Health team focuses on changing ‘risk culture’ to improve lives of older adults living with frailty and dementia

For Catherine-Anne Murray and Kathryn Hominick, changing how people view risk is key to enhancing the quality of life of older adults.

Through their work in Geriatric Ambulatory Care at Nova Scotia Health’s QEII Health Sciences Centre Camp Hill Veterans Memorial Building in Halifax, Murray, an occupational therapist, and Hominick, a clinical social worker have witnessed a growing health concern among older adults living with frailty and dementia.

According to the Alzheimer’s Society of Nova Scotia, in 2020, there were an estimated 15,300 people living with dementia in Nova Scotia. The province is also expected to see an 87% increase in this number by 2050, which means 28,649 more Nova Scotians living with dementia.

Atlantic Canada also has the oldest population in Canada, a trend that is expected to continue. In addition, one in four hospitalized older adults (65+) are living with frailty. “Older adults living with frailty are three times more likely to be hospitalized for 30 or more days and two times more likely to be re-admitted 30 days following discharge,” says Dr. Kenneth Rockwood, QEII Health Sciences Centre internist-geriatrician and clinician scientist.

In addition to their regular roles, Murray and Hominick have worked for many years to shift ‘risk culture’ and raise awareness about the concept of “dignity of risk” within healthcare and in the community.

“The current approach to risk affects the quality of life of older Nova Scotians and creates unnecessary pressure on our health system”, says Murray.

The team’s goal is to enable older adults to return home more often, return home sooner and remain at home longer by influencing attitudes and understanding among healthcare providers, caregivers and families about how to care for individuals with frailty and dementia.

Murray and Hominick are inspired by noted Maine family physician and author, Dr. Allan Teel that advocates, “Have the courage and generosity to allow the elders in your life to live their remaining years as independently and freely as possible. Take the time necessary to listen to their concerns. They may scrape their knees, or worse, but they will be living—not just waiting to die.”

The term Dignity of Risk was first used in the 1970s within the context of people with intellectual disabilities. This population was often viewed as not capable of living independently or making decisions for themselves, which often deprived them of many typical life experiences.

Today, the Dignity of Risk philosophy extends to the care of older adults in various healthcare settings including residential, hospital, and community, positively influencing older adults’ ability to remain at home longer despite risks related to dementia and frailty level. Dignity of Risk acknowledges that life experiences carry the risk of failure, and we must support people in experiencing a spectrum of success and failure throughout their lives.

To modify how we provide better care for older Nova Scotians experiencing frailty and/or dementia as well as respect their right to take risks, Murray and Hominick continue to increase understanding through education and coaching. This shift in ‘risk culture’ may also be accomplished in part by reducing ageism, paternalism and hypervigilant attitudes about safety to empower older adults to live their remaining years in the least restrictive way possible. 

Photo of Catherine-Anne Murray, occupational therapist, and Kathryn Hominick, clinical social worker in Geriatric Ambulatory Care QEII Health Sciences Centre, Nova Scotia Health.