FALL 2011 · VOL.13, NO.2
Edge Home
Mike Carter, left, and Ali Vahit Esensoy are matching up health care resources with demand. Photo by John Hryniuk
Filling gaps in seniors' services
How Mike Carter and Ali Vahit Esensoy propose getting resources where they're needed most by Dana Yates


What systems and resources are needed to support healthy aging? The question strikes at the heart of Mike Carter's work. A professor in the Department of Mechanical and Industrial Engineering (MIE) and founder and academic director of the Centre for Research in Healthcare Engineering, Carter has developed two models to help governments plan health services for the aging population.

"Over the next 15 to 20 years, as baby boomers age, the health care system is in for a rough ride," he says. "Economically, it's a bad idea to simply move people into institutional homes. Most people want to live independently at home."

How will they accomplish this? By accessing community supports, including meal delivery services and programs that help with personal care activities. The community support sector has grown organically through small, independent agencies, and hence the current patchwork of services in the province does not necessarily follow the people who need it the most.

That said, Carter has created models to help policy-makers see service gaps from a big-picture perspective. One example is the population-based allocation model (PBAM). Developed with Ali Vahit Esensoy, a PhD candidate in MIE, the PBAM grew out of a need among Ontario's Local Health Integration Networks (LHINs), regional collections of health care services and centres.

Starting in 2007, the provincial government distributed more than $1.1 billion to the LHINs through the Aging at Home strategy. The initiative was aimed at helping seniors to maintain good health and live independently in their own homes. As part of the strategy, each LHIN was responsible for providing funding for enhanced home care and community support services in their own region. But without an accurate assessment of existing services or local demand for them, the LHINs were concerned the funding wouldn't go to the areas of greatest need.

Using Statistics Canada data and in collaboration with service providers, Carter and Esensoy created profiles of the users of community support services. That information, in turn, was compared to the local supply of support services. From there, the researchers generated interactive maps that showed the distribution of service gaps in all the LHINs.

"So instead of using intuition or trial and error, policy-makers are using these data-driven tools to identify where resources are most needed," says Carter.

Going one step further, he and Esensoy have also created a model that evaluates the ripple effect of health care investments before funds are even allocated. The project also involves U of T researchers Timothy Chan (MIE) and Susan Bronskill of the Department of Health Policy Management and Evaluation.

Focusing on seniors, the investment response model (IRM) was developed with input from health service providers and experts from Ontario's health ministry and the LHINs. The resulting model analyzes the system-wide flow of elderly patients from five perspectives: the demand placed on hospitals, the burden experienced by informal caregivers, and the availability of home and community care, rehabilitation and long-term care services. Consequently, the IRM forecasts how investments in one area affect the patient flows across the entire system. And perhaps most importantly, the model estimates how long it might take for investments to make an impact.

Baycrest's amazing Virtual Brain
Randy McIntosh is helping us understand the mysteries inside our heads by Jenny Hall


Baycrest's Randy McIntosh: 'Can we take a patient's brain and facilitate recovery using new pathways?' Photo by Rob Waymen

Randy McIntosh's brain isn't very smart. It's about as astute as your average three-year-old. But it's getting smarter every day.

Housed in a supercomputing data centre, this "brain" is actually a model created by the Brain Network Recovery Group (Brain NRG), a consortium of 16 universities. McIntosh, a psychology professor at U of T, vice-president of research at Baycrest and director of Baycrest's Rotman Research Institute, helped found Brain NRG.

Much of neuroscience has focused on brain structure, seeking to map the architecture of the brain and to understand the connections between brain areas. With advances in biophysics over the past few decades, scientists have been able to measure brain function in living humans and animals using sophisticated neuroimaging techniques, moving toward an understanding of how stimuli are processed by the brain. Think of brain structure like a picture and brain function like a movie.

But so far the "movie" has been limited to single studies — a test subject gets an fMRI as part of a research study and the result is information about how that person's brain responds to, say, listening to a certain piece of music.

McIntosh's "Virtual Brain" is one of the first projects to model brain structure and function simultaneously. It is a fluid, responsive model that can show how the brain responds to anything from looking at a picture to undergoing a stroke.

"It's like an athlete," says McIntosh. "You can look at an athlete's body standing there, but it's hard to appreciate what they can do until they actually do it. With the brain, you can see the pipelines, the wires that connect certain brain regions, but until the brain is actually engaged, you can't really appreciate how structure enables and constrains function."

Recent years have seen an explosion of data collected on brain structure and function. McIntosh's group is collating the data to create and refine their model.

They started with a model of a monkey brain. It produced the same patterns of activity seen in functional neuroimaging studies of real monkeys, effectively validating their methods. They then modeled brain structure and function of a human child and were able to "age" the brain a few years. The ultimate goal is to create a prototypical adult human brain.

The applications are potentially game-changing. Imagine physicians being able to input the architecture of a stroke patient into the model. The Virtual Brain would allow them to test potential treatments, including learning about how the patient's brain could rewire itself.

"There are a number of ways of getting from point A to point B in the brain," says McIntosh. "Can we take a patient's brain and facilitate recovery using new pathways?"

The Virtual Brain will also help scientists understand aging. "We know that in aging there are multiple changes in the white matter in the brain. These changes have very few consequences in some people, but in others they have devastating consequences. What is it that makes one person resilient and another person not?"

Aside from prognostic innovations, the Virtual Brain could revolutionize basic research. "It's become a virtual lab. Things you can't do experimentally in a human brain you can do in the Virtual Brain, just to see what happens."

Surprisingly, the biggest hurdle in getting the project going wasn't scientific, but cultural. Creating the Virtual Brain required computer scientists to write the programs, neuroscientists who understood cognitive processes and clinicians who had access to patients. Historically these groups don't have much in common, or much reason to collaborate. Says McIntosh, "We started speaking the same language and working toward the same goal, and all of a sudden this huge innovation came about."



A prescription for muscle health
Catherine Amara and Konstantina Katsoulis are focusing on older women by Althea Blackburn-Evans


Much has been said about the importance of maintaining muscle to promote bone strength as we age, but muscle health plays a much broader role in keeping older adults healthy, says Catherine Amara.

"It's not only the quantity of muscle that's important. The quality of muscle impacts metabolism, and metabolic complications can impact health, mobility and the ability to live independently." The professor in the Faculty of Physical Education and Health is working with doctoral student Konstantina Katsoulis to evaluate the best ways to keep older muscles healthy and thriving.

As we age, we begin to lose muscle mass, strength and function. The condition, known as sarcopenia, is the quiet cause of a host of metabolic problems that are implicated in age-related diseases such as diabetes, Alzheimer's and Huntington's. In hopes of improving muscle function and minimizing the onset of sarcopenia, Amara and Katsoulis are exploring the effectiveness of different types of resistance training on adults 65 and older.

Specifically, the duo wants to determine whether strength training (for example, simple weightlifting) can be augmented by power training (the ability to lift weights at a faster pace) to improve muscle function. "We want to determine what are useful indicators of function in older individuals, and whether different measures are appropriate for healthy individuals versus infirm individuals," says Amara. "We hope to have a large cohort so we can look at the continuum of aging to gain a better understanding of how muscle health impacts systems health."

Amara and Katsoulis plan to conduct their study in six-month intervals, creating strength-training regimes for their subjects and then evaluating body composition, muscle quality and bone mineral content using the state-of-the-art equipment in Amara's lab. They'll also investigate the impact of their unique training protocol on aerobic and anaerobic capacity. "Some research shows that resistance training in older adults also has aerobic benefits — something we don't see in younger adults." This striking adaptive response of older muscle to resistance training is likely related to the reduced quality of muscle in the older cohort.

Aiming to share ideas and insight with colleagues in other disciplines, Amara and Katsoulis joined U of T's Collaborative Program for Women's Health — a unique-in-Canada program that brings together scholars from nearly 20 faculties and departments at U of T. The common focus on women's health will help Amara shape her research program. "While there's certainly research that demonstrates both men and women adapt very nicely to strength training, there are reports of differences in the way their muscles adapt and in how improvements in functional capacity are achieved. So we are interested in looking specifically at some of these gender differences." Amara hopes the interdisciplinary connections she makes through the Collaborative Program will generate bigger benefits down the road. "We want to identify broader ways of applying our research results to people in the community."

Catherine Amara says healthy muscle impacts overall health. Photo by John Hryniuk


EDGE · FALL 2011 · VOL.13, NO.2