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Will the elderly bankrupt Medicare in Canada?

HLST 3120 3.0

Health Policy II: Analyzing Processes of Power and Politics

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Introduction
As of 2015, 60 cents out of every dollar spent on health care is spent on the elderly.
While only 14% of the population belongs to this group now, it is projected to double by 2035.
This would result in spending every health care dollar on elderly while the other patient groups
receive almost nothing. To avoid such catastrophe, this essay will look at three areas where the
most money is being spent as well as strategies to reduce these costs.
Understanding the needs of the elderly is important to overcome this issue. Not all elderly
people hang around hospitals every day using health care services, over half of older patients are
actually living well and leading independent lives. But there is a small cohort of about 20 percent
of our older population that uses 80% of the health care resources. The main reason for this is
because our health care system wasnt designed for the current population. It was designed at a
time when people didnt live as long as they do today and didnt have as much chronic illnesses
or functional impairments. Because of this mismatched population and system, we need to
understand what exactly causes these patients to overuse the health care services. It is evident
from many literature reviews that the factors mostly contributing to increase in length of stay and
costs are: fall-related injuries, Adverse Drug Reactions, and cases of multimorbidity.
Fall-related injuries
A fall is defined as an individual unintentionally coming to rest on the ground, floor, or
other lower level and is considered to be the leading cause of injury-related hospitalizations
among Canadian Seniors. Falls result in an average length of hospital stay of approximately 3
weeks, which is 75% longer than the average length of stay for all causes of hospitalization
combined (Do, Chang, Kuran, & Thompson, 2015). In their study, Do et al. (2015) looked at the
epidemiology and trends of fall-related injuries among Canadian seniors aged 65 years and older.

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Once the number and rates of fall-related injuries were calculated for each survey year after
taking data samples from the Canadian Community Health Survey (from 2005-2013), they were
able to conclude that the fall-related injuries among seniors increased from 49.4 to 58.8 per 1000
population during this time, and realized that it mostly affected elderly women (Do et al., 2015).
It was also evident to increase with age as there was a 10% difference between those aged 65-69
and those aged 85 years or older.
The reports indicated broken or fractured bones as the most common type of injury
(37%), and the most commonly injured body part was usually the shoulder or upper arm (16%).
And when the injuries are categorized by the type of activity they were doing, walking on nonsnow or ice surfaces contributed to more injuries than actually walking on ice (45.2% vs
15.5% respectively). Going up or down stairs/steps only contributed to 11.8% of injuries (Do et
al., 2015). This helps us understand how most of these injuries can in fact be prevented if the
necessary measures are taken.
The study conducted by Johnson, Kelly and Rasali (2015) on Saskatchewan residents
further confirmed fall-related injuries as a key issue. In Canada, one in three older adults (over
65 years of age) suffers a fall each year and this figure increases to one in two (50%) of older
adults and those over 80 years of age (Johnson et al., 2015). These falls are considered to be
predictable and preventable, yet a recent report showed that falls were the leading cause of
overall injury cost, accounting for $8.7 billion in 2010 (Johnson et al., 2015).
Before coming up with a policy for best practice approaches to fall prevention, it is
important to analyze the risk factors associated with falling. These can be categorized in to
biological and medical risk factors, behavioural risk factors, environmental risk factors, and
socio-economic risk factors. Biological and medical risk factors include muscle weakness and

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diminished physical fitness, impaired control of balance and gait, vision factors etc. Behavioural
risk factors include history of previous falls, risk-taking behaviours, multiple prescriptions,
excessive alcohol consumption, clothing etc. Environmental factors involve the physical
environment such as stairs, hazards and assistive devices. Lastly the socio-economic factors such
as income, education, literacy levels, housing, and social connectedness all affect a persons
general health and, therefore, his or her risk of falling. If a strategic framework to be
implemented, then it is best to target a range of risk factors. For instance starting exercise
programs, better clinical management of chronic and acute illness, better medication reviews,
vision referral and correction strategies, and environment assessment and modification can all be
beneficial interventions.
Adverse Drug Reactions
World Health Organization defines Adverse Drug Reactions (ADRs) as a response to a
drug that is noxious and unintended and occurs at doses normally used in humans for the
prophylaxis, diagnosis or therapy of disease, or for modification of physiological function.
ADRs have the ability to place a patient in a life-threatening situation by worsening their medical
conditions and eventually extending their length of stay in hospital resulting in increased
healthcare costs. The rapid rise in the availability of new drugs can directly increase the risk for
patients to experience ADRs. Thus newer drugs, more drugs, or more expensive drugs isnt
necessarily better.
Chen, Bell and Wodchis (2012) employed a design to measure the frequency and costs of
Emergency Department (ED) visits related to ADRs for elderly patients who are greater than age
of 65. If the ICD-10 code for ADR was used during the visit by the triage nurse, then it was
considered to be part of the study. Among these adults, they found 0.75% of total annual ED

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visits to be ADR related, while 21.6% of those patients ended up being hospitalized. When
looking at the costs, the authors found a staggering $333 per ED visit and a much greater ($7528)
cost per hospitalization. In Ontario this would account for an annual cost of approximately $13.6
million, or a projected $35.7 million in Canada. (Chen et al., 2012). For better treatment, this
study suggested that it is crucial to identify cases of ADRs as early as possible, however, the
only effective way to reduce it would be to focus on preventative methods. Effective use of
Computerized Provider Order Entry (CPOE) systems and Radio Frequency Identification (RFID)
technology are interventions that must be carried out.
CPOE systems can eliminate errors caused by misreading or misinterpreting handwritten
instructions. They also can intercept orders that might result in ADRs or that deviate from
standard protocols. RFID technology on the other hand, makes it easier to guarantee that
medications are legitimate. Since an electronic record of the transfer of drug from the point of
manufacturing to the point of dispensing is created, the safety of the patient and public health is
secured. This also allows the retailers to quickly distinguish, isolate, and report suspected
counterfeit drugs in the market. With all these effective strategies in place, the excessive use of
hospital services by older adults with ADRs will be reduced.
Multimorbidity
Multimorbidity or poly-morbidity in older adults, which is the co-occurrence of two or
more chronic conditions, is also known to be associated with high costs and gaps in quality of
care. In a study done by Kone Pefoyo et al. (2015) the prevalence of multimorbidity among
Ontarians, rose from 17.4% in 2003 to 24.3% in 2009, a 40% increase. This increase over time
was evident across all age groups. According to these authors, chronic diseases have reached
epidemic proportions and constitute the leading causes of death in the world. In Canada, 74% of

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individuals aged 65 and older reported having one or more chronic conditions in 2008 (Kone
Pefoyo et al., 2015). Hypertension & Arthritis were the most commonly found co-existing
chronic conditions among Ontarians in 2009 (Asthma, Depression, and Diabetes were also seen
in patients with 5+ conditions) (Kone Pefoyo et al., 2015).
Another interesting study done by Roberts, Rao, Bennett, Loukine and Jayaraman (2015)
found that the people who reported 3 or more chronic conditions had certain characteristics in
common. They were mostly elderly females, falling under the lowest income quintile and their
level of education was some high school. Also, living in a rural area, having Aboriginal status,
and being born in Canada further increased those odds of attaining multiple conditions (Roberts
et al., 2015). These individuals visited the hospital more than individuals who belonged to a
higher income quintile with higher education level. For prevention efforts, the authors suggest
improving several lifestyle factors such as minimizing tobacco and alcohol use, increasing
physical activity, and eating a well-balanced diet. However, understanding socioeconomic
determinants and behavioural risk factors could have a broader, systematic effect on outcomes
such as quality of life and the cost of health care (Rosella et al., 2014).
If we look at the social determinants of health, it is hard to miss food insecurity.
Household food insecurity is when one or more members of a family dont have access to
adequate food due to lack of income. It is a strong indicator of poorer physical and mental health
status among children as well as adults, which may eventually lead to the development of a
variety of chronic health conditions such asthma and depression (Tarasuk et al., 2015). Not only
does this impact the multimorbidity rate but it is also increases the probability that they will
become high-cost users of health care. Tarasuk et al. (2015) found that when compared with total
annual health care costs in food-secure households, adjusted annual costs were 16% ($235)

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higher in households with marginal food insecurity, 32% ($455) higher in households with
moderate food insecurity, and 76% ($1092) higher in households with severe food insecurity.
Conclusion
To overcome this burden on the Canadian health care system, it is important to
understand and focus on the small cohort population of elderly patients who use more health care
services than anyone else. When we start to understand their needs, we can work better to
provide that care. Fall-related injury, Adverse Drug Reactions and Multimorbidity visits were
specifically looked at to accumulate annual costs. These were mostly unnecessary visits which
could have been prevented if the proper procedures were taken. A best practice approach to fall
prevention should be issued by each of the provinces in order to prevent unnecessary falls. ADRs
can be prevented by the effective use of systems such as CPOE and RFIDs. As for
multimorbidity, it is common to get more than one condition as you age, however, the socioeconomic risk factors can be greatly reduced if more food services are provided to food
insecurity individuals as well as a strategic framework to build houses for the homeless. The goal
should be to improve population health and reach the health care targets of sustainability, hoping
for better quality of care, and improved patient outcomes.

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References
Chen, W., Bell, C. M., & Wodchis, W. P. (2012). Incidence and economic burden of adverse
drug reactions among elderly patients in Ontario emergency departments. Drug Safety,
35(9), 769-781. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714138/
Do, M. T., Chang, V. C., Kuran, N., & Thompson, W. (2015). Fall-related injuries among
Canadian seniors, 20052013: an analysis of the Canadian Community Health Survey.
Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and
Practice, 35(7), 99-108. Retrieved from http://www.phac-aspc.gc.ca/publicat/hpcdppspmc/35-7/ar-01-eng.php
Johnson, S., Kelly, S., & Rasali, D. (2015). Differences in fall injury hospitalization and related
survival rates among older adults across age, sex, and areas of residence in Canada.
Injury Epidemiology, 2(1), 1-10. doi:10.1186/s40621-015-0056-1
Kone Pefoyo, A., Bronskill, S., Gruneir, A., Calzavara, A., Thavorn, K., Petrosyan, Y., . . .
Wodchis, W. (2015). The increasing burden and complexity of multimorbidity. BMC
Public Health, 15(1), 415. Retrieved from http://www.biomedcentral.com/14712458/15/415
Roberts, K. C., Rao, D. P., Bennett, T. L., Loukine, L., & Jayaraman, G. C. (2015). Prevalence
and patterns of chronic disease multimorbidity and associated determinants in Canada.
Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and
Practice. 35(6), 87-94. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26302227
Rosella, L., Fitzpatrick, T., Wodchis, W., Calzavara, A., Manson, H., & Goel, V. (2014). Highcost health care users in Ontario, Canada: demographic, socio-economic, and health

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status characteristics. BMC Health Services Research, 14(1), 532. Retrieved from
http://www.biomedcentral.com/1472-6963/14/532
Tarasuk, V., Cheng, J., de Oliveira, C., Dachner, N., Gundersen, C., & Kurdyak, P. (2015).
Association between household food insecurity and annual health care costs. Canadian
Medical Association Journal. doi:10.1503/cmaj.150234