TORONTO—Perhaps the best single marker on how well we have progressed as a country is not the growth in per capita income, though that’s important, but our increase in life expectancy. Between 1921 and 2014-16, the average life expectancy at birth in Canada increased from 60.6 years to 84 years for women and from 58.8 years to 79.9 years for men, or by more than 20 years for both women and men.
But that doesn’t mean all’s well. As a new study funded by the Canadian Frailty Network, one of the federal Networks of Centres of Excellence, and produced by Ryerson University’s National Institute on Ageing points out, “a longer life does not necessarily mean a healthy life at advanced ages.” Too many older Canadians are living in a state of frailty, which puts them at greater health risks and a lower capacity to live independent lives.
And as Canada’s population continues to age, we will face a growing challenge not only in seeking to provide a decent quality of life for older Canadians but also in meeting projected soaring healthcare costs from an aging population. According to Statistics Canada, there were 3.9 million Canadians 65 and older in 2001 and 6.4 million in 2017, with the number projected to rise to 9.4 million in 2030 (barely a decade from now). The number who are 80 or over has grown from less than one million in 2001 to about 1.6 million now and projected to pass 2.6 million barely a decade from now. Canadians 65 and older currently account for just over 15 per cent of the population but 45 per cent of healthcare spending. That’s about $100-billion a year or about five per cent of GDP.
This growth points to the need for new approaches to addressing the health and social needs of an aging population and one place to start is by looking at how to better deal with frailty.
Frail Canadians are those who face functional decline—a reduced ability to look after themselves in activities of daily living and self-care, such as bathing, getting in and out of bed, maintaining continence, dressing and undressing and preparing meals and eating. They face challenges in living independently and engaging with the community through shopping for groceries, accessing transportation, doing housework, managing medications and managing household finances. They have difficulty managing minor illnesses, such as flu, migraine and other health problems that people typically can manage themselves. Many frail Canadians suffer from heart disease, cancer, lung and breathing problems, arthritis and mobility problems.
But this is more than a medical issue. “The quality of an individual’s social life is increasingly being recognized by researchers as an important factor in determining whether they will be living with frailty, how severe their level of frailty will be, and the likelihood that they will experience negative health outcomes as a result,” the research study warns, referring to isolation and poverty as forms of “social frailty.” In other words, “having lower income and fewer social connections is associated with frailty in older adults.” This means that “having a well-functioning, supportive social and community network can help prevent frailty in older adults, leading them to be more resilient, less depressed, and to live longer and healthier lives.”
The report calls for routine screening for frailty in all individuals 70 and over by health-care providers. Today, patients are often treated for a single problem—flu or a broken bone—but broader tests for frailty are rarely taken. Yet the real problems of an older person may come from poor nutrition, lack of exercise, overmedication, lack of mobility and social isolation, poverty and housing—increasing their risks of ongoing deterioration and increased dependence on the healthcare system.
Yet there are interventions that can better prevent or reverse frailty, such as physical activity and improved nutrition as well as community initiatives to reduce social isolation, loneliness and poverty, all of which can contribute to poorer health and increased frailty.
So as the report stresses, as well as improving the capacity of the health-care system to test and identify frailty, we will need service models that better support older adults living with frailty, with more community-based models of care that may better support the frail elderly, enabling them greater independence in their lives, and reducing the need for hospitalization or institutionalization. The result should also mean using more expensive health care. The report also suggests Canada adopt a Danish program of what it calls reablement into the delivery of home care, where individuals receiving home care also receive help in ways to be more independent and less dependent on caregivers and the health-care system, including pursuing ways so that individuals do not become lonely or socially isolated.
This frailty challenge should be a major priority for Canada’s new Minister for Seniors Filomena Tassi, although she was unable to find time to attend a recent national summit on frailty which brought together several hundred frontline practitioners and researchers for two days to share community initiatives to address frailty. Her mandate letter from Prime Minister Justin Trudeau does not directly mention frailty as an issue to be addressed. Yet it is estimated that about 25 per cent of Canadians 65 or older are medically frail, and 50 per cent past 85 are medically frail—that’s more than one million Canadians, a number that is expected to grow significantly. Without addressing frailty directly, we could face a future health and social crisis.
By making frailty a priority in health care and social policy, and enabling frail Canadians to remain as independent as possible, governments, the report says, can help Canadians to “not only live longer, but live better as well.” It’s a worthy national goal.
David Crane can be reached at email@example.com.
The Hill Times
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