Peter Uhlenberg, PhD
Jenifer Hamil-Luker, MA
Department of Sociology,
University of North Carolina,
Chapel Hill, NC, USA.

Towards the end of life, many older people experience physical decline that forces them to depend upon others for care. This loss of independence, never an easy life transition, is often made more difficult by the limited opportunities that those in long-term care (LTC) have for interacting with other people. Yet, as all sensitive medical professionals know, older adults in LTC, like people at every other stage of life, need meaningful social relationships in order to thrive. Thus, it is unfortunate that long-term care institutions tend to be highly age-segregated, providing few chances for older residents to develop and enjoy friendships with children and young people. It is not necessary, however, that social isolation and age segregation be the common experience of those in LTC. This article reports on efforts to promote intergenerational relationships in LTC, the potential benefits of greater age integration, and research findings of what conditions facilitate positive outcomes from exchanges between children and older adults in LTC.

Benefits of Age Integration
Nursing homes, assisted living facilities and day care providers are increasingly bringing the young and old together on a regular, formally planned basis to build enduring, mutually beneficial relationships.

Jean Chouinard, MD
Medical Director,
Complex Continuing Care Program,
SCO Health Service,
Ottawa, ON.

Background
The likelihood of admission to a nursing home (NH) is very much age-related. Roughly 5% of patients over the age of 65 live in institutions; this proportion rises to 50% for people aged 90 and up. With cutbacks in health spending, and the rising demand for this type of care, the NH populations are becoming increasingly frail and often have multiple coexisting active health problems on a background of precarious homeostatic reserve. Currently, over 50% of our inpatients are totally dependent on help for their care. Only 15% of these inpatients can ambulate independently. Such patients are also at much higher risk of complications. In our facilities, the yearly incidence rate of pneumonia is 200% (!), with a case fatality rate of 30%. Between 5 and 10% of patients admitted to Ontario Chronic Care Facilities will develop a pressure sore every quarter. Annual mortality rates in institutions range from 15 to 30%.¹

Some definitions--in much abridged version²
A care process is a series of sequential or parallel interactions among clinicians and between clinicians and patients aimed at a given outcome.

Michael Gordon, MD, FRCPC
Vice President Medical Services
and Head Geriatric and Internal Medicine,
Baycrest Centre for Geriatric Care,
Head, Division of Geriatrics,
Mt. Sinai Hospital,
Professor of Medicine,
University of Toronto,
Toronto, ON

Leigh Turner, Ph.D|
Baycrest Centre for Geriatric Care

Ethics Education in the Geriatric and Long-Term Care Setting
Baycrest Centre for Geriatric Care now has an innovative program in ethics education. Developing a well-rounded educational program in bioethics, intended to benefit all levels of staff within the geriatric and long-term health care setting, was a considerable challenge. With few models to emulate, this program was undertaken to provide the staff with the knowledge and means to respond to important ethical challenges in an appropriate manner. The system of unit-based ethics rounds, which has been implemented over the last several years, has been very successful and may serve as a prototype for other long-term care and geriatric facilities.

The Unit-based Model
The standard hospital model for providing assistance in resolving ethical issues includes an ethics committee that offers a consultation service. This structure, which exists at Baycrest, has been in existence for about a decade in the long-term care system, following its introduction to the acute care system years before.