Statistics Canada's recent report on census information has got Canadians thinking about the impacts of its aging population, and rightly so. Canada's population is undergoing an age transformation that will have profound consequences on individuals, communities and the nation as a whole. Canadians aged 65 and over currently represent 13% of the population. In 25 years, that number will increase to 21%. Can Canada's healthcare system handle the needs of our aging population in the future without bankrupting taxpayers? Let's examine this question based on solid science.

In 1970, if it had been predicted that the use of hospital services in Canada would increase based only on age projections, it would have been wrong. The number of days patients spend in hospitals has actually decreased by 66%. Why? Because people's lifestyles have over time become healthier, therefore the demand on health services has changed. As well, developments in therapies, practices, programs and policies have also improved health and changed the way health services are delivered. Does this mean that everything is fine for older Canadians, and that our younger population need not worry about its future healthcare needs? Not quite.

Indicators point that baby-boomers in their later years will be in better health than today's seniors. However they are likely to expect and require different things from the health care system. Compared to other health issues, research on aging-related ailments such as Alzheimer's disease or functional decline, i.e. general mental and biological decline, is currently underdeveloped. Cognitive decline, such as Alzheimer's and other dementia currently affects one in four Canadians over the age of 65. With the dramatic increase of that age group by 2026, the number of cases is expected to reach epidemic stages. And apart from known ailments, there is not enough scientific data today to allow us to correctly predict the healthcare needs of future older Canadians. Clearly research on aging needs to be at the top of the research priority list. That is why the federal government created in 2000, under the umbrella of the Canadian Institutes of Health Research, the Institute of Aging, with the mandate of advancing knowledge in the field of aging to improve the quality of life and health of older Canadians.

While research on aging is being carried out, current scientific findings, if implemented, can help the healthcare system handle the needs of our aging population, as I pointed out recently to the Romanow Commission:

• Better social conditions for seniors decrease their demand for healthcare services. Among others, initiatives related to income, transportation and housing will improve the health of seniors. Specialised medical services, including geriatric and rehabilitation services, are cost effective. For example, for each dollar invested in day hospitals, the system saves $2.16 in subsequent health care costs.

• Homecare and other community services provided to frail seniors are always less costly to the system than care and services provided in institutions, even intermediary ones (in between personal residences and nursing homes). Despite this known fact, the portion of the budget dedicated to homecare in each province varies only between 2 to 6%.

• Improving the continuity of care for seniors by co-ordinating the delivery of health and social services, and reducing duplication and fragmentation of services has many benefits, such as improving drug compliance, reducing functional decline, and cutting subsequent visits to the emergency room by 27%.

• Training of workers in gerontology and geriatrics is still deficient in Canada. As well, having untrained personnel carrying out tasks that should normally be performed by trained professionals, in order to save money, has a negative impact on the quality of services, and reduces the ability to apply recent scientific findings.

• No scientific data shows a need to entrust the private sector with the financing, management and delivery of care and services. Studies prove that despite the fact that the US spends more of its money on its health care than countries with public systems, the quality of care is not superior, and life expectancy and infant mortality are higher. In Canada, many of the current problems with the healthcare system are attributable to the steady decline of public health expenditures per capita since 1992. It is time to reinvest in our health care system.

The full presentation I made to the Romanow Commission can be viewed on the CIHR site.

If moderate increases to Canada's public healthcare system, which can be easily absorbed by the growing economy, are made… and as long as proper scientific research on aging is conducted… and subsequent translation into real services, practices and policies is carried out… then it can be expected that innovative solutions will be discovered and implemented… and that quality of life, as well as the safety and the efficiency of Canada's healthcare system will improve to the point where it will be able to handle the needs of future older Canadians. Then baby-boomers, including myself, can take comfort in the realisation that there will be no healthcare apocalypse on the horizon.

Dr. Réjean Hébert
Scientific Director, Institute of Aging

Dr. Réjean Hébert is a renowned researcher on aging in Canada and internationally. A trained doctor of medicine, he is professor in the department of family medicine at the Université de Sherbrooke, and former director of the Research Centre in Aging at the Institut universitaire de gériatrie de Sherbrooke. Dr. Hébert's research relates to functional decline in seniors (epidemiology, health services). He is currently engaged in evaluative studies on the efficacy of health services and programs, particularly integrated networks of services for the elderly and disabled. He is also involved in research on caregivers of patients with dementia. He developed and validated the Functional Autonomy Measurement System (SMAF), a disability rating scale widely used in Canada and other countries for clinical and research purposes. He has published more than 100 research papers in international journals. In addition, he is associate editor of Précis pratique de gériatrie, a French-language textbook on geriatrics. Dr. Hébert is the founding Scientific Director of the Institute of Aging.