this group into a global collaboration to share data and study this at the large scale needed to address the inherent complexity. Complexity in critical illness is going to be much more difficult than complexity in cancer because it includes how we treat patients, as well as economic factors, such as the capacity of our health care system to support patients and train physicians.

It’s easy to be aspirational and to say this is what we need to do but what’s important is that we actually do it. One of the strategic decisions we made was that the people who realize this aspiration are those who are younger and have academic timelines that are measured in many decades. This is going to be a many-decade process. But we’re hopeful that we’ve taken the first step. ■ H

COVID-19 BECAME THE PROVING GROUND FOR THE HYPOTHESIS THAT RESOLVING HETEROGENEITY CAN AID IN FINDING EFFECTIVE TREATMENT.