The way Freda Leung sees it, it’s not the resources you have, it’s how you make them work together that helps improve quality of care.
It’s a philosophy which threads through her holistic approach to geriatrics, ensuring our elders maintain their quality of life at all stages of living and care, especially those with diabetes.
As such, Freda’s unique combination of skills as a pharmacist, Certified Geriatric Pharmacist and Certified Diabetes Educator at The Scarborough Hospital, brings together her passions to unlock both resources available and to evangelize best practices in medication and diabetes management.
Her approach has won accolades from the community and her peers but ask her about it and she’ll modestly shrug: “I have the good fortune of being mentored by many distinguished and dedicated peers.”
The elderly have multiple issues, not only related to the changes in their metabolism and their body composition, she says. They are also prone to accumulate chronic diseases which may be managed by different physicians. As their pill burden increases, they are at risk of experiencing adverse effects. When their cognition is affected, taking their medications becomes a daunting task, thus non adherence and unsafe practices follow.
It is not uncommon to see elderly patients taking sleep medications or receiving narcotics for pain, for example, may find the drugs stay in their system longer, because of their metabolism.
“They might get up in the middle of the night and be unsteady on their feet, and slip and fall,” she said, which in turn creates more health problems if they break a leg or hip or suffer a concussion.
Those with diabetes are especially at risk, Freda says, the glucose lowering effect of the diabetes medications are more pronounced in the elderly especially in those who have inconsistent meal habits, as their blood sugar levels can drop quickly, putting them at risk of falls.
It was more than a decade ago while working on the orthopedic unit with intake patients she first started to notice a link between falls, fractures and diabetes in seniors. The pharmacy department encouraged her continual participation in the Diabetic Clinic and her pursue of becoming a certified diabetes educator.
Managing issues before they start, whether they’re living at home with support or in a facility, is beneficial to both patient and resources, she says.
“I’ve had patients end up in emergency with low blood sugar who say they are taking their insulin but then you find out they take it at 7 a.m. and don’t eat until an hour later or sometimes they skip breakfast altogether,” says Freda. “And that’s not good. I had another gentleman who was taking his insulin but not mixing it properly and injecting it in the same spot even it was bruised, so you never knew what dosage he would get.”
In her role as a consultant, she works with long term care facilities, empowering them to adopt best practices to optimize glycemic management of their residents.
“Long term care facilities are like mini-hospitals so it’s important to have the right protocols in place,” she said.
Freda’s passion comes naturally, in part because she has the experience of caring for her own elderly parents.
Her work has led to her presenting at the Canadian Diabetes Association’s national conference and to research papers published in journals such as the Canadian Journal of Diabetes, the Long Term Care Journal, as well as designing diabetes education programs at the Ontario Pharmacists’ Association and a specialized program “Diabetes Management in The Elderly” at the Michener Institute for Applied Health Sciences.
She first came to TSH in 1995, leaving a decade later to start her own consultancy and then returning this past year to work with the acclaimed Geriatric Assessment and Intervention Network (GAIN) Clinic which serves at risk seniors in Scarborough and is part of resource stretching east to Lakeridge and Peterborough.
“I was excited about combining my clinical experience with my pharmaceutical background and diabetes experience,” she says. “What we’re working on is a much more holistic model, which recognizes resources and allows us to connect the dots.”
Her latest pursuit is to facilitate the mutual referral of elderly patients with diabetes between the GAIN Clinic and the Diabetes Clinic.
One clinic may not have a diabetes specialist or a dietitian; the other may not have access to a full interprofessional team experience in geriatric care.
“But with the alignment of the two clinics, it’s a mutual use of resources,” she said.
The end result, she said, is better patient care, better quality of life and better use of resources.
“We don’t have a study yet to prove it, but we know that shipping patients to emergency and back isn’t optimal,” she said. “An ounce of prevention is so much more effective.”