New report examines how seniors use the health system and where improvements can be made
December 1, 2011 – As the baby boom generation begins to turn 65 this year, the aging of Canada’s population will accelerate. As a result, the health care system will need to adapt to meet the future needs of a growing senior population, according to a new report released today by the Canadian Institute for Health Information (CIHI). Health Care in Canada, 2011: A Focus on Seniors and Aging shows that, while Canada’s seniors (age 65 and older) are living longer and are healthier than ever, they are frequent users of the health system, costing more than any other segment of the population. Representing just 14% of the population, seniors use 40% of hospital services in Canada and account for about 45% of all provincial and territorial government health spending.
“Although the impact of population aging on health costs has remained relatively stable over time, health care planners and providers are rightfully looking at ways to meet the needs of a growing senior population,” says John Wright, CIHI’s President and CEO. “The number of Canadians age 65 and older is expected to nearly double to 25% of the population by 2036. Understanding where gaps exist and where efforts can be concentrated will help ensure that the system remains strong and efficient for Canadians of all ages.”
CIHI’s report identifies opportunities for the health system to meet these changing needs, including improved integration across the health care continuum, an increased focus on prevention and more efficient adoption and use of new technologies.
Improved integration across the health care continuum
Canada’s seniors often require care from different providers across various settings, including a family doctor’s office, a specialty clinic, a home care service, a pharmacy, a hospital and/or a long-term care facility. However, the study identifies gaps in the continuity of seniors’ care.
As with Canadians of all ages, seniors who become acutely ill may require care in hospital, where they could encounter issues related to patient flow and appropriateness of care. Seniors who arrive at the hospital may first make contact with the emergency department, where they are likely to stay longer than non-senior adults do. CIHI’s report shows that seniors spend more time in emergency departments than their younger counterparts before being admitted to hospital (3.7 hours compared with 2.7 hours in 2009�2010).
Also related to patient flow for hospitalized patients is alternate level of care (ALC) stays. Patients are considered ALC patients when they have completed the acute care phase of their treatment but remain in an acute care bed. Seniors account for 85% of all ALC patients-approximately 85,000 cases a year. CIHI data shows that nearly half of all senior ALC patients (47%) were waiting to be moved to a long-term care facility.
“Our health system can no longer afford to operate in silos. Ensuring continuity of care across the continuum will not only lead to a more efficient use of resources, it can potentially lead to better care and in turn better quality of life,” explains health policy researcher Marcus Hollander. “This is particularly important in the senior population, because they receive care from many different care providers in various settings.”
The study also highlights the fact that improved integration can help promote safe and appropriate drug use in seniors. Many Canadian seniors take several prescription drugs, and the number of seniors taking multiple drugs is on the rise. In 2009, almost two out of three (63%) Canadians age 65 and older took 5 or more prescription drugs from different drug classes, with close to one-quarter (23%) taking 10 or more-up from 59% and 20%, respectively, in 2002.
It is not only the number of different medications, but also the specific medications seniors are taking that present challenges. CIHI data shows that, in 2009, 1 out of 10 Canadian seniors was taking a drug from the Beers list, an internationally recognized list of prescription drugs identified as potentially inappropriate for use by seniors. The use of these drugs has declined over the past decade. Seniors also take more over-the-counter medications and vitamins or other supplements than any other age group, possibly adding to the risks associated with multiple medications.
“As medications may be prescribed by different health care providers, without an accurate account of current treatments, seniors can be at increased risk of potential interactions or adverse events,” explains Dr. Pamela Jarrett, a geriatrician in New Brunswick. “While all health care providers do their best to ensure seniors are not taking medications that may negatively interact with each other, regular medication reviews with their family doctors or pharmacists can help reduce the risk of medication interactions.”
John Wright explains: “Team-based approaches to delivering primary care may help ensure seniors are receiving appropriate care. Physicians and pharmacists working together in the same practice can lead to increased communication on prescribing and lower the risk of a senior experiencing adverse drug interactions or side effects.”
An increased focus on prevention
Multiple chronic conditions-more than age-are associated with high use of the health care system. As the risk of developing chronic conditions increases with age (76% of seniors reported at least 1 of 11 major chronic conditions in 2008), prevention plays a key role in healthy aging, both to manage existing chronic conditions and to delay or prevent the onset of new ones.
Research shows that good primary health care in the community can help patients with chronic conditions-such as asthma, congestive heart failure or diabetes-avoid costly hospital admissions. The report estimates that 1 out of every 11 emergency department visits by seniors is for a chronic condition that can potentially be managed in the community. Of these seniors, nearly half (47%) are hospitalized.
Many health professionals may have a role in supporting and promoting prevention strategies. Family physicians often act as an initial contact, and although 95% of Canadian seniors have access to a family physician, some reported challenges accessing primary care. In 2009, less than half could get same- or next-day appointments, and more than one-third (34%) reported waiting six or more days for an appointment. This could result in potentially avoidable visits to emergency departments or walk-in clinics for care.
Seniors also visit other primary health care providers-such as psychiatrists, social workers and dentists-less often than younger adults, potentially reducing the amount of preventive care received. In 2008�2009, nearly half (44%) of Canada’s seniors had not had a dental check-up in the previous year. Studies have shown that poor oral care can contribute to poor health in older age, affecting nutrition, body weight and the progression of many diseases.
Preventing falls is another important strategy to keep seniors healthy. Falls are the leading cause of injury hospitalization among seniors, accounting for 9% of all emergency department visits and almost 80,000 hospital admissions in 2009�2010. The study highlights an opportunity to prevent falls in several settings across the continuum of care. About 1 out of 14 (7%) seniors hospitalized in complex continuing care beds fell within a month of assessment, compared with about 1 out of 8 (12%) in residential care facilities. More than one-quarter (28%) of seniors receiving home care services experience a fall within 90 days of assessment.
Efficient use of new health technologies
The use of new health innovations and technologies can help ensure that seniors are receiving appropriate care. For example, widespread adoption of electronic health records could facilitate physician decision-making by ensuring access to complete information on patients’ medical conditions and medications.
The vast majority (93%) of Canadian seniors live at home-and technological advances can allow them to stay at home for longer. For example, for seniors receiving home care services, a medication monitoring system equipped with a sensor-trigger system allows family members to monitor which medications were taken when from anywhere in the world.
“We know that the growing proportion of seniors in Canada’s population is going to impact the health care system,” says Jean-Marie Berthelot, CIHI’s Vice President of Programs. “Collecting more comparable data, on a variety of settings across the care continuum, can help policy-makers identify and understand key issues across sectors of care and ultimately better plan and prepare for the future.”
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca