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The health-care system must do better at
addressing conditions that restrict how we live as we get old
By Kenneth Rockwood Contributor Troy Media
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HALIFAX, N.S. /Troy Media/ -
Should medicine be ageist?
A young trainee doctor
recently proposed to me that it should. Health care is overstretched, she
argued. "We can't do everything for everyone, so why spend money on old people,
who have little chance of benefit?"
For her, ageism is not all
that bad - in fact, it's a practical response to limited resources.
I'm unpersuaded. Ageism is not
benign. We fail older people when we treat them, as typically we do, in ways
that are at odds with how ageing works. Ageism masks our need to do
The challenge is the
complexity of ageing. With age, almost all diseases become more
Health care has become pretty
good at assembling teams that specialize in specific problems, creating focused,
And patients do best when
their single illness, no matter how complicated and no matter what their age, is
their main problem. Subspecialized care may work very well for
But as we age, we're more
likely to have more than one illness and to take more than one medication. And
as we age, the illnesses that we have are more likely to restrict how we live -
not just outright disability, but in our moving more slowly or taking care in
where we walk, or what we wear or where we go.
Not everyone of the same age
has the same number of health problems. Those with the most health problems are
frail. And when they're frail, they do worse. Often, those with frailty do worse
because health care remains focused on single illness. Our success with a
single-illness approach has biased us to think that this is the approach we
should always take.
When frail people show up with
all their health and social problems, we see them as illegitimate or unsuited
for what we do.
So would the young doctor be
right if instead of restricting care in old people, she simply opted for
restricting care for frail people? Should frailism be the new
For health care, such a notion
would be self-defeating. If frail patients are unsuited to the care that doctors
provide, we must provide more suitable care.
Frail older adults consume a
lot of care. Far better that those of us in the health system treat them as our
very best customers. That would improve care for everyone.
No one admitted to hospital
benefits from poor sleep, but (mostly) we get away with it in our fitter
patients. Not so in the frail, in whom it leads to worse outcomes: longer stays,
more confusion, more medications, more falls and a higher death
No one benefits from being
immobilized too long. No one benefits from not having medications reviewed, or
from poor nutrition, or inadequate pain control, or getting admitted when care
at home would be better or in not clearly discussing goals of care. Just because
the health system mostly gets away with it in fitter patients is no reason to
Changing routines to improve
care will benefit everyone. But it won't happen if we see frailty as an
acceptable form of ageism. We need to invest in better care and in better
understanding how to design, test and implement it.
As important as subspecialties
are, by definition each subspecialty group benefits a small fraction of people.
The skills required to provide expert general care, particularly for frail older
adults, have been less celebrated. Compared to disease research, ageing and
frailty are barely on the funding radar screen.
In any guise, ageism can be
insidious. We don't have to go far to find it. I find it in myself when I'm in a
long line. It's not the science of how movement becomes slow that saves me then
- it's realizing that slowness is not a moral failing, much less one directed at
What we do in our health
system now fails older people who might benefit if we provided better care. In
that way, it fails us all.
Attitudes must change.
Medicine should not be ageist. It shouldn't even be frailest. We must work to
provide better care for frail older adults, especially when they are
Kenneth Rockwood is a geriatrician in Halifax, N.S., and a
researcher with Canadian Frailty Network (CFN), a not-for-profit organization
dedicated to improving care for older Canadians living with
Move health research
out of the academy and into the community
Health changes require greater input by
people trained to create a difference - and that's not happening in
By Stephen Bornstein with Adalsteinn
TORONTO, Ont./Troy Media/ - Canada has a mismatch between the
world-class health research we produce and how that research is implemented into
our health-care system.
Our doctoral graduates are among the most productive and respected
researchers in health services, health policy and health economics - and
Canadian universities are often in the global top 10 for these areas of study.
Yet our health system continues to underperform.
Where's the disconnect?
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The Commonwealth Fund ranks
comparable health systems around the world on a number of performance
indicators. It continually places Canada as one of the worst performers across a
number of categories, such as timeliness, safety and efficiency of care. Only
the United States routinely performs worse, sitting at last place
It would be easy to point to health-care funding as the culprit but
that's largely not the case.
Canada spends roughly 10.4
per cent of its gross domestic product on health, more than the United Kingdom,
New Zealand and Australia.
The truth is, we often don't manage our health system
But much can be done to lift Canadian health care out of its poor
Over the last several decades, a number
of studies from
experts inside and outside of Canada have pointed out the gap between the performance of our system and the level we
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Landmark reports from Manitoba and Ontario show that a patient's
likelihood of getting needed surgery depends heavily on where they
live. Studies also show a huge gap between what we know to be effective and
appropriate care and what people actually receive. And a study from over a
decade ago shows that nearly one in 13 hospital visits resulted in adverse
health events with nearly nine per cent of these ending in preventable
follow-up study last year shows that little has
We can do better, but how?
Health system changes require greater input by people trained to
create and use evidence to design, implement and evaluate them. That's not
happening in Canada.
Every year, more than $3.5 million is invested in the training
of health-care-related PhDs in Canada. But for the majority of them, the
likelihood of academic employment is low and declining. In fact, the
vast majority will work in health services and management fields, not
academia. Yet our doctoral programs in health sciences don't prepare them for
An extensive interview-based study found that our recent health
PhDs are not having the impact they could have on Canada's health system - the
sort of impact that many of our most advanced graduates with PhDs see as the
goal of their careers and the reason for their training. While well prepared in
academic terms, they lack preparation in the managerial and leadership skills
necessary to make tough decisions based on evidence with a relentless commitment
to evaluation and improvement across the system.
It's time to move health research out of the academy and into the
We now provide experiential learning opportunities during and after
PhD training, where individuals get the opportunity to work with hospitals,
government agencies and other health-care providers in the community - to apply
their skills and findings directly in the service of health system
We're building an open source curriculum to teach health PhDs
essential managerial and leadership skills they need to make sure their
expertise gets translated into better decisions across our health
Discussions about health funding will always be important, but we
need to make sure we have the personnel to make the system better, regardless of
the dollars transferred between levels of government.
We have a great resource in Canada's university-based training
programs in health services and PhD graduates who want to make a difference. Now
we need to make sure they have the opportunity.
Adalsteinn Brown is an
expert advisor with EvidenceNetwork.ca, the director of the
Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair
in Public Health Policy at the University of Toronto. Prior roles include senior
positions in the Ontario government. Stephen Bornstein is director of the Centre
for Applied Health Research and a professor at Memorial University. Prior roles
include senior positions in the Ontario government.
The alpine touring craze is confirmed: sales of rando-ski passes are up, and
so are equipment sales at the Boutique Expérience SUTTON, which had counted on
the trend and acquired an even more specialized back country equipment this
The boutique has also experienced a 140 % increase in helmet sales, and a
150 % increase in goggle sales, in comparison to an average year, mostly in
response to its even wider selection and improved layout.
New skiers were also three times as many to pick up a new winter sport this
holiday season with our initiation packages.
Monday pass and Friday pass sales (168 $) are still increasing, making this
year their best since their introduction.
More activities to come
Even though the holiday excitement is over, Mont SUTTON is not slowing down.
From January 10th to February 16th, those 50 and over,
men, and women are all celebrated on their own 25 $ ski days: 50+ Club Tuesdays,
Suits and Ties Wednesdays, and Divas on Skis Thursdays. What’s more, every
weekend, skiers are encouraged to take a pair of new skis out for a run for free
from our demo deck. An ideal way to try before you buy from the Boutique
Expérience SUTTON! For all upcoming activities at Mont SUTTON: www.montsutton.com/activities.
can use sliced Canadian bacon for a lower-fat version of this hearty egg
Prep: 5 min
Total: 40 min
tablespoons olive oil
large sweet onions, thickly sliced
teaspoon coarse salt
teaspoons balsamic vinegar
cups cubed (½ inch) cooked potatoes
cup cooked greens, such as mustard or kale, chopped
slices bacon, cooked and crumbled (optional)
large eggs, beaten
Directions 1. Preheat the oven to 350°F.
2. In a 10-inch ovenproof skillet, heat the oil
over medium heat. Add the onion slices, 1/2 teaspoon of the salt, and 1/8
teaspoon of the pepper. Cook, turning with tongs, until well browned, about 10
minutes. Sprinkle with the vinegar and cook 1 minute longer.
3. Add the potatoes, greens, bacon (if
using), and remaining 1/2 teaspoon salt and 1/8 teaspoon pepper. Pour the eggs
over the vegetables and stir to blend. Cook over medium heat until the mixture
begins to set, about 3 minutes.
4. Place the skillet in the oven and bake for
15 minutes, or until set. Let stand 5 minutes, then invert onto a platter. Cut
into wedges to serve.
Nutritional Facts per
Calories 213.8 cal
Fat 11.3 g
Cholesterol 284.9 mg
Sodium 557.5 mg
Total sugars 6.8 g
Dietary fiber 2 g
To expedite the review and approval process for over-the-counter
sun care, the US Food and Drug Administration issued new guidelines this week,
outlining the data required to demonstrate that sun care ingredients are
generally recognized as safe and effective...