Integrative Teams to Ease Canada’s Healthcare Burden

The challenge of caring for the aging population is one of the most pressing problems the Canadian healthcare system is facing. The aging of Canada’s population is accelerating, with the number of seniors projected to increase from 4.2 million in 2005 to 9.8 million in 2036, representing 13.2% and 24.5% of the total population, respectively.1 Rising health care costs due to population aging has fuelled debate about sustainability of healthcare in Canada.

Seniors have special health care needs due to the unique realities they face as they near end-of-life, including frailty and chronic conditions amongst other things. About 65% of those 65 and older have 2 or more chronic conditions, and 25% have 4 or more.2 Co-morbidities are one of the main reasons that seniors are disproportionately high consumers of the healthcare system, spending 50% of provincial and territorial health care dollars.2 Canadian health services will need to adapt to address these needs in order for Canada’s universal and comprehensive healthcare system to be sustainable.

Primary care in Canada needs to be reorganized so that it can manage the care of complex cases. As the current system works, geriatricians or family physicians with specialist certification provide older adults with care. In 2001, the ratio of geriatricians per senior in Ontario was approximately 0.57 per 10,000.2 The proposed ratio is 1.25 geriatricians per 10,000 seniors, which is still comparatively low to professions such as pediatrics that have a current ratio of 7.5 per 10,000 in Ontario.2 The alarmingly low ratio of physicians specialized in elderly care demonstrates the need for a shift in the way health care services are provided.

By altering the methods in which Canada provides care to their elderly population, better support and care can be provided to seniors. Training all health human resources in geriatric specialties would create a more integrative care approach. This would mean that in order to receive specialized care for frailty and multiple chronic conditions, seniors wouldn’t have to seek out the limited expertise of geriatricians. Nurses, physician assistants, personal support workers, family physicians, and all other health care providers should have mandatory training in geriatric medicine and care as part of their education. In 2005, a study was conducted on Canadian medical schools demonstrating that the total mandatory hours in geriatric training ranged from 10 to 299 hours.3 There should be an increase in training time spent in geriatric medicine to create consistency among schools, and this training should go beyond the doctors themselves and into all levels of the healthcare system.

Having a mix of health providers trained to meet the health care needs of the aging population can help Canada achieve their goals of improved access and high quality care. It can help to ease the shortage of geriatricians, and this can benefit the overall health outcomes of patients considering they no longer have to wait to receive specialized care. It will also help to limit functional decline in seniors, which will keep them out of emergency rooms and urgent care centers, reducing wait times for other Canadians. An integrated system of care would be more cost-effective and result in less hardship for older adults and all Canadians.4

This team approach also means that there are now health care providers specialized in geriatrics available to devote time to preventative care for seniors. It is important that more attention is paid to caring appropriately and effectively for all frail elderly, and this care needs to start with health promotion and prevention activities.2 If we want to reduce the number of older people who develop disabilities and need extensive care, then we need to support prevention not only in younger and middle aged people, but also in older persons.

Active aging is a great way to get seniors in Canada healthier and living independently for longer. Programs should be created that empower elderly people to stay active as they age and to maintain control over their own health. By providing older adults with the opportunities to stay physically active, there is a reduction in frailty, which leads to a reduction in risk of falls, as well as reductions in incidence rates of heart disease and diabetes.5 Staying actively involved in the community also reduces the risk of social isolation among seniors, which reduces the risk of depression and other associated health problems.5 Active aging promotes improvements in physical health, mental health, and overall wellbeing, decreasing the need for health care services in the first place.

There is no doubt that Canada will be ‘greyer’ in the future than it is now. The demographic trend in today’s world is towards an older population, creating a heavy burden for the Canadian healthcare system. By reorganizing current methods of care, Canada’s healthcare system can remain accessible and comprehensive at a reduced cost. Emphasizing health promotion and preventative care throughout all age cohorts can delay the onset of frailty, reducing the number of co-morbidities experienced by older adults, which will ultimately ease the overall burden on Canada’s healthcare system.


References

  1. Addressing the challenges and opportunities of aging in Canada. Government of Canada Web site. http://www.hrsdc.gc.ca/eng/seniors/reports/aging.shtml#fnb5. Accessed November 10, 2013.
  2. Rich P. Canada’s aging population: demographic time bomb or economic myth. Elder Care. 2005;4:11-15.
  3. Gordon JE. Updated survey of the geriatrics content of Canadian undergraduate and postgraduate medical curricula. Canadian Geriatrics Journal. 2011;14(2):34-39.
  4. Better with age: a conversation about healthcare with older Canadians. Canadian Health Services Research Foundation Web site. http://www.cfhi-fcass.ca/sf-docs/default-source/aging-roundtable-reports/AgingFinalReport.pdf?sfvrsn=0. Accessed November 14, 2013.
  5. Hunter D. With governments across the world facing the prospect of an ageing population, the debate about ‘active ageing’ is entering the mainstream. Perspectives in Public Health. 2011;131(3):106-107.

Erin White

Erin recently graduated from the University of Western Ontario with her Bachelor of Health Sciences and is currently pursuing her Master of Arts in Health and Aging at McMaster University.