Editor's Note: The AMA's socioeconomic determinants of health podcast series is hosted by Alberta Doctors' Digest editor-in-chief Marvin Polis. But for this edition, we are turning the reigns over writer, Lori Weitz.

According to the Canadian Medical Association, “Social determinants are systematic social and economic conditions that influence a person’s health. They include income, housing, education, gender and race, and have a greater impact on individual and population health than biological and environmental conditions. Their impact can even be greater than that of the health care system itself.”

In fact, some determinants of health are beyond a person’s control, such as gender, race and genetics. But even factors that people are able to influence may seem out of their control. For example, high inflation could adversely affect the health of many seniors, particularly those on a fixed income. The costs of healthy food, transportation and accommodations are increasing, but their income may not keep pace. When it comes to making choices, what will they do without and how will that affect their health?

How can we help seniors age well and manage their health?

Dr. Marjan Abbasi is an associate clinical professor with the U of A Department of Family Medicine and the site lead for the Misericordia Hospital’s geriatric program. Dr. Abbasi asserts that we must proactively identify, assess and manage people at risk of frailty and decline before they become frail, and that includes their caregivers, who are at risk of frailty themselves. 

“Every day I see patients and wish that I had encountered them earlier,” says Dr. Abbasi. “We could have changed the trajectory of their declining health using interdisciplinary primary care teams.”

According to the Alberta Medical Association’s March 2022 survey Caregiving & SeniorsSupports in Alberta, participants receiving help from a caregiver felt they were able to access needed medical care all or most of the time. They did indicate they needed support in other areas such as funding for home renovations, transportation, errands and home maintenance.

“All these things need to be priorities,” explains Dr. Abbasi. “Primary care needs to be proactive and robust. That means including social determinants of health as part of a senior’s overall health care picture. Do they have food security? Can they afford their medications? Can they stay active? Can they get to their medical appointments? Do they have a caregiver or other supports in place?”

Putting these supports in place is the basis of the Seniors’ Community Hub, a primary care program that works with seniors to set health goals that are meaningful to them and link them to the right supports to achieve those goals. Dr. Abbasi co-created the program with Dr. Sheny Khera to identify, assess and manage frailty. One of the essential elements is providing community-based support to patients and their caregivers, which also helps alleviate caregiver burden.

A video from the AMA archives: Caregiver Burnout - it's not just patients who need help. (Video producer credit: Marvin Polis)

When the caregivers become frail

So, let’s talk about caregivers. It’s not just the seniors becoming frail; their caregivers are also aging.

A recent report from the National Institute on Ageing’s National Seniors Strategy points out the following:

  • As the number of older Canadians continue to increase, so will the need for unpaid caregivers and the demands placed on them. 
  • The number of older Canadians requiring the support of unpaid caregivers is projected to more than double by 2050. At the same time, projections show there will be 30% fewer close family members who would potentially be available to provide unpaid care.
  • The cost to unpaid caregivers includes negative career impacts, lost wages, decreased retirement income, and adverse effects on physical and emotional health.

“We must apply the same approach to looking after our caregivers,” says Dr. Abassi. “If our health care system is struggling to keep up now, imagine the difficulty if we allow our caregiver to become frail.”

Dr. Abbasi looks at programs like the Seniors’ Community Hub to offer solutions. Involving the caregiver’s needs as part of the patient’s treatment plan is essential.

A recent Alberta Doctors’ Digest article about seniors and caregivers, Supporting seniors and their caregivers, noted that physicians can help lighten the burden on caregivers by being mindful of how their care plans will affect both patients and caregivers. 

  • Can care be provided in the home? 
  • Can multiple appointments be grouped together to reduce travel time and missed work? 
  • Are the suggested interventions feasible? 
  • How can physicians be compensated to more easily treat seniors, inclusive of their caregivers, with complex health needs?

    It comes back to the family physician as the coordinator of a patient’s care.

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