Nurse scientist offers care for patients and caregivers

Maureen Markle-Reid lovingly places her hand on a photo of a woman with curly hair and a beaming smile among the images of older adults that grace the walls of the Aging, Community and Health Research Unit at McMaster.

The woman is her grandmother, Kathleen Marck, who had a battle with Alzheimer’s that was devastating for the family. Marck’s daughter, Frances Markle – the beloved mother of Markle-Reid and a McMaster alumna – was diagnosed with the same disease a few years ago. Markle-Reid quietly notes that as her mother’s caregiver, it hasn’t been easy navigating the health-care system to ensure her mother has access to the appropriate care.

“For years I’ve been studying and writing about family caregiving, but to be a caregiver myself is a whole different ball game,” Markle-Reid says. “I have had to navigate the system on my own, and that has been the biggest eye-opener for me. This experience has helped to inform my research.”

Markle-Reid’s research focuses on developing and testing interventions to enhance the quality of life of older adults with multiple chronic conditions, and of their family caregivers, while reducing demand for health services.

Markle-Reid, a registered nurse, joined McMaster as a full-time faculty member in 1987. Currently an associate professor in the School of Nursing, she will be promoted to professor in July 2018.

She is also the Canadian Institutes of Health Research (CIHR) Tier 2 Canada Research Chair in Person-Centred Interventions for Older Adults with Multimorbidity and their Caregivers.

Markle-Reid hopes her research will lead to improved practices and policy development to provide timely, appropriate and quality health-care services for older adults that promote optimal aging at home.

“We have found over and over that there is a large gap between needs of older adults and the capacity of the system to meet those needs,” she says. “If people’s needs are not met, they will often show up appropriately or inappropriately in the hospital emergency room.”

Central to Markle-Reid’s studies is the creation of new and innovative interventions, which are co-designed by patients, caregivers, and providers, and have a heavy emphasis on system navigation. The identification of a gap in care through to the development of the intervention involves feedback from patients and caregivers, as well as health-care providers and other stakeholders.

“System navigation is where we need to focus because the current health-care system is not well designed to meet the needs of older adults with multimorbidity,” Markle-Reid says. “This population has complex medical, social and psychological needs, and are using a patchwork of services and supports, that are not well coordinated.”

One intervention, which Markle-Reid co-developed with patients, caregivers and providers, focuses on improving the quality of life and care for community-living older adults with diabetes and multimorbidity. It involves a partnership between diabetes education programs and community centres.

The intervention is delivered by a team of certified diabetes educators, including registered nurses and registered dietitians, and community providers, like the YMCA. It involves regular in-home visits by a registered nurse or a registered dietician, and monthly diabetes wellness program offered at a community centre, with transportation provided as needed.

This monthly event includes diabetes education from a registered dietician or registered nurse, group exercise, a meal and peer support. As well, each participant receives an in-home visit by the same dietician or nurse who was at the monthly session.

The six-month intervention has been tested in five regions in Ontario and three regions in Alberta. Markle-Reid’s team has partnered with Diabetes Action Canada to scale up the intervention across Ontario, Quebec and P.E.I.

“Our trial showed that people who were part of the program had better health and quality of life, especially in the area of mental health, at the end of six months,” Markle-Reid says. “Even when you add the home visits and wellness session to the overall cost, it did not cost the system any more to provide this program, compared to usual diabetes care.”

Hamilton and McMaster University are near and dear to Markle-Reid, who was raised here. Her grandfather, Patrick Marck, lived on King Street West near the university and worked as a lawyer into his early 90s. His longevity and ability to age at home continues to serve as an inspiration to her.

She completed her BScN at McMaster, helping pay her way through school by working as a lifeguard and swimming instructor at the university pool. After working as a cardiac-care-unit and intensive-care-unit nurse at St. Joseph’s Healthcare Hamilton and a cardiac-care-unit nurse at the Toronto Western Hospital, she completed an MScN from the University of Toronto while working at Saint Elizabeth Health Care, later returning to complete a PhD in nursing from McMaster.

She proudly notes husband, David, and their two sons, Matthew and Michael, are also McMaster alumni.

Among her many accomplishments, Markle-Reid is most proud of the establishment of the Aging, Community and Health Research Unit at McMaster, co-founded with colleague Jenny Ploeg in 2012. Markle-Reid, Ploeg and Ruta Valaitis from the School of Nursing serve as its scientific directors.

Ploeg, a close colleague of Markle-Reid for almost 20 years, says her interventions reflect her inclusive approach and commitment to improving the lives of others.

“Maureen is considered a national leader in nursing intervention research, often using high quality pragmatic randomized controlled trials,” says Ploeg, professor at McMaster’s School of Nursing.

“Through her Canada Research Chair, she has designed, implemented and evaluated a number of innovative interventions that have resulted in improved health and quality of life for older adults and their caregivers. She is committed to capacity building of her trainees and actively engages them in her program of research.”

Markle-Reid says she hopes her legacy will include a reputation for pushing the envelope in her field of research and reinforcing the importance of collaborative research involving patients and caregivers.

“We need to meaningfully engage patients and caregivers in research to create relevant interventions that improve the quality of people’s lives,” she says.