Research Institute for Aging: Resident-centred, practice-guiding research.
Research Institute for Aging
Resident-centred, practice-guiding research.
By: Philip Rouchotas, MSc, ND
Issue: April 2010
The Schlegel-University of Waterloo Research Institute for Aging (RIA) promotes research relevant to aging in community and congregate settings. It focuses on practice-relevant research as a driving force behind innovation and quality care. Through partnerships with the University of Waterloo and Conestoga College, the RIA attracts research projects to “living research environments” within long-term care and retirement communities, with a view to immediate translation of research to practical training application for caregivers. The “living research environments” include ten facilities offering a continuum of care that are home to over 3,000 residents. These facilities vary in size, ethnicity (cultural, language, faith), and specialized care populations. Materials and information generated through research-to-practice initiatives are shared with other long-term care facilities and system networks to promote research-informed quality care.
The primary goal of the RIA is to enhance the care of older adults in both community-based and long-term care environments through the development and implementation of innovative research and training programs. The research collaborations and training initiatives fostered by the RIA are practical, hands-on, and have a direct link to resident quality of life.
The RIA is a product of the philanthropic spirit and vision of Dr. Ron Schlegel, whose family has been providing long-term care to Ontario residents since the 1950’s. Co-owner of the 10 long-term care facilities that operate under Oakwood Retirement Communities Inc., plus the Village of Winston Park in Kitchener and the Village of Aspen Lake in Windsor, he has committed $6 million over 10 years (plus additional annual contributions), to develop the Institute. Memoranda of Understanding are in place with the University of Waterloo, Conestoga College, the Centre for Family Medicine, and the University of Guelph for research and training activities.
Dr. Mike Sharratt, formerly Dean of the Faculty of Applied Health Sciences at the University of Waterloo, is now the Executive Director of the RIA. Although he retired from UW in 2007, he still maintains a university connection as an adjunct Research Professor. Josie d’Avernas, MSc, serves as the Associate Director of the RIA. Three Schlegel Research Chairs have also been appointed: Dr. George Heckman in Geriatric Medicine, Dr. Safa Elgamal in Neuroscience, and Kristie Clark as RIA Chair for Enhanced Seniors Care (located at Conestoga College). Together this team oversees the many exciting research initiatives of the RIA.
Dr. Sharratt and Dr. Ron Schlegel have been acquainted since their days of undergraduate training. In a phone interview with Dr. Sharratt, he described Ron as a visionary and entrepreneur. In spite of the fact that Ron holds a PhD in social psychology and an honorary Doctorate, he asks everyone to call him Ron. He is directly involved in the ownership of the ten long-term care communities that serve as research centres for RIA initiatives. Ron was exposed to the long-term care community environment from a very young age, as his father owned and operated a “Nursing Home” in the 1950’s in London, Ontario. He began his education in long-term care by age ten, as he was called upon to deliver meals to residents before and after school.
Dr. Sharratt has always been inspired by the Mennonite values of caring and respect that Ron brings to the Villages. “The resident-centred aspect of our Villages is the cornerstone of our program’s success. Research for the sake of research is not of interest to our team. In order for a project to be considered, there must be an expectation for outcomes directly impacting resident’s quality of life, and subsequent impact on quality of care. The result is that residents do not fear the arrival of researchers, but instead welcome them.
“They know participation in the proposed research program is likely to be of immediate benefit to them”.
The result has been the establishment of a unique research culture. The researchers are serving the interests of the residents, and not the other way around.
Dr. Sharratt also described the partnership with Conestoga College as a key aspect of the success of the RIA. Direct applicability to resident’s daily life remains integral to all of the initiatives and key to that is a workforce that is well-trained and passionate about seniors care. Once successful outcomes are demonstrated, Conestoga College is able to train students (e.g. PSW’s and RPN’s), who deliver the programs.
Nine distinct areas of research have emerged as programs of the RIA. These include:
• Agri-food for Healthy Aging (A-HA)
• Fitness and plasticity of aging
• Functional Abilities Program (FAP)
• Geriatric Medicine
• Murray Alzheimer Research and Education Program (MAREP)
• Optimizing medications for seniors
• Senior-friendly physical Environments
• Spiritual care for seniors
• Vascular aging
Our team at IHP was impressed with the breadth and depth of these research programs. Dedication of a program to “spiritual care” piqued our interest. The research team, acknowledgeing the lack of consensus in defining spirituality provided the following broad definition: “That which lies at the core of each person’s being, that is concerned with ultimate meaning and purpose and that is expressed through values, hopefulness, vocation, and relationship with oneself, others, the natural worlds and the transcendent. It may or may not include religious practices”. Forging into this important and under-researched area represents a new frontier in integrated healthcare practice.
The vascular aging program is also of tremendous significance. Cerebrovascular blood flow is able to be measured non-invasively and is correlated with changes in cognition. This has implications for residents with stroke as well as those with Alzheimer’s Disease and related dementias.
The Functional Abilities Program (FAP) is yet another key area of focus. Dr. Sharratt described this as the RIA’s “most well-established research-to-practice program”. Under the research leadership of neuropsychologist Dr. Eric Roy, this program takes findings from his research to develop instruments for assessing cognitive and motor functioning in residents of long-term care facilities with the aim of promoting independence in mobility and functioning in daily living activities. This program has led to the integration of full time kinesiologists into the care team at each of the Schlegel Villages and generated many success stories of residents who regained lost functional capacities through participation in FAP.
Fintness and Plasticity of Aging is Dr. Sharratt’s particular area of research interest. Recent reports from McMaster University highlight a very poor rate of referral to, and utilization of, rehabilitation programs for patients in settings of secondary coronary prevention, yet exercise alone predicts a 24% reduction in all cause mortality risk in such settings, while basic diet advice predicts a 56% reduction in all cause mortality risk. Among the elderly, physical activity programs are known to reduce cardiovascular mortality, as well as risk of falls and subsequent osteoporotic-related fracture, not to mention enhancement of bone mineral density and delay/prevention of sarcopenia (age-associated muscle atrophy). Enhanced quality of life is also a routine finding among studies of physical activity in older adults.
The Agri-Food for Healthy Aging (A-HA) initiative is among the newest of the research tracks of the RIA, but described by Dr. Sharratt as the research arm with the potential to deliver one of the biggest impacts of all existing programs. Jessica Demeter, MSc, serves as the program manager, coordinating collaboration between RIA, University of Waterloo, and University of Guelph. A-HA encompasses several research objectives, key among them including sensory perception of food, enhancing the mealtime experience, and creation of functional foods designed to enhance the nutritional quality of residents’ diets.
Four scientists spearhead the research initiatives of A-HA:
• Dr. Lisa Duizer, Assistant Professor, Department of Food Science, University of Guelph (area of focus - sensory perception of food).
• Dr. Alison Duncan, Assistant Professor, Department of Human Health and Nutritional Sciences, University of Guelph (area of focus - soy-based functional foods).
• Dr. Heather Keller, Professor, Department of Family Relations and Applied Nutrition, University of Guelph (area of focus-psycho-social determinants of food intake).
• Dr. Ken D. Stark, Associate Professor, Department of Kinesiology, University of Waterloo (area of focus - omega-3 based functional foods).
During the interview with Dr. Sharratt, he repeatedly returned the focus of the conversation to the RIA, efforts of Dr. Schlegel, and the exceptional team of scientists the RIA has been able to gather to implement the mandate of resident-centred care. The focus required “returning” because I found myself equally fascinated with his amazing career long before his appointment as Executive Director of the RIA. Dr. Sharratt founded what was the first lifestyle-based cardiovascular rehabilitation program in the Kitchener-Waterloo area over 35 years ago, known as Hardy Hearts. The program has subsequently spawned a similar rehabilitation program for cancer patients. At the core of Dr. Sharratt’s teachings is lifestyle modification. Exercise, achieving and maintaining a healthy body weight, smoking cessation, and improved food quality are the cornerstones of health. And what is required to deliver them, or more importantly to support compliance with them, is a multidisciplinary team of healthcare providers. For more information on the RIA’s research initiatives, visit www.the-ria.ca.
IHP is grateful to Dr. Sharratt and Jessica Demeter for taking the time to educate us about RIA. Care of the elderly is a powerful research platform for examining the power of diet and lifestyle in health promotion, disease prevention/management, and quality of life. The RIA has important work underway. Their passion and success is changing the face of healthcare for seniors, one meal and one workout at a time.