Executive Summary

1. The enormous growth in the number of persons 65+ is a global phenomenon. In Canada, the 65+ age group is the fastest-growing population sector, and the 85+ age group is the fastest-growing subset. Life expectancies are increasing and the gender gap is narrowing. Women are more likely than men to be unattached, living alone, poor, without a caregiver, and less educated. Varying rates of provincial senior population growth will result in uneven demands on the health care system and will continue as young adults leave home in search of employment, thus leaving areas with a high proportion of seniors. If urbanization trends continue, 85% of seniors will live in cities by 2025.
2. The three major determinants of independence are health, wealth and social integration. Programs aimed at promoting independence may not be appropriate as individuals age and become increasingly frail. Seniors will enjoy relatively good health with only a short period of disability at the end of their lives, at which time they become significant health care users. The most common health conditions among seniors are diseases of the joints, hypertension, heart disease, respiratory problems, diabetes and osteoporosis. The number of persons with functional limitations increases significantly with age, and the most frequently reported disabilities are mobility limitations.
3. Aging is associated with an increase in depression. The prevalence of dementia, including Alzheimer's disease, increases with age. Caring for so many patients over an increased length of time may present a serious challenge.
4. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. A holistic multi-disciplinary approach is gaining popularity as are multi-disciplinary teams to assess needs prior to offering services.
5. Single entry, coordinated assessment and case management lead to increased efficiency and help ensure that people receive the appropriate level of care in the community. Common assessment tools and classification systems, coordinated case management and effective management, and the capacity to plan at a system-wide level combined with a political will, should help the long-term care sector reach its full potential.
6. Provincial reforms tend to regionalise services and expand community-based long-term care and support services in response to the desire of people to stay in their own homes. Long-term care policies of most provinces emphasize a social long-term care model. Cutbacks in federal transfer payments to the provinces will be felt most severely beginning in 1997-98, and already strained budgets will have to be stretched even further.
7. Maintaining health and preventing disease can help seniors stay independent community members, while enjoying a high quality of life. Researchers agree that the greatest advances in health in the future will come from healthier lifestyles and environments. Care must be taken to ensure that seniors are aware of the services available to them.
8. About 80% of care provided for seniors is informal care by family and friends, a situation which will provide a challenge in the future. The majority of informal caregivers are women and most are over 60 and suffer from their own health problems. The shift from institution-centred long-term care to community-based long-term care will result in more women providing increased amounts of caregiving. Because problems in combining paid work and caregiving will increase, programs that address this issue are required. Care for the caregiver is an essential component that cannot be overlooked, and respite care is one of the most unmet needs of caregivers.
9. Risk factors for institutionalization include availability of the spouse as a caregiver, presence of dementia or functional impairment, and need for supervision or assistance in performing the ADLs. There is an ongoing need for institutions, which are now characterized by later admission ages and a larger proportion of frailty and dementia patients. The majority of first-time residents are female and the average age is 85. Closing institutional beds on the incorrect assumption that many residents can manage in the community would create a crisis in which the most disabled persons are left without adequate care. The emerging availability of community-based services reduces but doesn't replace the need for institutions.
10. Alternatives to institutionalization, such as home care and housing options, are becoming increasingly popular. There is an ongoing debate over the cost-effectiveness of home care.
11. Ethical issues include advanced directives and health proxies, elder abuse, euthanasia and assisted suicide, consent to treatment, the use of restraints, the right to privacy and autonomy, the right to sexual expression, the abuse and neglect of residents, and the right to long-term residency despite the facility's inability to provide increasing care.
12. Aboriginal people and disabled persons have special needs.
13. Canada needs a computerized national information system based on an agreed-upon level of care classification.