Annual per capita growth rates in acute care costs are increasing fastest for older adults. Given that this growth rate is expected to increase continually, it is imperative that we develop new cost-conscious models that can meet the complex needs of older patients.
The biggest problem is that our hospital model was developed years ago when most adults tended not to live past 65. Not were they living with chronic illnesses and they usually only had one active problem that brought them to hospital. While things still function well for younger patients like this, it is increasingly being recognised that a model that focuses on treating one issue at a time disadvantages older people who often present with many chronic problems.
We are increasingly coming to understand how traditional models of care also put many older patients at risk for adverse complications such as falls, delirium, drug-interactions, functional decline and death. What is most worrying is that few have come to appreciate that many of these adverse outcomes are preventable.
Even if we acknowledge the need for reforms in primary and community care, older adults will still require to be taken into hospital. Studies have also demonstrated that focused models of care that consider the unique needs of older hospital patients in emergency, inpatient, outpatient, community and home care settings can improve overall outcomes while at the same time reducing lengths of stay, admissions, readmissions, and inappropriate resource utilisation – thereby improving the overall capacity and efficiency of the system.
However, implementing innovative models that challenge deeply ingrained traditional ways of providing care has proved to be a significant challenge. Nevertheless, there has never been such an urgent imperative to develop comprehensive, evidence-based care strategies to improve the care of older adults.
As Canada is facing these exact same issues, it may also hold solutions for the NHS to consider as well. For example, Mount Sinai Hospital in Toronto became the first acute care hospital in Canada to make geriatrics a core strategic priority for the entire institution. It developed a new model of comprehensive acute care for elders focused on always delivering older patients the right care, in the right place at the right time. .
What is impressive is that this model, which seeks to identify and deal with issues early, has achieved impressive results quickly. The hospital's overall quality of care has improved; it has reduced the need for and lengths of admissions, decreased readmissions, while increasing overall patient and staff satisfaction. In short, patients are returning home in better health and staying there longer. Other hospitals in Canada are following suit given that 60% of hospital expenditures there are directed at the older population.
Could the elderly bankrupt Britain? Absolutely. However, by viewing challenges as opportunities to transform our dated models of caring for older adults, we can help ensure that the greater efficiency and capacity that will be needed can be sustained within the existing public system.
Dr Samir Sinha is the director of geriatrics for Mount Sinai and the University Health Network Hospitals in Toronto, Canada, and a research affiliate with the Oxford Institute of Ageing. This is an abridged version of a presentation he is giving to the Nuffield Trust's health policy summit in Dorking, Surrey. Guardian Healthcare Network will be covering the event on the site and on Twitter. Follow us @gdnhealthcare. To hear more about the Health Policy Summit and other healthcare news, sign up here to receive our weekly email.
Sourced from The Guardian, 1st March 2012.