Keeping seniors safe shouldn't lead to isolation and loss of autonomy

Castanet is introducing a new, monthly column aimed at addressing seniors' issues. It will appear here, on the opinion page, on the second Monday of each month and is written by Dr. Kevin Wade, a palliative care physician and the chief medical officer with Gravitii Technologies Inc., a B.C. company that has developed a platform to connect the public with compassionate, professional home care providers.

In their 2018 book, The Coddling of the American Mind, Greg Lukianoff and Jonathan Haidt coined the term “safetyism” to identify a cultural belief in which safety has become a sacred value.

They describe a modern campus culture where young people are coddled and insulated, protected from people, ideas and opinions they deem “unsafe”. The young people fail to develop resilience or any risk tolerance, and are deeply unhappy with the state of the world.

A similar culture of safetyism similarly affects our current approach to the care of the elderly in North America. In trying to keep older people safe from harm, we have created a culture of fear, although those fears are different from the ones expressed by young people.

This culture leads to isolation, loneliness, loss of autonomy, and institutionalization. Taken together, these factors can often lead to an earlier death than if more risks were tolerated to maintain autonomy.

In my work as a palliative care physician in Victoria, B.C., I see patients both in hospital and in the community. I’m closely involved in their discharge planning and regularly attend future-planning meetings with patients and families when they are preparing to leave hospital.

Almost invariably, the question of safety is foremost.

“We just want them to be safe” is a typical statement made during these meetings by the adult children of my elderly patients. It is a reasonable consideration, but “safe” is an ill-defined concept. What they often mean is “they want their parents to be monitored, protected and supported, which implies institutionalization. That reflects a culture that older adults must be insulated, protected and kept safe, especially from the physical harms such as a fall or aspiration.

That culture undermines the importance of autonomy and dignity. By prioritizing harm avoidance over all other values, we restrict the decision-making to just those salient points of physical risk. That leads to early institutionalization.

A 2017 study by the Canadian Institute for Health Information suggested one in five seniors in Canadian care facilities could be cared for at home, and hospitalized patients are three to eight times more likely to end up in a care facility than be patients at home.

While some of these patients are in care by choice, many others are there as a consequence of safetyism and loss of autonomy.

Our aim should be to empower patients and families to make those decisions in a fully informed way, with the ability to find the support they need wherever they want to live.

Their care should work with the existing home and community care system, in B.C. and elsewhere. Ultimately, we want patients to make their own decisions, optimizing quality of life while still being safe and to define for themselves what that means.

Dr. Kevin Wade is a palliative care physician and the chief medical officer with Gravitii Technologies Inc., a B.C. company that has developed a platform to connect the public with compassionate, professional home care providers.