Forget me not
'We're seeing just the tip of the iceberg."
Those words are from Dr. Randall McCuaig, the physician overseeing the Specialised Geriatric Clinic at Delta Hospital. And his comment stems from the fact Deltans, as a group, are getting older.
According to recent Stats Canada figures for 2011, 15.5 per cent of Delta's population is at or beyond retirement age, up significantly from figures collected in the previous Canada census in 2006.
And the marked rise in that segment of the population is, in part, shaping the type of health care being offered locally now, and into the future at Delta Hospital.
Annette Garm, Site Director at Delta Hospital, told the South Delta Leader that planning is well underway to examine how to best serve that anticipated wave of older patients when they arrive on the hospital's doorstep.
"The master concept plan really looks at what services we're going to need in that zero to 15 year period, what are our priorities in the next two, three and five years, and what do we see forecasted after that," she said.
Two areas at the top of the list are improvements in the short term—between two and five years—to the medical imaging department and laboratory services.
But significant changes in the longer term have also been earmarked to deal with the aging population.
There's a call to increase the number of medical beds at the hospital from the current 51 to 100. With the current average age of those using them now at 80 to 85 years old it's clear to see at what demographic the resources are being aimed.
Then there's a possible doubling of the number of a residential care beds, which now stands at 92.
"We are in a community that has a very large demographic of an aging population, although we are not growing as rapidly as some of the other communities are, we are growing especially around the area of the aging adult," Garm said. "In Ladner and Tsawwassen there is a great, emerging need for residential beds. Then we'll probably have to revisit the emergency department and see if it is big enough."
With the current peak number of ER visits topping 30,000 annually, Garm said there is still some room to accommodate more. But for how long, the future is uncertain since Delta Hospital works within a constellation of services within Fraser Health which serve 1.6 million people from Burnaby to Boston Bar.
Also part of the longer term needs—six to 15 years—is an increase of mental health beds.
Keeping other needs in mind
One area also hoping to receive some attention as part of Delta Hospital's plans for future expansion of services is the Specialised Geriatric Clinic—specifically, the memory clinic which has been offered locally for the past three years.
"It's (memory clinic) mainly to assist family physicians in the management of complex medical issues," McCuaig said. "And for the most part it is dementia and memory difficulties. But we also look at poly pharmacy—medication management—frailty, and fall/risk assessments. Anything to do with people getting older and basically becoming a bit more complex.
"The majority of our work is with dementia, though, managing dementia cases because dementia never has a single entity patient like a gall bladder patient or heart attack patient," McCuaig added. "Dementia involves the caregivers, the loved ones, the family. The whole dynamic of treating dementia involves everyone, not just the patient."
The clinic currently has about 200 patients on its books, receives about three to four new referrals each week, and has a wait list time of around three months, depending on the severity of the case.
Estimates for the future patient load?
"The prediction is that it's going to get huge," McCuaig said. "As the population ages we know we're going to get more dementia cases—that just goes hand in hand. The longer you live, the more likely you're going to develop a mental illness, whether it will remain in the mild dementia for your life, or markedly progress to the middle or late stage of dementia, nobody really knows."
What he and Sally Bearblock, nurse at the Specialised Geriatric Clinic, both understand is that facilities will have to grow to serve that expected rise in patients.
"Essentially, what we're looking at is trying to get more (doctor-patient) time. We (currently) have funding for one day a week. What can be done and what should be done—only time will tell," McCuaig said. "I think that better education for family physicians, too, will help them to be able to better manage dementia patients in their own offices. Will we be able to fully look after all of these cases? I have no idea."
"It is a bit of the chicken and the egg," Bearblock said. "The program is growing, the referrals are constant. But the program cannot grow until we get a physical space here. So, we want it to grow, but it's just finding the room. They (patients) keep rolling in every day, and the wait list gets a little bit longer."
"We've done a lot of work with the master site concept planning for Delta Hospital and the specialised seniors clinic is an identified need. And we are requesting more space as well," said Sharan Brar, manager of the clinic for Fraser Health.
What's required are a pair of treatment rooms, and some clerical space.
That may sound quite modest when looking at some of the items higher up the needs list at Delta Hospital, but the expected increase in the number of older patients will hopefully make it a reality.
Short term expansion of the labs and medical imaging is expected to cost $12 to $13 million. That has yet to receive approval from provincial authorities, said Garm.
"But so far, we've been doing our planning, making our case and moving along, hoping we will get the next steps in place—executive approval and funding."
For servicing those dealing with aging and dementia issues, that approval would be welcomed.
"Our limitation, right now, is space," Bearblock said. "And everyone familiar with Delta Hospital is aware for the need of expansion. So, in the future, as the program expands and space becomes available, I think we'll be able to pull in those allied health resources."