Take a glance at any Canadian hospital; chances are the most obvious thing you’ll see will be glowing red letters that read EMERGENCY.
Our hospitals were designed as acute care institutions, and not much about their focus has changed in the six decades since Canada’s health care system took shape. Meanwhile, our large bulge of post-war children has moved into their senior years, and their care needs have shifted from traumatic injuries to chronic disease. Today, Canadian seniors—who make up 14% of the population — account for 40%of hospital use. Because their needs are more complex than those of younger patients, their hospital stays are longer.
What’s more, those complex needs send them back to hospitals more frequently. On the front lines, Canada’s emergency doctors report seeing more frail seniors returning to hospitals, and their observations are borne out in a CMAJ study. Of more than 700,000 Ontario patients over the age of 65 who were studied,12% had to be readmitted to hospital within 30 days of being discharged. Forty per cent of the patients had five or more chronic medical conditions, typically arthritis, type 2 diabetes, heart disease, anxiety, depression or cancer.
The study showed that seniors who were discharged to their homes with home care provided by the system were the most likely to need readmission. They also had the longest stays in hospital. Patients who were living in a nursing home before the first admission were also more likely to be admitted a second time.
Clearly, these seniors are not being well served by hospitals, and the lack of alternative approaches is leading to inefficiencies.
Two physicians — Dr. George Heckman of the University of Waterloo and Dr. Paul Hébert of the Centre Hospitalier de l’Université de Montréal — have identified approaches they believe can better address the needs of frail seniors with chronic illnesses. Along with other researchers in the Canadian Frailty Network, they used a set of assessment tools developed by interRAI, an international consortium of researchers and practitioners, to evaluate 5,000 older Canadians in 10 hospitals.
Their results show that complex needs and frailty can be identified early, allowing administrators to determine which older patients will develop complications in hospital, which ones are at risk of a long hospital stay and which ones are at risk of ending up in a nursing home.
Heckman and Hébert concluded, “Reliable information is a fundamental requirement to make our health care system, and especially our hospitals, senior-friendly, allowing better targeting of programs to respond to needs along the entire trajectory of life.”