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“ AT TEN, A CHILD; AT TWENTY, WILD; AT THIRTY, TAME, IF EVER; AT FORTY, WISE; AT FIFTY, RICH; AT SIXTY, GOOD OR NEVER” “ I GROW OLD LEARNING SOMETHING.

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Presentation on theme: "“ AT TEN, A CHILD; AT TWENTY, WILD; AT THIRTY, TAME, IF EVER; AT FORTY, WISE; AT FIFTY, RICH; AT SIXTY, GOOD OR NEVER” “ I GROW OLD LEARNING SOMETHING."— Presentation transcript:

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2 “ AT TEN, A CHILD; AT TWENTY, WILD; AT THIRTY, TAME, IF EVER; AT FORTY, WISE; AT FIFTY, RICH; AT SIXTY, GOOD OR NEVER” “ I GROW OLD LEARNING SOMETHING NEW EVERYDAY”

3 OUTLINE Age distribution Changes with aging Concerns Pros & cons Accommodation Solutions Examples

4 Population structure and ageing Data from May Most recent data: Further Eurostat information, Main tables and Database. Planned article update: May 2015.Further Eurostat information, Main tables and Database

5 Population structure and ageing Data from May Most recent data: Further Eurostat information, Main tables and Database. Planned article update: May 2015.Further Eurostat information, Main tables and Database

6 CUTOFF POINT? AGE > 60 YRS ? > 65 YRS ? > 70 YRS?

7 22% between yrs 7% between 65-74yrs 3% > 74 yrs

8 1994: 23% ASA members > 55 yrs % ASA members > 55yrs

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10 6 main governmental hospitals Total = 167 anesthesiologist Average age ~ yrs

11 CHANGES WITH AGING

12 - Decline in fluid intelligence [ capacity to process information & reason; critical To analyzing & solving complex problems] - Reservation of crystallized intelligence [ cumulative information acquired throughout life & include Professional expertise & wisdom]

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14 Capability and maintenance of skills Medical errors Adequate functioning “ anesthesiologist > 65 yrs in Ontario, Quebec and British Columbia had 50% more cases involving litigations and almost twice the number of cases involving severe patient injuries compared to anesthesiologists < 51 yrs”

15 - Well balanced clinical skills - Experience - Wisdom - Enhanced capacity for prudence and planning Pros - Predictable decrements in mental, physical and behavioral functions - Reduce cognitive function - Reduce ability to perform complex tasks rapidly and to multitasks - Reduces stamina to endure prolonged work rotations. - Increased adverse patient related events Cons

16 HOW TO ACCOMMODAT E CHANGES ??

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18 1) MENTAL, COGNITIVE AND EDUCATIONAL EVALUATION

19 EVALUATION TOOLS Neuropsychological assessment…. e.g. Addenbrook’s cognitive examination-revised ( ACE-R) Physician practice enhancement program- collage of physicians and surgeons of British Columbia physician achievement review in Alabasta Mini mental state examination PACE program [ physician assessment and clinical education program ]

20 - Peer review - PREP - SAP etc….

21 2) NO FURTHER ONCALL DUTIES FOR THOSE >65YRS OLD

22 3) NO FURTHER HIGH ACUITY PROCEDURES FOR THOSE > 65YRS OLD

23 4) RETIREMENT FROM OR CLINICAL PRACTICE WITH POSSIBLE CONTINUATION OF NON-OR CLINICAL OR OTHER NON-CLINICAL ACTIVITIES FOR THOSE > 70 YRS

24 5) SIMULATION Formative: assessment for learning by identification of weakness and deficiencies for Summative: assessment of learning for achievement of an adequate standard of Facilitate assessment of crisis resource management

25 Pre-determined age ?? Fundamental principle: based on individual basis and not age. Routine cognitive evaluation of older physician

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27 A) VICTORIA HEALTH PROFESSION REGISTRATION ACT 2005 AND ITS PREDECESSOR- THE MEDICAL PRACTICE ACT 1994

28 - Preliminary investigations of medical practitioners/ medical students; based on: * Mental and physical health * Presence of incapacity * Alcohol of drug dependence “RESULTS” - Youger medical practitioners are more likely to be notified to the board because of concerns about substance misuse or psychiatric disease - Older practitioners are more often notified because of concerns about cognitive functioning From October 1 st 2004 to September 30 th 2006, “ cognitive/other” notification made up 50% of all notification.

29 OPTIONS AND Counselling to consider cognitive problem ? + refusal to retire = for neuropsychiatric No agreed standards to the level of impairment sufficient to warrant suspension

30 B) PHYSICIAN PATENCY ASSESSMENT PROGRAM BETWEEN

31 Screening of 45 participants (1) Physicians performing well = no or mild cognitive impairment (2) Significant number performing poorly = significant neuro-psychological difficulty (3) Cognitive impairment was more marked in elderly physicians.

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33 REFERENCES CAN J ANAESTH.CAN J ANAESTH SEP;61(9): EPUB 2014 JUL 2. * THE AGING ANESTHESIOLOGIST: A NARRATIVE REVIEW AND SUGGESTED STRATEGIES. BAXTER AD BAXTER AD 1, BOET S, REID D, SKIDMORE G. BOET SREID DSKIDMORE G ANESTHESIA & ANALGESIA: JUNE VOLUME 92 - ISSUE 6 - PP DOI: / ECONOMICS AND HEALTH SYSTEMS RESEARCH: SPECIAL ARTICLE * ISSUES OF CONCERN FOR THE AGING ANESTHESIOLOGIST KATZ, JONATHAN D. MD

34 REFERENCES MED J AUST.MED J AUST DEC 1-15;189(11-12): KNOWING - OR NOT KNOWING - WHEN TO STOP: COGNITIVE DECLINE IN AGEING DOCTORS. ADLER RG ADLER RG 1, CONSTANTINOU C.CONSTANTINOU C ACAD MED.ACAD MED OCT;81(10): COMPETENCE AND COGNITIVE DIFFICULTY IN PHYSICIANS: A FOLLOW-UP STUDY. TURNBULL J TURNBULL J 1, CUNNINGTON J, UNSAL A, NORMAN G, FERGUSON B.CUNNINGTON JUNSAL ANORMAN GFERGUSON B

35 REFERENCES JRSM OPEN.JRSM OPEN APR 9;5(5): DOI: / ECOLLECTION A RETROSPECTIVE STUDY OF COGNITIVE FUNCTION IN DOCTORS AND DENTISTS WITH SUSPECTED PERFORMANCE PROBLEMS: AN UNSUSPECTED BUT SIGNIFICANT CONCERN. KATARIA N KATARIA N 1, BROWN N 1, MCAVOY P 1, MAJEED A 2, RHODES M 1.BROWN NMCAVOY PMAJEED ARHODES M AN AOA CRITICAL ISSUE FUTURE PHYSICIAN WORKFORCE REQUIREMENTS: IMPLICATIONS FOR ORTHOPAEDIC SURGERY EDUCATION EDWARD S. SALSBERG, MPA; ATUL GROVER, MD, PHD; MICHAEL A. SIMON, MD; STEVEN L. FRICK, MD; MARSHALL A. KUREMSKY, MD; DAVID C. GOODMAN, MD, MS J BONE JOINT SURG AM, 2008 MAY 01;90(5): POPULATION STRUCTURE AND AGEING DATA FROM MAY MOST RECENT DATA: FURTHER EUROSTAT INFORMATION, MAIN TABLES AND DATABASE. PLANNED ARTICLE UPDATE: MAY 2015.FURTHER EUROSTAT INFORMATION, MAIN TABLES AND DATABASE

36 REFERENCES UC SAN DIEGO PACE PROGRAM LECTURES: PRACTICING MEDICINE LONGER: AGING PHYSICIAN POPULATION/ NEURPPSYCHOLOGICAL PERSPECTIVES. DR. WILLIAM PERRY – PHD QUEBEC AND ONTARIO EXPERIENCE. DR. WILLIAM MCCAULY, MD-CPSO

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