JGH’s Geriatric Medicine Department supports the elderly with innovative initiatives

Director of Geriatric Medicine Dr. Ruby Friedman credits Jewish General Hospital (JGH) Foundation donors for supporting important services in the department

Dr. Ruby Friedman, Director of Geriatric Medicine at the Jewish General Hospital (JGH), likes to remind medical students of one important thing: “Over the course of their career, almost every doctor will see a lot of elderly patients.”

As a result, it’s crucial that all doctors have a good grounding in how to help their patients maintain wellness as they age.

That’s why, when a new and greatly expanded geriatric care centre was opened at the JGH in 2021, it was named the Susan & Aron Lieberman Family Wellness in Aging Geriatric Centre. The name recognizes the importance of caring for patients’ overall health and autonomy – as opposed to treating only a specific illness or issue – and honours the Centre’s major donors.

The JGH’s long history of prioritizing geriatric medicine

Dr. Friedman, whose career in geriatric medicine at the JGH began in 1985, is very proud of the JGH’s long history of prioritizing geriatric medicine, thanks to the long-standing vision of JGH and JGH Foundation leaders. “This has allowed us to build our specialized geriatric services for the great benefit of the community,” he said.

This focus makes sense because 40% of JGH patients are over age 75, compared to the Quebec hospital average of about 35%. The average age of patients over 75 at the JGH is 83.

There are many elderly outside of institutions living to very old age. “They’re out there in the community and we need to have a plan and interventions to help them,” said Dr. Friedman. “We have to adapt, and we are.”

To meet all these needs, the Centre provides four specialized outpatient clinics. The waiting room, which is painted a bold and cheerful red, leads into these clinics via brightly lit hallways adorned with striking photographs of Montreal and colourful patient artwork.

The Memory Clinic, which has had ongoing support from the JGH Foundation, was a pioneer in the field in Canada and internationally when it started almost 30 years ago. As a centre for teaching and research, it collaborates with other research centres across Canada and in the United States. It’s where the MoCA memory test (Montreal Cognitive Assessment) was developed; the test was subsequently translated into many languages and used worldwide. The Memory Clinic helps people, including some in their 50s, to understand, manage and adapt to memory issues, which Dr. Friedman said are “very disconcerting and upsetting to patients because our mind is who we are.”  

The Geriatric Assessment Unit helps primarily patients in their 80s or older who have multiple medical issues. The goal is to optimize what is often very complex care and recognize frailty issues. “This is actually a great medical success story,” said Dr. Friedman, “because we have had to learn how to manage people who have lived and aged with serious chronic illnesses for a very long time, something that never happened before”. The unit has a multidisciplinary team including nurses, physiotherapists and occupational therapists who provide comprehensive evaluation and refer patients to community services to help promote wellness.

The third facility at the centre is the Senior Oncology Clinic to meet the needs of the elderly with cancer. “We help them understand their risks and options,” said Dr. Friedman, to evaluate how their other health issues, such as frailty, might impact their cancer care and treatment choices.

The fourth facility is the Mobility Clinic. “Mobility is huge for the totality of individual well-being,” said Dr. Friedman. “Our goal is to keep people mobile while working on other health issues.” For example, he said medication to lower blood pressure can cause dizziness as people age, affecting mobility, so it’s vital to find a balance to prevent cardiovascular problems without seriously impacting mobility. Sophisticated technology, such as a large “electronic carpet,” gives detailed data to help health professionals understand exactly why someone is having difficulty walking, or how their walking might provide clues to other medical issues.

Donations key to funding new initiatives, education

One of the primary uses of JGH Foundation donations in the Geriatric Medicine Department is for its Innovations Fund. This provides the flexibility to start new services or programs before receiving government funding or to allow staff to get specialized training for new services that would otherwise not be possible. “It makes a huge difference for us to have these resources available so we can act quickly when opportunities arise,” Dr. Friedman said. “Otherwise we just wouldn’t be able to continue to be innovators and leaders in the field.”

For older patients who are in the hospital, an innovative service is the Hospital Elder Life Program, or HELP, which is totally financed by donations to the JGH Foundation. The JGH was the first site in Quebec and the second in Canada to launch this program. Trained HELP volunteers are present on multiple medical and surgical units in the hospital and work with multidisciplinary teams on the units to assist elderly patients with difficulties related to cognition, nutrition, and mobility. Among those providing HELP services are McGill University students who participate as part of their studies. In the past year, the HELP program has become a required rotation for students in occupational health, physiotherapy and nutritional health.

“The results speak for themselves,” said Dr. Friedman. “The patients in the HELP program leave the hospital five days earlier than those who don’t take part. This improves access to inpatient units for patients awaiting admission from the Emergency Department.  Even accounting for some self-selection bias, there’s a big benefit that helps free up hospital beds to ease congestion in the ED.”

All of these initiatives and innovations, he said, add up: “They help us to achieve our goal of keeping people as functional as possible for as long as possible and living in their homes.”

To make a donation to the Jewish General Hospital Foundation, please go to www.jghfoundation.org