SREMI Research Chair

SREMI’s support for the chair in Geriatric Emergency Medicine research has led to significant advancements in the past year translating into important impact for our community.

With innovative approaches such as using volunteers to reach out to socially isolated and lonely seniors, using powerful basic science techniques like metabolomics to better understand delirium, the use of technology and artificial intelligence to improve outcomes for older people who need emergency care and new national and international mentorship and collaborations, Dr. Jacques Lee is improving the lives of older Canadians.

Social Isolation and Loneliness

Social isolation and loneliness contributes to 45,000 deaths per year in Canada – as much as smoking and diabetes. However, few interventions to address these incredibly important social determinants of health in older ED patients exist. Therefore, Dr. Lee’s team has reached out to over 5,000 older people discharged from the ED to test the HOW RU intervention which matches older people with similar-aged hospital volunteers for weekly chats.

Scientifically, this allowed Dr. Lee to establish some of the first estimates of the impact of social isolation and loneliness among older Canadian ED patients. Aside from the direct impact of connecting over 135 older people with volunteers, extensive media coverage of Dr. Lee’s research on The National, The Current radio show, Global News and The Globe and Mail among others has tremendously raised awareness of the impacts of social isolation and loneliness on a national level.

In addition, Dr. Lee’s students have explored the use of additional innovative interventions including using younger volunteers and the Making Art, Making Change intervention. He has also made interesting discoveries about the experiences of older people with social isolation and loneliness. Specifically, Dr. Lee discovered that many older people with objective measurements of loneliness do not identify as lonely, perhaps due to stigma. He is also developing a simple, quick screening question to help busy front line ED staff identify loneliness.

Femoral (Hip) Fractures and Delirium

Dr. Lee’s research on delirium remains at the forefront of efforts to understand this complex condition. Despite over 400 years of study, the underlying brain processes leading to delirium are still not fully understood. To address this gap, Dr. Lee is using an innovative approach, focusing on older patients with hip fractures who present to the ED. While factors known to prevent delirium - such as mobility, proper nutrition, and avoiding psychoactive medications like opioids - are typically unavailable to these patients, this presents a unique challenge. Although 95% of patients with hip fractures are delirium-free upon arrival, up to 30% will develop delirium within seven days. Dr. Lee’s program aims to identify biomarkers that emerge after delirium onset. By collecting bio-samples on arrival and daily thereafter, he is working to uncover early indicators and develop new diagnostic tests. This research could also reveal the underlying mechanisms of delirium and guide new drug therapies to prevent or reverse the condition. To date, Dr. Lee has enrolled over 140 out of 604 patients across Toronto, Ottawa, and Quebec City, with 40 developing delirium. Enrollment in Quebec City will begin next month. While these discoveries may take two to three years to fully materialize, their potential to transform delirium diagnosis and treatment is immense.

Working with the biostatistical support of Dr. Shelley McLeod, Dr. Lee completed an in-depth analysis of a trial where over 200 emergency physicians from 3 provinces were trained to perform ultrasound guided regional anesthesia or “nerve-blocks”. This trial, currently being submitted to JAMA, demonstrated that the blocks were safe, effective, and could be performed quickly. Significantly this trial found that delirium was reduced by 58% in those randomized to the treatment group. This trial has significant promise to influence clinical practice and improve outcomes in older people with hip fractures.