1. There Exists no National Standards, Guidelines or Consensus Around what Appropriately Meeting the Needs of Older Canadians Should Encompass
Although there is a pressing need, we still do not have a national consensus as to what ‘good’ looks like as it relates to what we will feel represents a society that is ‘ageing well’ or around the optimal delivery of care, services and supports for older adults and those who care for them. Indeed, especially when it comes to defining quality care for older adults, we find that even our existing clinical practice guidelines or practice standards rarely take into account the challenges that many older Canadians living with multiple chronic diseases and functional limitations currently face and can even be conflicting at times.1,2 A lack of national standards, guidelines or consensus around what appropriately meeting the needs of older Canadians should encompass means that it is difficult to hold systems, providers and citizens accountable to themselves and others.
2. You Cannot Monitor and Improve What You Can’t or Don’t Measure
At the same time that we don’t know what ‘good’ looks like, it’s clear that we are unable to measure and monitor our ability to achieve our aims. Measurement is a key enabler for allowing organizations, systems, as well as the public to assess and understand their overall performance and progress towards achieving their aims. While this sounds straightforward, we know it is also very important to be thoughtful around what we choose to measure, as there can easily be unintended consequences to measuring one outcome measure over another.
A great body of research from the United Kingdom has repeatedly demonstrated that the drive to achieve and demonstrate improvement in government selected indicators for health system performance around areas such as wait times, also created a number of unintended consequences related to ‘gaming’ the overall system that sometimes led to the worsening of other un-monitored outcomes.3 This is why it’s important to design a set of measures that can provide a ‘balanced’ view of system performance as well.
Finally, in choosing what we will measure, we need to ensure that the metrics and indicators that we end up selecting reflect our aspirations towards achieving standards of health and well-being for older adults and the future provision of care, services and support. For example, as it relates to the future care of older adults, we will want to ensure we have measures and indicators that better reflect our ability to deliver more integrated and community-based care that today’s older and increasingly diverse Canadians want and need.
3. Our Current Research and Innovation Priorities are not Routinely Focused in the Right Areas
The bulk of current research and innovation initiatives are still focused on the old ways of delivering services and care, often forgetting about the growing heterogeneity of our overall population, let alone the growing challenges of effectively meeting the needs of an ageing population.
With a growing recognition that the increasing numbers of older adults in our society are not just more ‘chronologically mature’ but are also increasingly living with growing rates of hearing, visual, cognitive and functional limitations – it is clear that traditional approaches to developing research and innovation initiatives for them must better reflect their increasingly diverse needs. Indeed, the way we will need to deliver services, care and support for older Canadians will have to occur in ways that often requires a more complex, nuanced, multi-sectoral and context-specific approaches. This will necessitate different research methodologies and approaches to develop and evaluate new and more effective ways of delivering services, care and support. Ensuring that our future research and innovation activities are more inclusive of the intended users in the design, implementation and evaluation phases will further help to ensure their chances of being successful as well.