For many years, concern has existed in Canada over the extensive, if not predominant, use of hospitals by older people (De Coster, Bruce, & Kozyrski, Reference De Coster, Bruce and Kozyrski2005; Evans, McGrail, Morgan, Barer, & Hoertzman, Reference Evans, McGrail, Morgan, Barer and Hoertzman2001; Hebert, Reference Hebert2002; Menec, Bruce, & MacWilliam, Reference Menec, Bruce and MacWilliam2005). This concern is growing as accelerated population aging, illustrated not only by a rapidly increasing number of people aged 65 and older but also those aged 80 and older, is becoming increasingly evident (Canadian Institute for Health Information, 2011; Canadian Medical Association, 2016; United Nations Development Programme, 2016; Statistics Canada, 2016b). Persistent long waits and wait lists for hospital-based health care services have fed this concern (Wait Time Alliance, 2015). However, some researchers and others have argued that older people should not be blamed for full hospitals, nor for Canada’s long waits and wait lists for hospital care (Canadian Medical Association, 2015; 2016; Canadian Institute for Health Information, 2012a; Sutherland & Crump, Reference Sutherland and Crump2013; Verma, Petersen, Samis, Akunov, & Graham, Reference Verma, Petersen, Samis, Akunov and Graham2014; Wilson, Hewitt, Thomas, Mohankumar, & Kovacs Burns, 2011; Wodchis, Williams, & Mery, 2014). To address this quandary, we analysed current complete, individual-anonymous, inpatient hospital utilization data for all Canadian provinces and territories (except Quebec) to compare the use of hospitals by older (age 65 and older) versus younger (birth to age 64) persons. We then assessed the findings in relation to Canada’s current and projected age structure, as well as relevant population health and hospital utilization and accessibility considerations.
Methods
For this study, we obtained complete individual-anonymous 2013–2014 and 2014–2015 Canadian population-level inpatient hospital data (excluding stillbirths) for analysis. These were the two most recent years of Discharge Abstracts Database (DAD) data available in mid-2016 from the Canadian Institute for Health Information (CIHI). The DAD contains comprehensive socio-demographic and clinical data on all hospitalization episodes in every Canadian province and territory, with the exception of Quebec. Quebec does not provide health care or other data to CIHI for comparative or other analyses. The DAD is focused on inpatient hospital care, and so does not contain data on outpatient or emergency department visits. The exception is when an emergency or ambulatory care visit is immediately followed by an admission to hospital for one or more days of inpatient care; in those cases, DAD data is collected for that specific hospitalization episode. Research ethics approval for this study was obtained from the University of Alberta’s Health Research Ethics Board (#Pro00063626).
We conducted identical exploratory-descriptive statistical tests appropriate for the level of data in each of the two separate data years. We undertook this initial analysis to ensure that no data issues were present, such as missing variables or a large amount of missing data in any variable. In addition, this analysis was undertaken to ensure that no major unexplained utilization or patient socio-demographic differences occurred from one year to another. This initial analysis revealed no data issues and similar year-to-year findings. Consequently, the comparative findings reported here are confined to the more current (2014–2015) year. With some exceptions, we reported on hospitalization episodes and not on the findings for individual patients, as each hospitalization episode required a hospital bed to be available and inpatient admissions were essentially limited by the number of beds available for use. The SAS (version 9.2) software program was initially used for this analysis, as required since the size of each annual data set is enormous. For smaller data subsets, we used the SPSS (version 23) software program.
We confirmed our findings through repeated data analysis (three times in each case). We also assessed the findings against those presented in other Canadian hospital data analysis reports, although many of these reports focus only on the use of hospitals by older people (Canadian Medical Association, 2016; Canadian Institute for Health Information, 2011; Gruneir et al., Reference Gruneir, Kwong, Campitelli, Newman, Anderson, Rochon and Mor2014; Menec, Lix, Nowicki, & Ekuma, Reference Menec, Lix, Nowicki and Ekuma2007; Ng, Sanmartin, Tu, & Manuel, Reference Ng, Sanmartin, Tu and Manuel2015). Moreover, it is relevant to note that the first author has conducted many population-based hospital utilization and other population-based studies previously, a factor relevant for research quality assurance purposes. Familiarity with the DAD database and past experience with managing large databases were helpful for this secondary data analysis study.
Results
A total of 2,491,040 inpatient admissions to all hospitals in Canada (excluding Quebec) occurred in 2014–2015. That year, 1,864,735 individuals were hospitalized one or more times. Of these individuals, 1,253,116 (67.2%) were younger (birth through age 64) and 611,619 (32.8%) were older (age 65 and older). Moreover, of these individuals, 1,776,630 (95.3%) were discharged alive and 88,105 (4.7%) died in hospital. Deceased patients averaged 75.1 years of age (79 = median, 83/84 = mode, 0–110 range), with the majority of hospital decedents (79.7%, n = 70,209) 65 years of age or older. In contrast, across all hospital episodes, the average patient age was 48.8 (54 = median, 0 = mode, 0–110 range). People under the age of 65 were responsible for 63.0 per cent of all inpatient hospital episodes.
Over half of all hospital episodes (56.4%) were associated with females. Younger patient hospital episodes were also more likely to involve females (59.5%). In contrast, older patient hospital episodes were almost equally as likely to involve females as males (51.1% and 48.9% respectively), although this slight difference was still significant (χ2 = 16486.1, df = 2, p < .001). Also across all hospital episodes, older patients were slightly more likely to be admitted to hospital with a preadmission flag than were younger patients (0.8% and 0.7% respectively), another slight but significant difference (χ2 = 66.76, df = 1, p < .001). However, 60.2 per cent of all preadmission flags were linked with younger patients and 39.8 per cent linked with older patients. Preadmission flags, useful for planning and providing appropriate care, typically denote that co-morbidities exist or that there are other factors involved, such as a need for palliative care.
Age-based differences in the place discharged to or transferred to after the hospital episode ended were also noted. Across all hospital episodes that did not end in death, 78.0 per cent of discharges/transfers were to a private residence, 9.8 per cent were to a private residence receiving home care services, 1.2 per cent to a chronic care facility, 2.1 per cent to a nursing home, and 1.1 per cent to a home for the aged. However, 2.9 per cent of all older patient discharges/transfers were to a chronic care facility as compared to 0.3 per cent of younger patient discharges/transfers. Moreover, 5.3 per cent of all older patient discharges/transfers were to a nursing home as compared to 0.3 per cent of younger patient discharges/transfers, and 2.8 per cent of all older patient discharges/transfers were to a home for the aged as compared to 0.1 per cent of younger patient discharges/transfers. In total, 88.7 per cent of younger patient hospital episodes and 59.8 per cent of older patient hospital episodes ended with a discharge or transfer to a private residence. When the discharge or transfer was to a private residence receiving home care services, 33.6 per cent of these discharges/transfers involved younger patients and 66.4 per cent involved older patients.
Although a wide range of primary diagnoses were present among all admitted patients, some age-based differences were found. For hospital episodes involving younger patients, the most common diagnostic cluster was pregnancy and childbirth (19.1%), followed by the non-specific diagnosis of factors affecting health and contact with health services (16.7%) and cardiovascular disorders (10.9%). For older patient hospital episodes, the most common diagnostic cluster was cardiovascular disorders (19.8%), followed by respiratory disorders (11.8%) and digestive disorders (9.4%).
In addition, for all hospital episodes in 2014–2015, older patients were more often admitted to hospital by ambulance than younger ones (48.0% and 17.2% respectively), a significant difference (χ2 = 270693.8, df = 1, p < .001). Younger-patient hospital episodes accounted for 37.8 per cent of all hospitalizations involving an ambulance, while older-patient hospital episodes accounted for 62.2 per cent. In contrast, younger-patient hospitalizations were more than twice as likely to follow an emergency room (ER) visit as compared to older-patient episodes (61.9% and 30.9% respectively), another significant difference (χ2 = 223076.6, df = 1, p < =.001). Younger and older patient episodes of hospitalizations that followed an ER visit were nearly equal in proportion (49.4% and 51.6% respectively), however.
Just over 10 per cent of all hospital episodes (11.5%, n = 286,071) involved a special care unit (SCU), such as an intensive care unit or coronary care unit. Patients admitted to an SCU averaged 52.9 years of age (61 = median, 0 = mode, range 0–105), with 58.5 per cent of all SCU episodes that year involving younger patients. When death occurred in the SCU, 64.6 per cent of these decedents were older and 35.4 per cent younger, a significant difference (χ2 = 5600.5, df = 1, p < .001). However, only 1.2 per cent of all SCU-admitted older persons and 0.4 per cent of all similarly admitted younger persons died in the SCU. As indicated above, 88,105 persons died that year in hospital. Only 724 deaths or 0.8 per cent of the total occurred during an intervention in the SCU or another hospital location. Older individuals were more likely to die during an intervention than younger ones (68.9% and 31.4% respectively), another significant difference (χ2 = 310.456, df = 1, p < .001).
As shown in Table 1, the length of stay for all 2,491,040 hospital episodes in the 2014–2015 year averaged 6.8 days (3 = median, 1 = mode). When the hospital episode included SCU care, the hospital stay was nearly twice as long, 11.75 days on average (6 = median, 1 = mode). The hospital stay for the 88,105 individuals who died that year was also longer, 16.4 days on average (3 = median, 1 = mode).
Table 1: Hospital length of stay comparisons
Note. ALC = alternative level of care. * Significantly different means; F test; p < .001.
Hospital episodes can comprise an acute portion as well as an alternative level of care (ALC) portion that typically involves waiting in hospital for placement in a rehabilitation facility or nursing home (Canadian Institute for Health Information, 2012a; Wilson et al., Reference Wilson, Vihos, Hewitt, Barnes, Peterson and Magnus2014). Table 1 shows that the acute portion of hospital episodes in the 2014–2015 year varied from, on average, 5.9 days to 10.9 days when the hospital episode involved an SCU whereas the acute portion of hospital stays for the 88,105 individuals who died averaged 13.6 days. The ALC portion of hospital stays also varied across patients: from 1.0 day on average across all hospital episodes to 2.8 days on average for the individuals who died that year and 0.9 days on average whenever the hospital episode involved an SCU.
Age-based differences in hospital stay lengths were found. As shown in Table 1, across all hospital episodes, older patients had significantly longer total, acute, and ALC stays than younger patients. However, across all hospital episodes, younger patients had longer SCU stays as compared to older patients (138.0 and 106.3 hours respectively), another significant difference (t = 32.43, p < .001).
Finally, for all hospital episodes, we found a significant positive correlation between age and total days’ stay in hospital (Pearson r = .171, p < .001), as well as for the acute portion of hospitalizations (Pearson r = .180, p < .001) and the ALC portion of hospitalizations (Pearson r = .082, p < .001). Moreover, when the hospital episode involved an SCU, we found a significant positive correlation between age and total days in hospital (Pearson r = .144, p < .001), as well as for the acute portion of these hospital stays (Pearson r = .139, p < .001) and the ALC portion of these hospital stays (Pearson r = .084, p < .001). In contrast, for deceased individuals, a significant negative correlation existed between their age and length of total stay (Pearson r = –.013, p < .001), their age and acute stay (Pearson r = –.043, p < .001), and their age and SCU stay (Pearson r = –.085, p < .001). However, for individuals who died in hospital, a positive correlation was found between their age and length of ALC stay (Pearson r = .021, p < .001).
Discussion of Findings
Dispelling Myths about Old Age and Hospital Utilization
This study, undertaken to compare the use of inpatient hospital beds by older and younger Canadians, revealed that only 37.0 per cent of all hospitalization episodes in regions outside of Quebec were associated with people aged 65 and older. Compellingly, it is evident that older people are not the most common, or predominant, hospital patient.
It is also important to consider that 15.3 per cent or 4,277,000 of all 27,960,300 Canadians living outside of Quebec in 2015 were 65 years of age or older (Statistics Canada, 2016a). The DAD data revealed 32.8 per cent of all individuals admitted to hospital one or more times in the 2014–2015 year were 65 years of age or older; it is therefore evident that older Canadians have approximately twice the risk of being hospitalized as compared to younger Canadians. However, because the DAD data revealed a total of 611,619 older individuals were admitted to hospital in the 2014–2015 year, this demonstrates that only around 14.3 per cent of all older persons living in Canada (excluding Quebec) were admitted to hospital one or more times that year.
This use of hospitals by such a small proportion of older people is remarkable as the burden of death and dying is principally borne by older people (Statistics Canada, 2015; Wilson et al., Reference Wilson, Truman, Thomas, Fainsinger, Kovacs-Burns and Justice2009). Multiple chronic illnesses are also much more prevalent at older ages (Public Health Agency of Canada, 2017b). It is therefore understandable why it is commonly believed that older people are often ill and high users of hospitals, and that hospitals are full of old people. The reality is that only a small (14.3%) proportion of Canadians aged 65 and older are admitted one or more times to hospital each year. Moreover, only two of every five persons admitted to hospital are older.
Refocusing Attention to Younger Persons
Among other implications, the findings of this study should serve to redirect the predominant if not sole attention from older people and their use of hospitals to considerations around reducing the need for and use of hospitals by younger people. Fortunately, babies are typically born healthy, but most acquire one or more chronic illnesses in their youth and younger adult years, as chronic illnesses are usually acquired before age 65 (Public Health Agency of Canada, 2017a; Statistics Canada, 2016b). Accordingly, this study indicates the imperative to help young people stay healthy and thus avoid the need for restorative hospital-based care prior to and after age 65. This idea is not new. For many years, it has been recognized that health in old age is largely dependent upon health prior to old age (Statistics Canada, 2016b).
Moreover, it is critically important to consider what can be done to reduce the avoidable use of hospitals by younger people. This reduction, given continuing population aging and the higher rate of hospitalization by older people, will be increasingly indicated in the future if the stagnant number of hospital beds in Canada despite population growth is not addressed (Canadian Institute for Health Information, 2005; Sutherland & Crump, Reference Sutherland and Crump2013). For instance, the DAD data revealed that pregnancy and childbirth was the most common diagnostic cluster or reason for hospital admissions by younger persons, with this diagnosis assigned, of course, only to females. As birthing outside of hospital is common practice in many developed countries (UNICEF, 2017), efforts in Canada to shift birthing out of hospital are indicated. Supported births outside of hospital would also reduce Canada’s exceptionally high caesarean section rate and the many complications that can occur with this surgery (Kelly et al., Reference Kelly, Sprague, Fell, Murphy, Aelicks, Guo and Walker2013).
Other lines of investigation and action to reduce the avoidable use of hospitals by younger people are indicated, particularly as this study showed 61.9 per cent of all admissions to hospital by young people were through the emergency department, twice the rate for older people (30.9%). Busby, Purdy, and Hollingworth’s (Reference Busby, Purdy and Hollingworth2015) review of published research on unplanned and potentially avoidable hospitalizations was undertaken because “unplanned hospital admissions place a large and increasing strain on healthcare budgets worldwide” (p. 324). Their research literature review revealed major, although still largely unexplained, cross-border and within-country differences in unplanned hospital admission rates. However, a lack of community-based clinical care guidelines was identified by the authors as a major reason for these unplanned hospital admissions, and they found low-quality primary (i.e., community-based or pre-hospital) health care services and open or readily available hospital beds were the two most commonly cited reasons for unplanned hospital admissions (Busby et al., Reference Busby, Purdy and Hollingworth2015).
Targeted Interventions
Many Canadian studies provide clear indications of where specific targeted interventions could be initiated, expanded, or improved to help younger people stay healthy and out of hospital or receive needed health care services outside of hospital. For instance, Gilca et al.’s (Reference Gilca, Deceuninck, De Serres, Boulianne, Sauvageau, Quach and Sknowronski2011) Quebec study found children who were immunized to protect them from influenza were much less often hospitalized than children who were not vaccinated. Carlisle, Mamdini, Schachar, and To’s (Reference Carlisle, Mamdani, Schachar and To2012) Canadian study identified adolescents suffering from psychiatric illnesses are often admitted and readmitted to hospital, with current community-based care identified as inadequate for their needs. Butalia, Johnson, Ghali, and Rabi (Reference Butalia, Johnson, Ghali and Rabi2013) found hospitalizations were common among Canadian adults diagnosed with type 1 diabetes, a disease often diagnosed soon after birth; with 40.0 the average age of hospital admission for type 1 diabetics. Kamal et al.’s (Reference Kamal, Lindsay, Cote, Fang, Kapral and Hill2015) 2003–2013 trend study of hospital admissions in Canada for stroke identified an increase over time in admissions by younger Canadians; with improved hypertension detection and treatment thus indicated for younger people. Moreover, Chen, Dales, and Krewski (Reference Chen, Dales and Krewski2001) found a much higher hospital admission rate in Canada among younger men diagnosed with asthma than older men similarly diagnosed, with indicates that newly diagnosed (younger) people need more education and services to prevent illnesses that require hospitalizations. In 2007, McIvor, Boulet, FitzGerald, Zimmerman, and Chapman concluded that no improvements in asthma control had occurred in Canada since 1999.
Hospital Stay Interventions
Another line of investigation and action could focus on age-based differences in the length of hospital stays. This study found the median hospital stay of both younger people and older people were not excessive (2 and 5 days respectively), and the most common hospital stay for both older and younger patients was only one day. These findings are concerning, as Busby et al.’s (Reference Busby, Purdy and Hollingworth2015) research literature review revealed short hospital stays are highly illustrative of inappropriate and avoidable hospital admissions. As such, more could be done, particularly in light of the typical short hospital stays by younger patients, to help younger people find quality health care services outside of hospitals and thus avoid hospital admission.
At the same time, the longer hospital stays of older patients require attention. The Canadian Patient Safety Institute (2016) recently highlighted the need for more early-discharge planning in hospitals and also the need to prevent hospital-acquired infections and other mishaps in hospital that keep people in hospital. Older patients experience more of these mishaps, and they also have much more serious effects from them (Canadian Patient Safety Institute, 2016).
ALC and Palliative Interventions
Finding longer average lengths of stay for hospitalizations that involve ALC days and also those that involve death in hospital reveal areas where improvements could be made for the benefit of these types of patients, primarily older ones. For quite some time now, it has been apparent that a portion of hospital stays in Canada is often used for the delivery of non-acute care; with unexplained delays in hospital discharge, minimal homecare services, few free-standing hospices, not enough nursing home beds, and a few other factors linked with both ALC days and death in hospital (Canadian Hospice Palliative Care Association, 2014; Canadian Medical Association, 2015; 2016; Costa, Poss, Peirce, & Hirdes, Reference Costa, Poss, Peirce and Hirdes2012; Seow et al., Reference Seow, Barbera, Pataky, Lawson, O’Leary, Fassbender and Sutradhar2015; Sutherland & Crump, Reference Sutherland and Crump2013). A recent comparative analysis of the availability of nursing home beds in developed countries revealed Canada has relatively few nursing home beds for population health needs (Wilson, Brow, & Playfair, Reference Wilson, Brow and Playfair2017). Moreover, fewer than 90 free-standing or community-based hospices that have inpatient beds exist in Canada (Canadian Hospice Palliative Care Association, 2014). More non-hospital care facilities such as hospices and nursing homes are thus likely needed to reduce ALC days in hospital and also death in hospital. It is possible to shift more deaths out of hospital, as a recent study found that a major reduction in hospital deaths has been occurring in Canada, to around 44 per cent of all deaths currently (Wilson, Shen, & Birch, Reference Wilson, Brow and Playfair2017).
Age-Informed Health Care Services
On the other hand, it is important to recognize that the longer average and median hospital stays by older patients may simply be a factor of their having more serious illnesses, as indicated by their relatively short stay before dying in hospital and also the finding that most (nearly 80%) of the patients who die now in hospital are older. Longer hospital stays by older people have previously been identified as a largely irreversible outcome of multiple serious co-morbidities (Canadian Medical Association, 2015; Public Health Agency of Canada, 2017a; 2017b; Statistics Canada, 2016b; Touchie, Reference Touchie2013). However, preventable factors may also be contributing to these long hospital stays, such as fatigue or burnout among the informal caregivers of ill or dependent older people (Canadian Institute for Health Information, 2011; Johansen & Finès, Reference Johansen and Finès2012; Public Health Agency of Canada, 2017b; Turcotte, Reference Turcotte2015). More home care services to support family caregivers are thus indicated (Canadian Institute for Health Information, 2012b; Canadian Medical Association, 2015; Seow et al., Reference Seow, Barbera, Pataky, Lawson, O’Leary, Fassbender and Sutradhar2015; Seow et al., Reference Seow, Sutradhar, McGrail, Fassbender, Pataky, Lawson and Barbera2016; Wilson, Brow, & Playfair, Reference Wilson, Brow and Playfair2017; Wilson et al., Reference Wilson, Vihos, Hewitt, Barnes, Peterson and Magnus2014).
It is also possible that the longer average and median hospital stays by older patients are the result of systemic undertreatment or delayed treatment as a result of ageism and other related correctable reasons (Canadian Medical Association, 2016). The finding that younger patients had significantly longer SCU stays than older patients suggests this concern is a possibility. Investigations of the impact of delayed health care consistently reveal that more serious illnesses often then occur, along with higher health care costs, longer hospital stays, and a higher mortality rate (Clark, Reference Clark2016; McIsaac et al., Reference McIsaac, Yang, Sundaresan, Doering, Vanwani, Thavorn and Forster2017).
A lack of age-appropriate or age-informed primary care and community care services for the health of older persons in Canada is also possible. For instance, community-acquired bladder and lung infections are now known to be common yet highly preventable reasons for hospital admissions, long hospitalizations, and also premature death in old age (Canadian Institute for Health Information, 2012b; Nasa, Juneja, & Singh, Reference Nasa, Juneja and Singh2012; Rowe & Juthani-Mehta, Reference Rowe and Juthani-Mehta2013). Moreover, although chronic diseases account for 70 per cent of all deaths in Canada now, less than one third of all terminally ill Canadians have access to supportive hospice, palliative care services, most of which are home-based (Canadian Hospice Palliative Care Association, 2014).
The ongoing scarcity of home care services and limited nursing home bed availability across Canada, which illustrate systemic health system and societal ageism, also means cognitively impaired and disabled older people are often admitted to hospital for supportive care, and they cannot subsequently be easily discharged from hospital (Canadian Institute for Health Information, 2012b; Canadian Medical Association, 2015; Seow et al., Reference Seow, Barbera, Pataky, Lawson, O’Leary, Fassbender and Sutradhar2015; Seow et al., Reference Seow, Sutradhar, McGrail, Fassbender, Pataky, Lawson and Barbera2016; Wilson, Brow, & Playfair, Reference Wilson, Brow and Playfair2017; Wilson et al., Reference Wilson, Vihos, Hewitt, Barnes, Peterson and Magnus2014).
Although Canada ranks 5th in the Global Age Watch Index pertaining to overall social and economic well-being for older Canadians (HelpAge International, 2015), serious barriers to accessing age-appropriate health care services are of concern. The Government of Canada’s (2017) recent pledge of $6 billion dollars for home care services expansion, including palliative home care, over the next 10 years is therefore highly relevant to monitor for its effect on the health of older Canadians and both their need for and use of hospitals.
Hospital Accessibility Considerations
As older people were not found to be the predominant hospital patient, nor SCU patient, it is relevant to reflect more broadly on why hospital accessibility issues exist in Canada. It is important to consider the role that hospital downsizing in the 1980s and 1990s has had for Canada’s currently full hospitals and the long waits and wait lists for hospital care. In Canada, the number of hospital beds dropped from a peak of 179,256 in the 1988–1989 year through to 2000–2001 when only approximately 115,000 beds remained (Canadian Institute for Health Information, 2005). This outright loss of one third of all hospital beds has been followed by continuing stasis in hospital bed numbers despite population growth (Sutherland & Crump, Reference Sutherland and Crump2013). The 2016 census found the population of Canada totaled 36,284,400, with older people outnumbering those aged 0–15 for the first time in history (Statistics Canada, 2016a). Canada’s 2.1 hospital beds per 1,000 persons has earned Canada a ranking of 30 in the Organisation for Economic Co-operation and Development’s (2016) 33-country hospital accessibility comparison study. As a result, Canada could have too few hospital beds to meet the acute health care needs of citizens, young and old.
Alternatively, hospital efficiency and health system developments could be lagging behind what is needed in light of Canada’s limited number of hospital beds. For instance, nurse case management and salaried nurse practitioner services, although common elsewhere, are currently not common in Canada; yet both have been shown to reduce hospitalizations among people living with chronic illnesses and old-age frailty (Archibald & Fraser, Reference Archibald and Fraser2013; Thomas, Wilson, Birch, & Woytowich, Reference Thomas, Wilson, Birch and Woytowich2014; Sangster-Cormley et al., Reference Sangster-Gormley, Carter, Donald, Misener, Ploeg, Kaasalainen and Wickson-Griffiths2013). Moreover, transitional care planning through improved teamwork is another possibility, as this has been shown to reduce the need for moves from one care setting to another, often home or nursing home to hospital (Wilson et al., Reference Wilson, Hewitt, Thomas, Mohankumar and Kovacs Burns2011).
Conclusion
This study of Canadian hospital utilization data revealed that younger people are the most common hospital patients and also the most common SCU patients. Other age-based findings were similarly revealing, including the much higher rate of younger people being admitted to hospital through the ER. Hospital admissions following an ER visit are unplanned or unscheduled and therefore much more difficult to accommodate as compared to pre-planned and scheduled admissions. For younger people, hospitals appear to be a place more for recovery whereas for older people, hospitals appear to be a place more for chronic and supportive care, including end-of-life support. These findings indicate inadequate home care, nursing home, and hospice support in Canada, services that are largely used by older persons. Consequently, systemic issues pertain to the lack of access to alternative care and care providers, particularly community-based care options. Last, and certainly not least, this study reveals it is incorrect to believe older people are the “cause” of Canada’s hospital accessibility issues. Unless this belief is corrected, ageist health care services and societal ageism could prevail.
