Supply versus demand: Extending the reach of geriatric medicine to match the needs of our aging population

By Paula Rochon and Nathan Stall

This decade, Canada will be crowned as a super-aged nation – 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. As our aging population increases, so too will the demand for health services. Aging is universally relevant – if we are not already part of the 65-plus bracket, we are either caring for someone in this group or will eventually be in it ourselves.

While chronic conditions including heart disease and diabetes impact some of us, aging affects all of us. For women specifically, aging holds particular relevance. They account for almost 55 per cent of the older age group and this proportion increases with advanced age.

Geriatricians are central figures for our aging population, but the gap between supply and demand is widening. Canada is home to only 304 geriatricians and most are concentrated in urban areas, adding another layer of difficulty in terms of access. Our health system is largely based around intervening once there is an illness, but geriatricians play an important role in prevention and helping older people live independently in their homes. While we do need more geriatricians, we will not be able to create the army of physicians that would be required to provide one-on-one care for all older Canadians. As a result, we must implement alternative strategies and new models of care to extend the reach of these specialists.

Canada is doing this through research, which has widened the capacity of geriatricians beyond one-to-one consultations. Research has and will continue to provide healthcare professionals with the evidence needed to best care for our aging population. We have excellent geriatricians who double as clinician scientists working to create the evidence that all health care providers will need to improve the care of older adults for the future.

The American Geriatrics Society has proposed a four-pronged approach to increase the reach of geriatricians that can also be applied here 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.

To encourage more geriatric experts in Canada, we need to implement earlier exposure to this field in medical school so that future doctors are made aware of the specialty early on in their careers.

More geriatric training for the entire workforce will also help increase the reach of geriatric medicine and relieve some of the demands on our stressed health system. This is being done in family medicine with the ‘Care of the Elderly’ training, which offers additional expertise for primary care providers in how to care for older adults. We need to continue to implement shared models of care where geriatricians work with teams of primary care providers to help build their capacity in geriatric medicine. Everyone on the health care team – from the receptionist who first interacts with the patients, to the nurses, pharmacists, social workers and physicians – all need expertise in caring for older people. Improving care is not an individual responsibility, it takes a village.

We also need more public health education to empower older adults and their caregivers. Family caregivers play an important role in helping our older demographic age in place, but they need the proper support, clinical education and resources. Caregiving – which traditionally falls to women – can be stressful and impact the health of caregivers themselves. Caregivers are recognized as central to the circle of care and positively impact the health outcomes of the older adults they care for. By providing at-home care, these caregivers are essential in allowing older people to age in-place, reducing the need for admission to long-term care facilities. Our aging population relies heavily on family caregivers, so we need to ensure that they are given the proper support and resources to do this important role.

Finally, to lessen the demands on our health system, we need to work with our communities and government to implement stronger health policies around social isolation and loneliness. Loneliness is common among older adults – particularly women. Healthcare providers may consider social prescribing to connect lonely older adults with sources of support in the community. Helping older adults stay engaged and connected can keep them healthier longer, which will optimize healthcare utilization. Community design can also reduce loneliness. By making neighbourhoods more walkable and accessible, we can promote health and wellness among our aging population. Paired with care from our geriatricians, health policy that supports us as we age can expand support for our aging population and improve health and wellness with aging.

Individually, aging impacts each of us. As a collective, we need to work to extend the reach of geriatric medicine – the health of our nation depends on it.

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 and Nathan Stall is a geriatrician and research fellow at the University of Toronto and Women’s College Research Institute.