Patient advocate's research involvement aims to improve care for frail homebound seniors

Vancouver resident Johanna Trimble loves her work as a patient family representative and patient advocate for frail elders, but she took on the role under circumstances that were frightening when her elderly mother-in-law was admitted from her independent living apartment to the Care Centre of her senior’s complex to recover from influenza and dehydration.

“Rather than just having extra care and days to recover, my mother-in-law, Fervid, was given additional medication and started to experience cognitive decline. It did not make sense to us in view of her original diagnosis,” explains Trimble. 

After looking at the new drugs she was taking, Trimble and her family eventually figured out that Fervid was having a severe drug interaction called serotonin syndrome (serotonin toxicity) from a pain drug combined with an anti-depressant.

“Because of understaffing, it took at least a couple of months before we were able to meet with medical staff. We gave them the info and they de-prescribed a couple of the drugs that we thought were the problem,” says Trimble. “From someone who was hallucinating, delusional, and couldn’t recognize her family because of the drugs, my mother-in-law came back to us completely, cognitively, and was just the same as she always was – a bright, with-it, person. She lived for four more years but she never returned to independent living because she had lost so much function and mobility by the time the medication issue was addressed.”

As a result of the experience, Trimble developed a strong desire to do something about the problem of frail elders not having a voice in their own care. She soon became involved in patient groups and dedicated herself to issues of overmedication, drug interactions, and elderly patient representation. 

Margaret mMcGregorDr. Margaret McGregor, family physician and researcher at the Centre for Clinical Epidemiology and Evaluation

Through her active participation, Trimble eventually met Vancouver Coastal Health Research Institute researcher Dr. Margaret McGregor, whose research supports the HomeViVE model of care. Started in 2008, HomeViVE is a Vancouver Community program that was initiated by Dr. John Sloan, a Vancouver family physician specializing in frail elder care whose primary care practice exclusively made house calls. HomeViVE involves family physicians and allied health professionals making regular visits to frail elders in their homes. The program provides 24/7 on-call service to a population of frail homebound older people. 

“There’s really good evidence that most frail people prefer to stay at home at the end of their life if they’re able to and we think this HomeViVE is one of the ways we can help them do this,” says Dr. McGregor, a family physician at Mid-Main Clinic in Vancouver and researcher at the Centre for Clinical Epidemiology and Evaluation. 

“We do believe that a service like HomeViVE is likely to result in reduced inappropriate visits to emergency departments and hospital admissions, which in this population can cause more harm than good.”