Dr. Rory FisherProfessor Emeritus, Department of Medicine
Dr Rory Fisher is a Professor Emeritus, Department of Medicine, University of Toronto
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Dr Rory Fisher is a Professor Emeritus, Department of Medicine, University of Toronto, and a member of the Division of Geriatric Medicine, Sunnybrook Health Sciences Centre. He was Director of the Interdepartmental Division of Geriatrics, Faculty of Medicine, University of Toronto and Director of the Regional Geriatric Program of Toronto. A former member of the National Advisory Council on Aging, Dr Fisher has been President of both the Canadian Association on Gerontology and the Canadian Society of GeriatricMedicine, and a Council Member of the InternationalAssociation on Gerontology.Dr Fisher was formerly President of the St. Joseph Moscati Toronto Catholic Doctors Guild and is currently the Vice-President for the Toronto and SWOntario Region of the Canadian Association of the Order of Malta. He is also a member of theAdvisory Council of the Canadian Catholic Bioethics Institute.
July 18, 2015
When the Ontario government cut acute-care beds in the 1990s, adequate home care was not put in place first, reflecting the head-in-the-sand approach of successive governments to an aging society.Home care has long been the Cinderella of the health-care system, underfunded and undervalued, yet it is of increasing importance.Preventative support to keep seniors independent in the community has markedly decreased, because resources are concentrated on the acute needs of patients discharged from hospitals. This leads to unnecessary early institutionalization.The burden is increasingly born by patients and their informal caregivers. These caregivers are often frail and vulnerable themselves or, if they are the patient’s children, there is the economic impact of taking them away from their work.Inevitably, there is a two-tier system, where the wealthy are able to obtain necessary support, while the rest are on waiting lists, receiving less than adequate care. With an aging society, the problem will become worse.It is time to review the whole community care system and, learning from other jurisdictions, put in place a comprehensive, transparent and properly funded home-care system.
Jan. 24: This week’s Talking Point – the grey wave bearing down on health care – and other letters to the editorThe Globe and Mail Inc.
January 24, 2015
The crisis is already here, given current pressures on the health-care system. You rightly support the Canadian Medical Association’s position on the pressing need for a national strategy, but you state that what needs to be done is not complicated, and that money should be spent on new, properly staffed long-term care facilities.The crisis is, however, systemwide. While it is key that enough long-term facilities are available, with staffing and resources to meet the increasingly complex needs of patients, this alone will not suffice. Acute hospitals have to adopt a senior-friendly approach; specialized geriatric service should be readily available for all seniors; more rehabilitation has to be provided that is specifically designed for the elderly; most importantly, many more community resources have to be deployed to enable seniors to remain in the community.Programs in different parts of the country have shown positive results doing this, and there is much to be learned from countries such as Denmark, where community programs have markedly decreased the need for new long-term care facilities.The time for discussion is over. Action is urgently required.
January 31, 2013
World renowned film director, Deepa Mehta, lung transplant innovator, Dr. Shaf Keshavjee, and celebrated actor and tenor, Michael Burgess, are among 25 extraordinary Ontarians appointed to the Order of Ontario.The appointees to Ontario's highest honour were chosen for their contributions to the arts, law, science, medicine, history, politics, philanthropy and the environment.The Honourable David C. Onley, Lieutenant Governor of Ontario, will invest the appointees at a ceremony on Wednesday, February 6, at Queen's Park.Named to the Order of Ontario are:Dr. Rory Fisher is a pioneer in the field of geriatric care, who has made monumental contributions to the fields of end-of-life care, ethics in geriatric care and prevention of elder abuse. He headed the Department of Extended Care at Sunnybrook Hospital in Toronto for almost 20 years.
September 09, 2013
While the first-ever geriatric day hospital was established in Oxford, England in 1958, Dr. Rory Fisher pioneered Canada’s first one at Sunnybrook.Providing a friendly and supportive place where seniors can learn to reach their goals, the hospital offers seniors a team of medical professionals, including a geriatric doctor, nurse clinician, physiotherapist, occupational therapist, recreation therapist, social worker and speech language pathologist.In January, Fisher was appointed to the Order of Ontario to recognize his leadership in geriatric medicine.
Recognition Memory and Verbal Fluency Differentiate Probable Alzheimer Disease From Subcortical Ischemic Vascular DementiaArch Neurol
2001Background Alzheimer disease (AD) and vascular dementia are among the most frequently occurring causes of dementia in the world, and their accurate differentiation is important because different pharmaceutical strategies may modify the course of each disease.Objective To determine which of 10 neuropsychological test scores can accurately differentiate patients with probable AD from those with subcortical ischemic vascular dementia (SIVD) for use in evidence-based clinical practice.
Fatty acid analysis of blood plasma of patients with alzheimer's disease, other types of dementia, and cognitive impairmentLipids
2000Fatty acid differences, including docosahexaenoic acid (DHA; 22:6n-3) have been shown in the brains of Alzheimer's patients (AD) as compared with normal age-matched individuals. Furthermore, low serum DHA is a significant risk factor for the development of AD. The relative concentration of DHA and other fatty acids, however, in the plasma of AD patients compared with patients with other kinds of dementias (other dementias; OD), patients who are cognitively impaired but nondemented (CIND), or normal patients is not known. In this study we analyzed the total phospholipid, phosphatidylcholine (PC), phosphatidylethanolamine (PE), and lysophosphatidylcholine (lysoPC) fractions of plasma from patients diagnosed with AD, OD, or CIND and compared them with a group of elderly control subjects with normal cognitive functioning. Plasma phospholipid and PC levels of 20:5n-3, DHA, total n-3 fatty acids, and the n-3/n-6 ratio were lower in the AD, OD, and CIND groups. Plasma phospholipid 24:0 was lower in the AD, OD, and CIND groups as compared with the group of control patients, and total n-6 fatty acid levels were higher in the AD and CIND groups only. In the plasma PE fraction, levels of 20:5n-3, DHA, and the total n-3 fatty acid levels were significantly lower in the AD, OD, and CIND groups. DHA levels were lower in the lysoPC fraction of CIND individuals only. There were no other differences in the fatty acid compositions of the different phospholipid fractions. Therefore, in AD, OD, and CIND individuals, low levels of n-3 fatty acids in the plasma may be a risk factor for cognitive impairment and/or dementia. Interestingly, a decreased level of plasma DHA was not limited to the AD patients but appears to be common in cognitive impairment with aging.
The Prediction of Alzheimer Disease The Role of Patient and Informant Perceptions of Cognitive DeficitsArch Neurol
1996Objective: To determine whether the perceptions of patients' cognitive deficits by either the patient or an informant could predict who would develop Alzheimer disease (AD) in a group of 120 memory-impaired patients without dementia.Methods: At entry into the study, patients were assessed by several measures that included neuropsychological tests and the Cambridge Mental Disorders of the Elderly Examination Interview Schedule. The latter schedule asks patients and their informants about their perceptions of cognitive deficits in the patients. After 2 years, patients underwent a diagnostic workup for AD: 29 had developed probable AD, whereas the other 91 did not develop dementia. We used logistic regression analyses to examine the predictive accuracy of patients' and informants' perceptions of deficits at entry into the study.Results: Informants' perceptions, not patients' perceptions, contributed significantly to the prediction of AD. The best prediction of AD was obtained by the regression model that included both informants' perceptions and 2 neuropsychological tests.Conclusions: These results demonstrate the clinical use of including informant perceptions about patients' cognitive deficits in the diagnostic assessment of AD. They also indicate that patients perceptions of their own deficits are not predictive of AD, but are related to depressive affect.
1988Neuropathologic confirmation is required to validate the NINCDS-ADRDA Work Group criteria for the clinical diagnosis of Alzheimer's disease (AD). Neuropathologic inclusion and exclusion criteria for AD, however, are not uniform. The purpose of this investigation was to examine the confirmation rate for the Work Group criteria against differing neuropathologic criteria for AD. The sample consisted of 57 cases, 22 of which had received a clinical diagnosis of AD. Nine neuropathologic criteria for AD were applied in a blind fashion to each of the 57 cases. Our results indicated that, depending on the neuropathologic criteria applied, the clinicopathologic agreement ranged from 64% to 86%. These findings demonstrate the need for universally accepted neuropathologic and clinical criteria for AD.
1981In a Canadian geriatric hospital, the report forms on the 2,177 untoward incidents occurring during the 1976–78 period were analyzed. The incident and fall rates were respectively 51.1 and 42.7/10,000 patient-days. Falls were the most common incident (82.9 percent). Of the patients who fell, 40.4 percent were over the age of 80 and another 27.5 percent were in the 71–80 age group. The majority fell more than once. Most falls occurred during the waking activity hours, and many were associated with the changing of position or posture, notably in the course of using a wheelchair. Alcohol was a factor in 4.2 percent of the incidents. Nevertheless, the rates for mortality and serious morbidity were low. Patients' rooms and toilets should receive extra surveillance, and the caretaker staff should exercise special care in the use of wheelchairs and assistive devices. More attention should be given to recording cases of postural hypotension, cardiac arrhythmias or drug side effects.
Area of Expertise
Quality of Care
Department of Medicine University of Toronto : Professor Emeritus
Division of Geriatric Medicine Sunnybrook Health Sciences Centre : Member
Interdepartmental Division of Geriatrics Faculty of Medicine University of Toronto : Director
Regional Geriatric Program of Toronto : Director
National Advisory Council on Aging : Former Member
Canadian Association on Gerontology : President
Canadian Society of Geriatric Medicine : President
International Association on Gerontology : Council Member
St Joseph Moscati Toronto Catholic Doctors Guild : President
Toronto and SW Ontario Region of the Canadian Association of the Order of Malta : Member
Health and Wellness