Advocate for the Elderly

Dr. Mihaela Nicula

Council Award Recipient: Dr. Mihaela Nicula

At its meeting in March, Council presented Dr. Mihaela Nicula, a Toronto geriatrician, with its Council Award. The award acknowledges Dr. Nicula’s dedication to the advancement of geriatric services and her excellence as a physician leader.

Dr. Nicula is a geriatrician at West Park HealthCare Centre — a west Toronto hospital that provides specialized rehabilitation and complex care. Since her arrival at the centre in 2015, Dr. Nicula has been the driving force for the development of its specialized geriatric services.

“Starting with inpatient consults across the rehabilitation and complex continuing care units, Dr. Nicula worked tirelessly to expand service offerings in response to the needs of our surrounding community,” said Dr. Bikramjit Dhillon, Chief of Staff/Chair, Medical Advisory Committee at West Park.

Dr. Nicula has vast clinical experience in the diagnosis and management of neurodegenerative conditions, delirium, falls, impaired mobility, osteoporosis, poly-pharmacy, and progressive frailty. But it may be the compassion that she brings to the direct care of her patients that makes her most deserving of the Council Award, say her nominators. She does not just see patients with challenging and complex medical needs, but rather, she sees and appreciates them as people whose many life experiences have informed their preferences, wishes, dreams and goals. When she develops a plan of care, she keeps it centred not only on what the patient needs, but what the patient wants.

Born in Romania, Dr. Nicula graduated from medical school in Bucharest prior to moving to Canada with her family in 1997. Upon arriving, she obtained licensure through the CPSO’s International Medical Graduate Program. From there, she studied Internal Medicine at the University of Toronto. When it came time select a sub-specialty, she did not hesitate. She saw geriatric medicine as an opportunity to create change and make improvements for those within this medically complex patient population, as well as their families.

In 2005, she joined the Department of Geriatric Medicine at the University of Toronto as an adjunct Assistant Professor. In this role, she aims to foster a passion for geriatric medicine in a new generation of doctors. 

We have a video of her remarks 🎥 when she accepted the award at the March meeting of Council at the end of the article. Below we speak to Dr. Nicula:

When you were a child in Romania, did you want to go into medicine?
Throughout my childhood and adolescence, I considered going into various things — including architecture! However, over time, I began to see medicine as a good fit for me. It helped that various people in my life also encouraged me to pursue medicine as a career.

What led you to doing a sub-specialty in geriatric medicine?
My amazing mentors during the residency program made me appreciate the complexity of this field and the many opportunities I would have to use these skills in improving the quality of care for frail seniors. I also like the interprofessional aspect of this work, which is fundamental to the comprehensive approach to geriatric medicine.

Were you aware of an affinity for older patients during your training?
I have always been very comfortable working with the elderly, and I think this goes back to the strong connection that I had with my grandparents. 

The number of Canadians over 85 is expected to quadruple in the next two decades. Are you concerned with what the future holds in caring for the elderly?
There is definitely a gap between the demand for geriatric services and the number of geriatricians we have in Canada. One way to increase our capacity is by redesigning the health-care system with an emphasis on primary care. Using this approach, it will be possible to promote healthy aging in the community and earlier identify seniors at risk of rapid functional decline who would benefit from outpatient or inpatient specialized geriatric services. 

Frail elderly are hardest hit by COVID-19. How did that affect how you worked?
Our clinic team implemented strategies to mitigate the risk of exposure for outpatients and increased access for virtual care based on a triage protocol. The inpatient rehabilitation of frail seniors has been significantly impacted by the rigorous infection control protocols and the limited opportunity for family visits. As such, we have had to become creative with how we provide our patients with the necessary emotional and physical environment for recovery to reduce their risk for developing complications.  

Are you optimistic that this dark time will present opportunities to better protect the elderly in the future?
In a way, yes. There are systemic weaknesses in how we care for our frail seniors in Canada — whether it is in the hospital or in long-term care. COVID-19 has shone a huge spotlight on these issues. But with this growing awareness and attention, there is a momentum building to improve the quality and access to care for this group. We will continue to need support and more evidence to make well-informed decisions for our patient population. 

Tell us about the new program for frail seniors.
The Frail Seniors Transition to Home Program addresses challenges faced by patients who have become extremely deconditioned during long and/or complicated admissions in acute care and cannot return to their previous living circumstances. Some of these patients suffer from various degrees of pre-existing levels of frailty and cognitive impairment that limit their rehabilitation potential.  

Our four-to-six week-long inpatient program offers an interprofessional, comprehensive assessment that leads to a personalized plan of rehabilitation, caregiver education, and support to transition to the most suitable community environment that matches the patient’s needs. The strength of our program lies in our collaboration with multiple internal stakeholders and external partners who can provide follow-up for the patients after they are discharged.

And making the success of this program all the more heartening, is that COVID-19 nearly derailed it.
The pandemic hit just as we were about to launch the program. It interfered with the original plan for implementation, which included staff training and communication with our acute care partners. However, we got back on our feet! The clinical staff at West Park, working with the Frail Seniors Transition to Home Program, has quickly adapted to these unprecedented circumstances. We received plenty of positive feedback from our patients who completed this program and from their caregivers.

You were an early adopter of virtual care, which became especially advantageous during COVID-19.
Yes, virtual care is particularly useful in geriatrics for follow-up visits as well as patient and caregiver education. The access to technology is a bit problematic for this demographic, but we have been able to provide care in the patients’ homes with the help of our community partners who have been facilitating some of our clinic consults.

What do you do to bring balance into your life?
A couple of ways that I bring balance to my work life is by debriefing any challenging or emotionally charged cases with my team, as well as allowing time for self-reflection. Outside of work, I de-stress by being in nature, connecting with my daughter, family, and friends (virtually, of course!), exercising, reading, and spending some time every week painting. Together, these outlets help me refresh so that I can return to work ready to go at the start of the week.

Video from Council