Let's Talk Research Annual Conference - 24th-25th September 2014 (Jane Martin...
The Grey Tsunami - Regulating Aging Professionals
1. College of Physicians and Surgeons of Ontario
QUALITY PROFESSIONALS | HEALTHY SYSTEM | PUBLIC TRUST
The Grey Tsunami:
The Regulation of Aging Professionals
Angela Bates
Manager, Committee Support
Compliance & Monitoring (CPSO)
2. “I have reached an age when, if someone
tells me to wear socks, I don’t have to.”
- Albert Einstein
3. College of
Physicians
and Surgeons
of Ontario
Key Themes
Our Aging Population
“Normal” Aging, “Successful” Aging
The Cognitive Continuum
Regulatory Approaches
6. College of
Physicians
and Surgeons
of Ontario
Our Aging Population
As the general population
ages,
so does the professional
population.
Should this worry
regulators?
7. College of
Physicians
and Surgeons
of Ontario
“Normal” Aging
Effects of normal aging on the
body:
Sensory organs
Reflexes
Skin
Bones
Metabolism and
hormone production
8. College of
Physicians
and Surgeons
of Ontario
“Normal” Aging
Effects of aging on the mind (cognition):
“Fluid” intelligence declines
Decline in recent memory/new memory formation
Attention changes
Processing speed slows
*Effects vary considerably among individuals
9. College of
Physicians
and Surgeons
of Ontario
“Normal” Aging
Some aspects of cognition tend to remain stable or
improve with age:
Language, conversation skills
“Crystallized” intelligence is stable
Remote memory is preserved
New brain cells can still be formed
12. College of
Physicians
and Surgeons
of Ontario
Mild Cognitive Impairment (MCI)
More serious cognitive decline
Subjective and objective indicators
Higher risk of developing dementia
Able to function with adaptations
13. College of
Physicians
and Surgeons
of Ontario
Mild Cognitive Impairment (MCI)
Amnestic vs. non-amnestic
Thorough assessments necessary to determine
underlying cause
Can be compensated for (e.g., reminder lists) and
does not necessarily interfere with daily living
MCI may be early stage of Alzheimer’s
15. College of
Physicians
and Surgeons
of Ontario
Dementia
Most common causes of age-related dementia:
Alzheimer’s Disease
Vascular (Blood Vessel) Dementia
Parkinson’s Disease
16. College of
Physicians
and Surgeons
of Ontario
Alzheimer’s Disease
Accounts for 60-70% of all cases of dementia
More prevalent at age 65 and older, but can begin
in 40s and 50s.
Slow onset: makes it difficult at first to distinguish
normal “forgetfulness” from pathological
condition.
17. College of
Physicians
and Surgeons
of Ontario
Alzheimer’s Disease
Progressive illness: worsens over time, to point
where patient may not be able to respond to
environment or remember loved ones.
Treatment aimed at symptom stabilization; no
cure.
18. College of
Physicians
and Surgeons
of Ontario
Alzheimer’s Disease:
Assessment & Diagnosis
Preferably conducted by neurologist and/or
geriatrician
No definitive diagnostic test; e.g., no x-ray or
scan or blood test but brain imaging may be used:
Single Photon Emission Computerized
Tomography (SPECT) Scan
Positron Emission Tomography (PET) Scan
19. College of
Physicians
and Surgeons
of Ontario
Vascular (Blood Vessel) Dementia
Second most common cause of dementia
Not a single disease, but a group of syndromes
relating to different vascular mechanisms.
May be caused by:
Stroke (CVA, or cerebrovascular accident):
but all strokes do not necessarily cause
dementia
Narrow or damaged blood vessels in the brain
20. College of
Physicians
and Surgeons
of Ontario
Vascular Dementia:
Assessment & Diagnosis
Neurological examination
Brain imaging
Carotid ultrasound
Neuropsychological testing
21. College of
Physicians
and Surgeons
of Ontario
Parkinson’s Disease
Progressive disorder of the nervous system
marked by impaired movement, coordination,
cognition and affect
Caused by impaired dopamine-producing cells in
the substantia nigra portion of the brain
Dopamine is a neurotransmitter involved in
regulation of movement and pleasure
22. College of
Physicians
and Surgeons
of Ontario
Parkinson’s Disease:
Assessment & Diagnosis
Clinical history and observation:
Tremor, slow movement, muscle rigidity
Onset on one side of body
Resting tremor
Responsiveness to dopamine
Neurological examination
23. College of
Physicians
and Surgeons
of Ontario
Capacity (Health) Assessments
Threshold for triggering assessment?
Assessments are invasive
Cannot be directed by regulator capriciously;
must meet statutory threshold (if governing
legislation articulates one); and take into
account considerations of procedural fairness
and privacy
24. College of
Physicians
and Surgeons
of Ontario
Capacity (Health) Assessments
Neuropsychological
Assessment of functional capacity
Neurological
Brain imaging (CT, MRI)
Geriatric
Occupational
25. College of
Physicians
and Surgeons
of Ontario
Adaptation
Most professionals will adapt their practices as
they age; e.g., limit tasks, hours of work
Issues:
Professionals with financial issues
Professionals who lack insight into health
issues and potential impact of same
26. College of
Physicians
and Surgeons
of Ontario
Regulatory Approaches to MCI
The grey area:
What options are there for addressing health
assessments which indicate MCI, but which do not
contain a clear statement of risk to public?
27. College of
Physicians
and Surgeons
of Ontario
Regulatory Approaches to MCI
Avoid solo practice
Close practice supervision, with regular reports
Regular follow-up with
Family physician
Geriatrician
Neuropsychological testing (repeat)
Neurological examination (repeat)
29. College of
Physicians
and Surgeons
of Ontario
References
Aging and Cognitive Decline:
Adler, R., Constantinou, C. (2008). “Knowing – or not knowing – when to stop: cognitive
decline in doctors”. The Medical Journal of Australia 189 (11/12): 622-624.
Salthouse, T., Atkinson, T., Berish, D. (2003). “Executive functioning as a potential mediator of
age-related cognitive decline in normal adults”. Journal of Experimental Psychology: General 132 (4):
566-594.
Salthouse, T. (2009). “When does age-related cognitive decline begin?”. Neurobiological Aging
30(4): 507-514.
Singer, T., Verhaegehn, P., Ghisletta, P., Baltes, P. (2003) “The fate of cognition in very old age:
six-year longitudinal findings in the Berlin Aging Study”. Psychology and Aging 18 (2): 318-331.
30. College of
Physicians
and Surgeons
of Ontario
References
Successful Aging:
•Baltes, Paul B.; Baltes, Margret M. (1990). "Psychological perspectives on successful aging: The
model of selective optimization with compensation". In Baltes, Paul B.; Baltes, Margret M.
Successful Aging. pp. 1–3
•Depp, Colin A.; Jeste, Dilip V. (2009). “Definitions and predictors of successful aging: a
comprehensive review of larger quantitative studies”. FOCUS 7 (1): 137–50.
•Jeste, D. V.; Harris, J. C. (2010). "Wisdom--A Neuroscience Perspective". JAMA: the Journal of the
American Medical Association 304 (14): 1602
Rowe, J. W.; Kahn, R. L. (1997). "Successful Aging". The Gerontologist 37 (4): 433–40.
31. College of
Physicians
and Surgeons
of Ontario
References
Mild Cognitive Impairment:
•Troyer, A., Murphy, K., Anderson, M., Moscovitch, M., Craik, F. (2008) “Changing everyday
memory behaviour in amnestic mild cognitive impairment: A randomised controlled trial”.
Neuropsychological Rehabilitation: An International Journal (8) 1: 65-68.
•Anderson, N., Murphy, K., Troyer, A. (2012). Living with MCI Oxford University Press: Toronto.
•Whitwell JL, Shiung MM, Przybelski SA, et al. (2008). “MRI patterns of atrophy associated with
progression to AD in amnestic mild cognitive impairment”. Neurology 70 (7): 512–20
32. College of
Physicians
and Surgeons
of Ontario
Contact
Angela Bates
Manager, Committee Support
Compliance Monitoring & Supervision
College of Physicians and Surgeons of Ontario
abates@cpso.on.ca
