1 Canadian Institute for Health Information

Health Care in Canada, 2011: A Focus on Seniors and Aging An Overview 2

HCIC 2011: A Focus on Seniors and Aging Today’s Canadian seniors live longer and are healthier than ever before. Seniors are frequent health system users, costing more than any other segment of the population. In 2011, Canada’s population entered a period of accelerated aging. Although modest to date, population aging will likely have a larger impact on the health care system in future. The report examined seniors’ current utilization patterns and considered ways the system can adapt to meet the aging population’s future needs. 3

Accelerated Aging 4 Proportion of Canadians age 65+ will almost double in 25 years: from 14% in 2011 to 25% in 2036.

Canada’s Seniors: Healthier and Living Longer Life expectancy at age 65 continues to increase; 86.1 years for women, 82.9 years for men Indicators of health status show a mixed picture with advancing age: 5 Increases in... Chronic disease prevalence Prevalence of functional limitations Obesity rates Smoking Decreases in...

Spending Growth Lower for Seniors Between 1998 and 2008, annual increases in total per capita public-sector health expenditures were lower for seniors (5.2%) than for younger adults (6.3%). 6

Between 1998 and 2008, aging was a modest driver of increases in public- sector health expenditure for hospitals (1%), physicians (0.6%) and drugs (1%). Aging has a greater impact (2.3%) on expenditures for long- term institutional care. 7 Aging: One Factor in Health Spending Increases

Seniors: Heavy Users of Health Care Seniors represent 14% of population, yet utilize 45% of all provincial/territorial public-sector health spending; 40% of acute hospital stays; 85% of hospital-based continuing care; 82% of home care; and 95% of residential care. They are also more likely than younger adults to visit family doctors frequently and make claims for publicly funded prescription drugs. 8

Primary Health Care: Key to Keeping Seniors Healthy 95% of seniors have a family physician. 45% report same- or next-day appointments, while 34% wait 6 or more days. 44% received no dental care in previous year, compared with 27% of adults age 45 to 64. Seniors less likely to visit psychologists, social workers and alternative providers, compared with younger adults. 9

Prescription Drugs: Also Key to Keeping Seniors Healthy 10 With increasing age comes increased prevalence of chronic conditions, and an increasing need for prescription drugs to manage them. In 2009, 63% of seniors on public drug programs claimed ≥5 drugs from different classes, while 23% claimed ≥10. Five of the top 10 drug classes used by seniors treat high blood pressure and heart failure.

Drug Safety Is a Concern In 2009, ~1 in 10 seniors were taking drugs that were potentially inappropriate. Seniors are more likely than younger adults to take over- the-counter drugs and supplements. Seniors are at increased risk of drug side-effects and interactions, compared with younger adults. Age-Sex Standardized Rate of Chronic Beers Drug Use

Seniors in Community Settings ~97% of formal home care recipients also have informal caregivers. ~17% of informal caregivers report distress in their role. Caregiver distress increases with time spent providing care. 12

Seniors in Residential Care Settings From 1981 to 2006, rates of institutionalization among seniors have ↓, but since 2004, intensity of care provided in residential settings has ↑ Seniors in residential care are more likely to be older (85+ years), unmarried and functionally dependent compared with those in community settings. 13 CharacteristicDescriptiveHome Care HCRS (%) Residential Care CCRS (%) Age% accessed seniors pop age Marital StatusNot married6476 Functional Status (Activities of Daily Living) Extensive assistance/ dependence 1874 Cognitive Performance Scale Moderate to severe1460

Compared with younger adults, seniors Seek care in EDs more often Spend more time once in EDs Are hospitalized at higher rates for conditions sensitive to ambulatory care 14 Room to Improve: Managing Chronic Conditions

Room to Improve: Falls Injuries 15 Falls are the leading cause of injury hospitalizations for seniors. Care SectorPercentage of Seniors (65+) Experiencing a Fall Time Frame Prior to Admission Visit Acute Care8%Prior to admission Emergency Dept9%Prior to visit Mental Health (Inpatient)12%30 days prior to admission assessment Within Care Setting Residential Care12%Within 30 days of assessment Complex Continuing Care7%Within 30 days of assessment Home Care28%Within 90 days of assessment

Room to Improve: Flow Across Care Settings 16 47% of seniors designated ALC are waiting for LTC placement.

Looking Ahead In the near future, the health care system will likely need to adapt to meet the changing needs of the aging population. Areas where decision-makers could focus include the following: 1.Improving integration across the health care continuum can lead to better care for seniors. 2.Increasing focus on prevention can help prevent or delay onset of chronic conditions and disability for seniors. 3.Adopting new health innovations and technology can help ensure that seniors are receiving appropriate care. 4.Collecting, managing, and reporting better information can better inform policy-making. 17

About CIHI’s Health Care in Canada series Annual report first published in 2000 Brings together data and information from many sources for broad examination of significant issue(s) Can access entire Health Care in Canada series at (free download) For more information, send an to 18

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