Study identifies gaps in primary health care for seniors with multiple chronic conditions

The number of health care services seniors use is determined more by the number of chronic conditions they have than by their age, according to a new study from the Canadian Institute for Health Information (CIHI). The study found that older seniors (85 and older) with no chronic conditions made less than half the number of health care visits as younger seniors (65 to 74) with three or more chronic conditions, such as diabetes, hypertension and heart disease.

CIHI's study Seniors and the Health Care System: What Is the Impact of Multiple Chronic Conditions? examines how seniors not living in institutions access health services and what kind of care they receive. According to the study, three out of four Canadians age 65 and older reported having at least one chronic condition, while one in four seniors reported having three or more.

Among the study's key findings:

• The 24% of seniors who reported living with three or more chronic conditions were responsible for 40% of health care use among Canadian seniors.
• Seniors with three or more chronic conditions reported using three times as many health care services as Canadians age 65 and older with no chronic conditions. Those with three or more chronic conditions also reported more than twice the rate of visits to a family doctor as seniors with only one chronic condition.
• Similar patterns of health care use existed among adults age 45 to 64; those with three or more chronic conditions made six times as many health care visits as those with no reported conditions.
• Seniors with three or more chronic conditions made three times as many visits to emergency departments as seniors with no reported chronic conditions.

"Our study shows that the presence of chronic conditions has a much higher impact on our health care resources than age alone. And with rates of diabetes and hypertension on the rise in Canada, the prevalence and resulting economic burden of these conditions is expected to increase as the population ages," explains Jeremy Veillard, Vice President of Research and Analysis at CIHI. "However, while the risk of developing chronic conditions increases with age, good primary care plays a strong role in managing them and even possibly delaying or preventing their onset."

CIHI's study findings are based on the 2008 Canadian Survey of Experiences With Primary Health Care, conducted by Statistics Canada and funded by CIHI and the Health Council of Canada, which surveyed adults not living in institutions or remote areas. The 11 common chronic conditions included in the study are arthritis, asthma, cancer, chronic pain, depression, diabetes, emphysema or chronic obstructive pulmonary disease, heart disease, high blood pressure, mood disorders other than depression and stroke.

The study found that Canadian seniors with three or more chronic conditions reported taking an average of six prescription drugs regularly, twice as many as seniors with only one chronic condition. Seniors with chronic conditions regularly taking at least five prescription medications were more than twice as likely to experience a side effect requiring medical attention (13%) as those taking only one or two prescription medications (6%). Yet less than half of seniors with chronic conditions reported that their doctor reviewed their medications (48%) and explained potential side effects (47%) at least some of the time.

"Seniors who are taking a large number of drugs face not only the risk of side effects from negative drug interactions but also the possibility of not taking their medications as directed," says Dr. Bill Hogg, Research Director of the C. T. Lamont Primary Healthcare Research Centre at the Élisabeth Bruyère Research Institute at the University of Ottawa. "Strategies to reduce the number of medications a senior is prescribed, when possible, can result in better compliance with medication regimens and lead to a better quality of life."

Reducing gaps in preventive care could lead to fewer health care visits

While the majority of seniors reported having a family physician, only two out of five (42%) reported that at least some time in the past year they had talked with a health professional about what they could do to improve their health or prevent illness (including quitting smoking, increasing exercise or limiting alcohol consumption). The results were similar for tomorrow's seniors, as only 45% of adults between the age of 45 and 64 spoke with their health care provider about things they could do to improve their health.

"As Canada's population ages, it is natural to assume that the prevalence of chronic conditions will increase," says Greg Webster, CIHI's Director of Primary Health Care. "Efforts to better understand the relationship between the management of chronic conditions and health care use can lead to better preventive care, which will result in healthier seniors and reduced costs to the system."