Dr. Nathan Stall began his career as a medical student at Mount Sinai Hospital where he has continued to work as both a clinician and scientist for the past seven years. As the new Geriatrics Site Lead for Sinai Health, his goal is to deliver life-changing care to complex older adults and their caregivers, produce world class research on ageing, and train the next generation of clinicians and scientists in geriatric medicine.
The population in Canada is aging quickly. By 2046, the number of Canadians aged 85 years and older could triple to almost 2.5-million people.
As older adults live longer, the demand for health care services is expected to surge in the coming years. Geriatric medicine will continue to be an instrumental part of the health care system as more people face the limitations and long-term health challenges associated with aging and chronic diseases.
We spoke with Dr. Stall about his new role, his career at Mount Sinai and Sinai Health, and how he envisions the future of care for older adults at Sinai Health.
What does your new role mean to you?
It is a dream to get the opportunity to lead the Geriatrics program and help shape the future of care for older adults at Sinai Health. Caring for older adults is a special privilege because they have incredible life stories to share. But also, as a physician, you must address the fact that their medical problems are often intertwined with complex social, functional and environmental circumstances, including intergenerational family involvement, caregiver stress, and socioeconomic pressures.
What drew you to the Geriatrics program at Sinai Health?
I have always wanted to work for the Geriatrics program at Sinai Health and help lead one of the largest sections of geriatric medicine in the country. At Mount Sinai Hospital, our inter-professional teams work together to not only address the medical issues our patients are facing, but also many other complicating factors. It’s truly an integrated, 360-degree approach.
I was also drawn to the research side of the Geriatrics program, as Mount Sinai in 2010 became the first academic health sciences centre in Canada to make geriatrics a core strategic priority. Together, Sinai Health and the University Health Network are producing high impact research that is changing how we care for older adults across the continuum of our health care system.
What do you hope to achieve in this role and what are your plans for the future?
I am privileged to lead one of the most academically productive sections of geriatric medicine in the country. I want to explore opportunities to grow world class research and science that complements the exceptional care we provide for older adults.
As a clinician scientist, my research focuses on unpaid family caregiving for dementia, drug safety for older adults, Canada’s long-term care system, and the health impacts of climate change on older adults. I feel extremely lucky to support the trainees in our section who are engaging in research focused on pressing issues related to ageing and older adults.
What is your biggest accomplishment as a geriatrician?
My proudest moments as a geriatrician were working with colleagues at Sinai Health during the COVID-19 pandemic. At the very onset of the pandemic, I helped lead Mount Sinai Hospital’s clinical response to support a Toronto long-term care home experiencing a severe COVID-19 outbreak. When a partnership was established between the hospital and the long-term care home on April 15, 2020, the home was already 16 days into a substantial outbreak, and there were 89 infected residents, resulting in 12 deaths and 47 infected staff members.
Our multi-phased partnership involved a cadre of Sinai Health nurses, administrators, geriatricians, psychiatrists, palliative care doctors, and infection control experts who were able to offer their support to the long-term care home. These efforts resulted in several lives saved, and demonstrated the incredible skills and dedication of our Sinai Health team.
How do your research interests inform your work at Sinai Health?
My research always strives to better inform how I care for my patients and their families. Often, new studies emerge from my frontline clinical experience.
For example, a few years ago I was asked to consult on an older patient who was delirious in the emergency department for unknown reasons. Our team evaluated the patient for the more commonly encountered precipitating causes of delirium, but we couldn’t identify anything obvious. We added a toxicology screen and discovered that the patient tested positive for cannabis. After discussions with the patient’s family it became clear that they had unintentionally consumed an extremely high dose of edible cannabis and became very ill.
Afterwards, I wondered how often this might be occurring to other adults, especially since Canada had recently legalized recreational edible cannabis. Using data covering the entire province of Ontario, our team found that Canada’s legalization of cannabis was associated with increased rates of emergency department visits for cannabis poisoning among older adults. This is just one example of how my clinical work informs my research and vice versa.
According to the Canadian Longitudinal Study on Aging, Canada is experiencing an unprecedented change in the make-up of its population. By 2036, nearly one in four Canadians will be age 65 or older. How is Sinai Health preparing for this change?
Canada is about to become a super-aged society, which means that more than one in four people living in our country will soon be over the age of 65 years. While many pundits describe this as a looming societal problem, I see this as a tremendous opportunity to think about how to change the way in which Canadians value older adults, how we can invest in preventative efforts to promote healthy aging, and how we can better ensure our older patients are getting the right care at the right time.
At Sinai Health we are becoming an age-friendly health system that focuses on four evidence-based elements of high-quality care, including enhancing mobility, preventing delirium and managing dementia, optimizing medication use, and supporting what matters most to older patients and their families.
