Annual per capita growth rates in acute care costs are increasing fastest for older adults.
Given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new cost-conscious models that are also able to meet the complex needs of older patients.
The biggest problem is that our current hospital care model was developed years ago when most adults tended to not live past 65 or were living with chronic illnesses and usually only had one active problem that brought them to hospital.
While things still function well for younger patients, it is increasingly being recognised that our current model, that focuses on treating one issue at a time, often disadvantages older adults, who typically present with many active chronic health problems.
As the system’s greatest users, we are increasingly coming to understand how our traditional models of care also put many older patients particularly at risk for adverse complications such as falls, delirium, drug-interactions, functional decline and death.
What is most concerning is that few have come to appreciate that much of these adverse outcomes are preventable.
Acknowledging the need for reforms in primary and community care, older adults will still require hospitalisation even under the best of circumstances.
Studies have also demonstrated how the implementation of 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 care 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 of care that challenge deeply ingrained traditional ways of providing care has proved to be a significant challenge.
Nevertheless, more than at any other point in our history there is an urgent imperative, with significant social and economic implications, to develop comprehensive evidence-based care strategies to improve the care of older adults in need of acute care.
As Canada is facing these exact same issues, it may also hold solutions for the NHS to consider as well.
For example, in response to the challenge of addressing the complexities of caring for older adults in hospital settings and across the continuum of care, Mount Sinai Hospital in Toronto became the first acute care hospital in Canada to make geriatrics a core strategic priority for the entire organisation.
With this mandate, it embarked on a unique approach to develop the innovative and comprehensive Acute Care for Elders (ACE) service delivery model that is focused on always delivering older patients the right care, in the right place, at the right time, through the development of innovative partnerships between health care providers, patients, families and local community agencies, while using existing resources.
What is impressive is that within a short period of time this model, which seeks to identify and deal with issues early, has achieved impressive results.
The hospital’s overall quality of care has improved. It has reduced the need for and lengths of hospital admissions; it has decreased hospital readmissions; while increasing its overall patient and staff satisfaction. In short, patients are returning home in better health and staying there longer.
Other hospitals across the country are now following suit given that 60 per cent of current hospital expenditure in Canada is directed to the older population, and that even small improvements in the way we care for them can have important health, social and economic benefits.
Could the elderly bankrupt Britain? Absolutely. However, by viewing our current 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 and financing structures to meet current and future demands for hospital care by everyone.
Dr Samir K. 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 article is an abridged version of a presentation given at the Nuffield Trust’s Health Policy Summit 2012.
Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own. This article is also available to read on The Guardian Healthcare Network website.
Sinha S (2012) ‘Could providing hospital care for the elderly bankrupt Britain?’. Nuffield Trust comment, 1 March 2012. https://www.nuffieldtrust.org.uk/news-item/could-providing-hospital-care-for-the-elderly-bankrupt-britain