There’s a “silver tsunami” forming — and it’s set to hit the shores of British Columbia sooner than you think.
“The silver tsunami is a real epidemiological phenomenon that we are only experiencing the first ripples of,” says medical resident David Sherman, one of only four physicians in the University of British Columbia’s subspecialty geriatric psychiatry program. “Our society is going to have the kind of aging population that we’ve never seen before.”
Over the next 25 years, Canada’s baby boomer population will continue to reach age 65 and older and in B.C. — according to Statistics Canada — the senior population is set to exceed the national average. With this surge of aging ‘boomers,’ B.C.’s doctors will begin to see an increased number of complex cases — individuals faced with a myriad of medical, mobility, and psychological issues, ranging from dementia and depression through to anxiety.
At the University of British Columbia’s Faculty of Medicine, subspecialty residency training programs, like geriatric medicine and geriatric psychiatry, have heard the sounding alarms and are equipping the next generation of doctors with specialized skills and knowledge to support the wave of aging baby boomers.
Community outreach a cornerstone of UBC residency training
Among this next generation of doctors is UBC’s Martha Spencer, completing her final year of subspecialty training in geriatric medicine.
“I grew up as an only child and developed a very close relationship with my grandparents,” says Dr. Spencer, recalling summers spent on the open road with her parents and grandparents. “From an early age, I learned to relate to older people and that’s where my love of helping elderly people and geriatrics began.”
Originally from Corner Brook, Newfoundland, Dr. Spencer says it was the focus on acute geriatric medicine that attracted her to UBC’s geriatric medicine subspecialty residency training program.
Over the course of the two-year program, geriatric medicine residents, like Dr. Spencer, are exposed to a wide range of rotations in everything from in-hospital acute consultation, rehabilitation, community, and long-term care geriatrics.
Residents also gain valuable experience conducting outreach in rural, remote and northern communities — including Prince Rupert, Haida Gwaii and Prince George.
Dr. Lawrence Lo, program director of the geriatric medicine training program, says he sees these outreach experiences as vital to residents’ overall development.
“It’s an eye-opening experience,” says Dr. Lo. “These outreach opportunities bring residents face-to-face with individuals who are in need of services and the hope is that it will impact how they advocate for patient populations going forward in their career.”
For Dr. Spencer, it was an outreach trip to Haida Gwaii — a remote archipelago off the north coast of B.C. — that reinforced her understanding of the important role geriatricians play in the wider health care system, providing support to family physicians on the front-lines of patient care in rural and remote regions across the province.
“Geriatricians work collaboratively with family doctors and can really help provide support with their more complex patients,” says Dr. Spencer, reflecting on her time in Haida Gwaii, where she worked alongside a local family doctor to conduct consultations with older patients in the community.
Working in isolation: a thing of the past
It was this ‘team-based’ approach that drew Dr. Spencer to the profession in the first place.
“I love working in a team — that’s one of things that I love so much about geriatrics,” says Dr. Spencer. “Because older patients can be very complex, you really can’t do it alone.”
This sentiment is echoed by her colleagues in UBC’s geriatric psychiatry subspecialty training program, which gives residents the tools and expertise to assess, diagnose and treat older patients with complex mental disorders.
“At the end of the day, elderly patients have such complex issues and it’s difficult for anyone to work in isolation — multidisciplinary teams are needed to serve the aging population,” says Jeanine Marshall, who is completing UBC’s geriatric psychiatry training program in Victoria, B.C.
Training the next generation
The important role that specialists and subspecialists play in the overall healthcare system is widely recognized.
“A sustainable health care system includes the training of specialty and subspecialty physicians,” says UBC’s Dr. Roger Wong, associate dean of postgraduate medical education. “The growth and demographics of B.C.’s population means that demand for physicians trained in subspecialties, particularly those who focus on medical conditions affecting the aging population, will continue to increase.”
According to Martha Donnelly, the director of UBC’s geriatric psychiatry residency training program, readying the next generation of geriatric psychiatrists for the “tsunami” is what keeps her going.
“We not only have a tsunami of older patients, we have tsunami of dementia,” says Dr. Donnelly, who built the university’s geriatric psychiatry program from the ground up and witnessed its official launch in 2012. “It’s very gratifying to be teaching the next generation.” And it’s not just about teaching residents to diagnose and treat the ‘textbook cases’ — it’s about teaching them to truly know the people they’re caring for. “I’ve often said to medical students: when I see a patient and take a history – it’s like reading a biography. These people have had very interesting lives — often 85, 90…sometimes 100 years of it. It’s extremely exciting to know about some else’s life and see that you can make a difference.”
For UBC’s geriatric psychiatry resident, Dr. Paul Blackburn it’s making a difference that matters most. “Geriatric psychiatry allows me to advocate for older patients,” he says. “Elders are faced with enormous changes in their lives — they may be dealing with bereavement of spouses, retirement after decades of work, dementia, their own mortality — this is incredibly difficult for patients and families to face. And without a little bit of extra training and understanding of how everything fits together, these can be difficult issues for doctors to face.”
UBC residents have received training in geriatric psychiatry through elective and fellowship opportunities since 1984. In 2012, when geriatric psychiatry was formally recognized as a subspecialty by the Royal College of Physicians and Surgeons of Canada, UBC was responsive and seized the opportunity to meet the province’s health needs – it was one of only a handful of medical schools across the nation to offer an accredited geriatric psychiatry subspecialty residency training program.