Health care quality / Health care transformation

Challenges of increasingly complex baby boomer patients

January 25, 2016

If there was ever a time and urgency for reform across all sectors of health care, now would be that time. With a massive proportion of the Canadian “baby boomer” population advancing into their senior years, the precedent for hospitals, long-term care facilities, and medical practices to prepare for the influx is of highest priority. The current infrastructure of the health care system at large will inevitably crumble under the sheer volume and complexities of incoming patient loads.

Increased Health Care Utilization for Chronic Condition Management

The vast complexities of caring for an aging population begin with the fact that they have a higher rate of chronic conditions and multiple comorbidities. According to the Canadian Institute of Health Information, approximately 75% of Canadian seniors are living with chronic conditions1. Managing these multiple chronic conditions places a significant resource strain on health care providers and institutions. Unfortunately, efforts to encourage greater patient self-management of chronic conditions have not proved to be as effective as many had hoped.

One study, developed by the Stanford Medical School Patient Education Research Centre, implemented the Chronic Disease Self-Management Program (CDSMP) in an Ontario health administrative region. Participants with 2 to 4 chronic conditions were required to attend 6 weekly self-care sessions intended to empower, educate, and encourage them in their own care, and ultimately reduce extensive resource utilization. Researchers examined the patients’ visits to the Emergency Department, general practitioner and specialist visits, and hospitalizations 1 year prior to and following their participation in the CDSMP; unfortunately, results indicated that the program did not alter health care utilization behaviour2.

This struggle to achieve optimal self-management is evident in the latest figures indicating that people age 65+ are likely to spend the most amount of time in the ED, upwards to 17.1 hours, and approximately 24% more likely to be admitted, particularly for chronic issues such as urinary disorders, abdominal/pelvic pain, or chest pain3.

Rising Cancer Diagnoses

The Canadian Cancer Society predicts that by 2030, cancer cases in Canada will rise by 40% as baby boomers age. The pressure of this influx will be felt across the health care spectrum, not just at specialized cancer care centres. According to Dr. Eva Grunfeld, of the Ontario Institute for Cancer Research, “concern should focus on whether the country’s health care systems will be ready to cope with all the additional cases […] if we’re not ready it will be a very, very problematic situation”1. The biggest problems facing patients who require specialized care, such as individuals with cancer, is the decline of specialized nursing care professionals.

Greater Need for Health Professionals

Unfortunately, recent reports indicate a decline in registered nursing professionals, due to fewer nursing school graduates, less registrations and registration renewals. Continuing to widen the scope of practice of many nursing and allied health professionals` roles will be critical to raising interest for future workers, as well as meeting the growing needs to aging patients. Nurse Practitioners (NPs) are an excellent example of reform that has been successful in diverting care from high cost hospitals, to smaller, often rural, clinics and long-term care facilities—preferred options for the elderly. In fact, Ontario is providing funding for 75 new attending NPs in long-term care facilities over the next 3 years, 30 of which began in Fall 2015. This is especially beneficial in the management of chronic conditions, as well as ongoing cancer care, when acute care is not required.

Beyond Baby Boomers

Healthcare reform, though a lengthy and complicated challenge, is needed fast. The imminent needs of baby boomers have raised the stakes and set the precedent for effective, creative healthcare solutions that will hopefully benefit people of all ages, but the current state of health care is unable to go on sustaining the weight of the inevitable and needs to make critical changes today.

Notes

  1. Canadian Institute for Health Information (2011) Primary Health Care Information Sheet. Senior and the healthcare system. What is the impact of multiple chronic conditions? Retrieved from http://www.cihi.ca/CIHI-ext-portal/pdf/internet/info_phc_chronic_seniors_en
  2. Impact of a chronic disease self-management program on healthcare utilization in eastern Ontario, Canada. 2015
  3. National Ambulatory Care Reporting System, Canadian Institute for Health Information.
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