Opinion: More research needed in health care for elderly (Dr. Rita McCracken)
For the first time ever, there are more people in Canada age 65 and over than there are under age 15, according to Statistics Canada. That makes up nearly six million — or 16 per cent — of the population. In B.C., seniors make up 13 per cent of our population. This demographic is set to increase by 3.5 per cent in the coming months, four times faster than the population at large. The World Health Organization is estimating that the number of people with dementia will double by 2030 compared to 2010, and triple by 2050. Many individuals with dementia will require some level of personal care, such as assisted daily living or residential nursing.
Canada’s aging population and all that accompanies it has raised concerns around how we should efficiently, effectively and compassionately care for elders. While everyone will age and notice changes in their body, for some, there is a significant decrease in their daily functional capacity, a condition called frailty — something that needs to be treated differently from old age. We will all die, and older, frailer people are usually closer to that event than others. A good death, which one hopes will follow a good life, is rarely one that occurs after 100 per cent of treatments and medications have been tried and maximum longevity has been obtained. Rather, a good death involves intentional health care planning that includes awareness of a patient’s experience of quality of life, personal values and realistic yet thorough knowledge of the capability of our modern medical interventions.
Surprisingly, frail elders are still rarely included in health research. A recent review of clinical trial enrolment for studies of certain acute coronary syndromes (including heart attacks) done at Duke University showed no change in the representation of older people in trials over the last 17 years. As a result, the delivery of medical care to those who are frail is often not differentiated from intervention and management plans studied only on more well or younger people. Worryingly, some observational studies suggest that many of those treatments, e.g. hospitalizations, some medical tests and medications, can increase disability, dramatically impact quality of life, and even expedite death in frail elders.
Dr. Rita McCracken writes.
Dr. Michael O'Shaughnessy