Preventing health crises in vulnerable older people

With a rapidly aging population, the systemic burden of managing multiple chronic conditions is growing – and hospitals are struggling to keep up. The high demand for inpatient beds translates into constant pressure on hospitals to quickly discharge stabilized patients back to the community. But some people aren’t ready to go home.

“What we’ve found is that when hospitals discharge older people back into their long-term care homes, these people end up back in the emergency room within the month,” says Dr. Andrea Gruneir. “Women are disproportionately affected, since the majority of older people are women.”

Gruneir’s population-based cohort study, published in the Journal of the American Medical Directors Association, is helping policymakers understand how gaps in the health-care system can increase the burden on emergency departments. The study examines health-care transition patterns, linking moves from hospital to long-term care with an increase in emergency department transfers.

“The study shows where some of the system’s weaknesses lie,” says Gruneir. The take-home message isn’t that hospitals should keep patients longer, but that “we need transitional care systems that ease vulnerable people back into the community.”

With more supportive transitional systems, Gruneir says that vulnerable older people will be healthier and better supported. And so will their spouses as well as busy “sandwich generation” children.

“Making health care more effective and more efficient is absolutely critical as the Ontario population ages,” says Gruneir.

Dr. Andrea Gruneir is an epidemiologist trained at Brown University with a program of research supported by the Canadian Institutes of Health Research. She is a scientist at WCRI and an assistant professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto.