Dr. Rachel Kyle, Geriatrician at St. Joseph’s Health Care London and Dr. Brad Moffat, Surgeon at London Health Sciences Centre partnered to create the Geriatric Risk Assessment for Care Enhancement (GRACE) Clinic to better support older adults as they make decisions about surgery
Photo credit: St. Joseph’s Health Care London
September 28, 2026
When Stuart Powers learned he would need to consider major surgery as part of his cancer treatment, he and his wife, Sharon, were faced with a difficult decision.
The procedure could be life-changing, but so could the recovery.
Instead of navigating that decision alone, Stuart was referred to the Geriatric Risk Assessment for Care Enhancement (GRACE) Clinic, a clinic partnership between London Health Sciences Centre (LHSC) and St. Joseph's Health Care London (St. Joseph’s) that brings specialists together to optimize general health and function of patients prior to surgery and help patients make informed decisions to ensure the highest quality of life afterwards.
The process
Older adults referred for surgery at LHSC are screened for frailty as part of their surgical assessment. For patients who may benefit from additional evaluation, surgeons can refer them to the GRACE Clinic, where a collaborative team from the General Surgery and Geriatric Medicine divisions at LHSC and St. Joseph’s work with patients and care partners to consider the whole person, including factors that are often overlooked; such as functional status and personal priorities.
Together, the team discusses individualized surgical risks within the context of aging and frailty, helping patients decide whether surgery ultimately becomes part of their care plan.
The impact
During a single visit to the GRACE clinic Stuart met with a team of specialists from both organizations to discuss every aspect of his health, treatment options and goals. Together, they explored if surgery is possible, and whether it was the right choice for him.
For Stuart, that collaborative approach made all the difference.
"I was treated extremely well by every doctor," says Stuart. "They really took their time with me, we chatted for three hours. They explained what surgery would involve, how long recovery would take, and all of my options."
For Sharon Powers, Stuart’s wife of 58 years, what stood out most wasn't just the expertise in the room but how the team approached one of the biggest decisions they had ever faced.
"They never told us what our decision should be," she says. "They just gave us all the information in a very kind and supportive way, then left it up to Stu."
The experience was unlike anything they had encountered before.
"The support was incredible," Sharon says. "They looked at everything from every angle. They even took me aside so I could share how I was feeling. We never felt rushed and we never felt pressured."
That patient-centred approach is at the heart of the GRACE Clinic.
"We are focused on delivering whole person care,” says Dr. Rachel Kyle, Geriatrician at St. Joseph’s. “We help patients understand their surgical options and support them as they decide what approach best aligns with their personal health goals. In the cases where patients want to move forward with surgery, we create an individualized pre-surgical care plan to help optimize their overall health, which can include access to a range of services such as rehabilitation, nutrition support, medication review and discharge planning.”
After discussing the risks and benefits, Stuart decided that radiation, not surgery, was the best path forward.
Today, Stuart continues to enjoy spending summers up north at their cottage, where he can continue doing what he loves; fishing.
"It clears everything out of my mind, " he says,
For Sharon, that's why the experience at the GRACE Clinic was so meaningful.
"He's still able to enjoy life," she says. "They helped us make the decision that was right for him."
For members of the GRACE Clinic care team from St. Joseph’s and LHSC, the partnership has been deeply rewarding.
"We are truly wrapping care around some of our most vulnerable patients,” says Dr. Brad Moffat, Surgeon at LHSC. “We have a surgeon and a geriatrician from both organizations in the room when we meet with the patient, which allows us to deliver coordinated care that can address all questions and concerns within a single visit. It is incredibly unique to have a model that brings together expertise from across organizations in service to our patients, and we are proud of the support we’ve provided to date."