It's time we improved the quality and quantity of care
for frail Canadians - and improved the health system for everyone in the
process
By John Muscedere
and Fred HorneEvidenceNetwork.ca
KINGSTON, Ont., EDMONTON, Alta. / Troy Media/ - Canada's health
system too often fails to deliver the complex care that frail patients need
between urgent health events.
When a frail older patient has an acute health crisis in Canada, the
system usually delivers excellent service.
But health - like quality care - is determined by more than just
response to medical emergencies.
The truth is, we rarely deliver quality chronic care, comprehensive
home care or continuous care, and in particular, poorly handle transitions
between care settings and providers.
We also often neglect more cost-effective interventions with proven
health and quality of life benefits, such as social supports that can help
people age in place.
Our overemphasis on acute care needs, and the consequent neglect of
other aspects of the health system, have serious consequences - especially for
those who are frail. These consequences include worsened health outcomes and
increased health costs.
Why?
The burden of 'frailty' in Canada is steadily growing. Today,
approximately 25 per cent of those over age 65 and 50 per cent of those over 85
- more than one million Canadians - are medically frail. In 10 years, well over
two million Canadians may be living with frailty.
Frailty is defined as a state of increased vulnerability, with
reduced reserve and loss of function across multiple body systems. Frailty
reduces the ability to cope with normal or minor stresses, such as infections,
which can cause rapid and dramatic changes in health.
Frail people are at higher risk for worsened health outcomes and
death than we would expect based on age alone.
The risk of becoming frail increases with age, but the two are not
the same.
Frail Canadians are the major consumers of health care in all
settings. Of the $220 billion spent on health care annually in Canada (11 per
cent of gross domestic product), 45 per cent is spent on those over 65 years
old, although they only represent 15 per cent of the population.
In spite of higher utilization of health care resources for those who
are frail, many therapies haven't been evaluated in this population and we don't
know if they are beneficial, cause harm, are cost-effective or waste
resources.
Are we overtreating some frailty with ineffective therapies and
tests, yet not providing adequate social and medical supports in other
areas?
The answer is almost certainly yes.
It's time we improved the quality and quantity of care for frail
Canadians - and improved the health system for everyone in the process. Here's
how:
We need to break down silos of care based on single diseases, single
organ failure, settings of care or clinical disciplines. Addressing frailty
requires a co-ordinated, multidisciplinary approach. Instead of having multiple
specialist appointments and replicating tests across different facilities, we
could have one-stop shops that cater to the needs of patients, not
providers.
We need to address the needs of frail elderly in a more equitable
health system across the country. As we outlined in our brief
to the Finance Committee 2017 pre-budget consultations, we could establish
funding based on age and frailty instead of the current per capita
model.
Funding enhancements should be directed towards strengthening primary
health care, along with social and economic supports. Most frail adults live in
the community; strengthening primary care and community supports are crucial to
help them age in their preferred settings.
We need to provide patients, clinicians and decision-makers with
high-quality evidence on the effectiveness of treatments for the frail. Most
research excludes the very sick and the elderly. Without evidence, aggressive
and expensive therapies are often overused without improvement in outcomes,
resulting in poor quality of life and wasted resources.
We need to improve the recognition and assessment of frailty to aid
in implementing more appropriate care and planning.
Identifying the most vulnerable of our aging population will allow us
to institute appropriate care plans and improve supports - so we can improve
outcomes, quality of life and the use of resources.
John Muscedere is the
scientific director and CEO of the Canadian Frailty
Network (CFN), a not-for-profit organization funded by the government of
Canada's Networks of Centres of Excellence program. CFN's mandate is to improve
the care for frail elderly Canadians and their families within the health care
system. Fred Horne is a health policy consultant and adjunct professor with the
University of Alberta's School of Public Health. He was Alberta minister of
Health from 2011 to 2014 and served as chair of the Provincial and Territorial
Ministers of Health. He is a member of the CFN Board of
Directors.
© 2016 Distributed by Troy
Media
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