Paula Rochon is a geriatrician, the vice-president of research at Women’s College Hospital and the Retired Teachers of Ontario Chair in Geriatric Medicine at the University of Toronto.
Nathan Stall is a geriatrician and research fellow at the University of Toronto and Women’s College Research Institute.
Jaimie Roebuck is a communications specialist at Women’s College Hospital.
The world’s population is aging, and so is ours. This decade, Canada is projected to join the ranks of other superaged countries such as Italy and Japan; by 2026, more than 20 per cent of our population is estimated to be 65 years and older, the majority of whom will be women. Aging affects all of us. We are either currently in this group, provide care for someone in this group or will eventually be in this group ourselves.
Many want to remain comfortable and live independently as they age, and to achieve this goal, older adults and their providers may want guidance from geriatricians, much-needed medical professionals who specialize in the care of older people. But society’s growing expectations around that care don’t seem to match up with the forecasts around the resources needed to realize them.
The numbers tell an important story about what it will mean to age in this country. According to 2019 Canadian population data, 17 per cent of our population – or 6.5 million Canadians – are older than 65. This number is growing rapidly. In comparison, children (14 years and younger) represent 16 per cent of the population, and this number has been steadily declining.
But our medical system doesn’t currently reflect these significant demographic shifts. Geriatricians play an important role in specialized care, helping older adults maintain their independence, providing guidance on the care of older adults in long-term care homes and offering consultation on more complex cases of older people admitted to hospitals – and Canada only has 304 of them. According to the Canadian Medical Association, most provinces have about one geriatrician for every 100,000 older adults and three of our provinces have only one geriatrician for the entire province. Within each province, most geriatricians practise primarily in urban areas, leading to geographic inequality in the ability to access their expertise.
In the meantime, there are nearly 10 times more pediatricians, with around 2,800 of them practising in Canada. This doesn’t add up.
Given the mismatch between the number of geriatricians and our aging population, new models of care have been proposed to extend the reach of geriatricians. Some suggest that the specialty should focus on increasing the capacity of all health-care providers to care for older people rather than just increasing the number of geriatricians. Consistent with this approach, primary-care physicians can obtain “Care of the Elderly” training to provide them with additional skills to care for older adults. This approach aligns with the American Geriatrics Society’s strategic goal to increase the number of health-care professionals who use geriatric medicine principles in caring for their older patients.
Research is another avenue we can use to spread the reach of geriatric medicine. Research led by geriatricians has demonstrated the benefit of falls-reduction programs to decrease preventable harm, the link between having a comprehensive geriatric assessment in hospital and living at home a year later, and the benefit of minimizing use of antipsychotic drug therapy among frail older adults in reducing serious events.
In the United States, where they face a similar demographic challenge, the American Geriatrics Society has proposed a four-pronged approach that can also be applied in Canada: more geriatric experts, more geriatric training for the whole work force, more public-health education to empower older adults and caregivers, and more health policy that can support us all as we age.
But we can also start by understanding the meaning of the numbers. By raising awareness about the number of older people in our country relative to the number of geriatricians, we can initiate a conversation and plan appropriate models of care to optimize the health and wellness of our population, before we’re in a crisis that’s inevitable because of the realities of time.
Aging is universal and holds particular relevance for Canadians this decade. The numbers matter – and they affect future health care for each of us.
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