reports

Health system use by frail Ontario seniors: an in-depth examination of four vulnerable cohorts

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences.

Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

Key Findings

OLDER WOMEN: A look at gender differences in health system use
•     A significant proportion of the “oldest old” are women.
•     Older women and men use hospital and physician services at similar levels; however, older women are more likely to use long-term care services.
•     Among older adults who receive long-stay home care services, a larger proportion of women live alone and rely on their children for support, whereas men also rely on a spouse.
•     Older women have a higher prevalence of multi-morbidity than older men.
COMMUNITY-DWELLING OLDER ADULTS WITH DEMENTIA: Tracking encounters with the health system
•     Community-dwelling older adults with physician-diagnosed dementia are high users of health system resources.
•     Women account for a larger proportion of older adults with dementia than men across age categories.
•     Older adults with dementia are more likely to experience a hospital stay over the course of a year than those without dementia, and they are more likely to have a larger proportion of their stay in alternate level of care beds than those without dementia.
MEDICALLY COMPLEX HOME CARE CLIENTS: Profiling risk following acute care hospitalization
•     Medically complex home care clients discharged from acute care had high rates of multi-morbidity and high rates of readmission.
•     Several screening tools are available to help identify high-risk individuals who would benefit from intervention—but each tool is best suited to measure a specific type of task.
•     Interventions that aim to reduce long-term care admissions should target individuals by using the MAPLe algorithm (a measure of functional impairment associated with long-term care admission).
•     Interventions aimed at reducing acute care readmissions should target individuals by using the LACE assessment tool (a measure of utilization and diagnoses associated with acute readmission and death).
OLDER ADULTS NEWLY PLACED IN LONG-TERM CARE An examination of service use and functional status during the wait
•     Older women account for an increasing proportion of long-term care placements as the population ages.
•     While waiting for placement in long-term care, older adults make frequent contact with the health care system and have high rates of emergency department use. In the year following long-term care admission, these high rates persist.
•     Wait times vary for long-term care placement; shorter wait times are associated with the highest priority levels and placement from inpatient settings.