What Are the Issues?

1. There Are No National Standards, Guidelines or a Consensus Around What Appropriately Meeting the Needs of Older Canadians Should Encompass
   

   Although there is a pressing need, there is no national consensus as to what represents a society that is ‘ageing well’ or providing ‘optimal delivery’ of care, services and supports for older adults and those who care for them. This is includes how quality care for older adults is defined – the existing clinical practice guidelines and 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.[3]^,[4] A lack of national standards, guidelines, or a consensus around what appropriately meeting the needs of older Canadians should encompass means that it remains 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
   

   Measurement is a key enabler in 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, what is being measured must be carefully considered, 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.[5] This is why it is important to design a set of measures that can provide a ‘balanced’ view of system performance as well.

   Finally, in choosing what is measured, metrics and indicators selected must reflect aspirations towards achieving standards of health and wellbeing for older adults and the future provision of care, services and support. For example, as it relates to the future care of older adults, measures and indicators must better reflect the ability to deliver more integrated and community-based care that today’s older and increasingly diverse Canadians want and need.

3. 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, and do not address the growing heterogeneity of the population, let alone the growing challenges of effectively meeting the needs of an ageing population.

   An increasing number of older adults 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 delivery services, care, and support for older Canadians requires a more complex, nuanced, multi-sectoral and context-specific approach. This requires different research methodologies and approaches to develop and evaluate new and more effective ways of delivering services, care and support. Ensuring that 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.

Evidence-Informed Policy Options

1. Establish a Framework for the Development, Collection and Reporting of Enabling Performance Measures and Indicators That Can Promote Shared Accountability in Advancing a National Seniors Strategy
   

   A considerable amount of literature is devoted to lists of indicators that are or could be measured around assessing the health and well-being of older adults, or the provision of care, services and support for older adults. In some areas, no widely accepted measures have been established. Therefore, in order to enable a National Seniors Strategy, the federal government should convene and facilitate the creation of a framework for the development of common metrics and indicators to help monitor progress around common initiatives established to enable the health and well-being of older Canadians.

   Within the domains of health care, these metrics and indicators should focus around the delivery of care, services, and supports across the entire continuum of care, with a particular emphasis on metrics that can assess system integration and transitions. The framework should also encompass metrics that can monitor the different perspectives that providers, individuals, and their caregivers may have.  The early work that the Canadian Institute for Health Information (CIHI) has been leading on behalf of the federal government with the support of Canada’s provinces and territories in the creation of some common home and community care metrics is a positive example of cross-jurisdictional collaboration to measure progress around common national aims. [6]

   As noted above, the federal government has already established agencies such as the CIHI, Statistics Canada and others to collect and analyse information and data relevant to Canadians as a whole. Therefore, these organizations in particular could be given a clear mandate to not only collect data, but also report it back in ways that can allow all levels of government, researchers, health professionals, and members of the public to promote a shared or mutual sense of understanding and responsibility for ensuring that established performance targets are achieved.

2. Consolidate and Scale Research and Innovation Activities to Improve the Health and Well-Being of Older Canadians

   In recognizing the demographic and fiscal challenges and opportunities that will come with an ageing population, there remains a clear opportunity to invest further in research and innovation projects that better address current and future issues. While a number of large funding initiatives (e.g. Canadian Institutes of Health Research (CIHR) Institute of Aging, AGE-WELL Networks of Centres of Excellence (NCE), Canadian Frailty Network (CFN), National Initiative for the Care of the Elderly (NICE) have been created to conduct ageing-related research and knowledge-translation projects, greater consolidation would help to advance learning and the spread of innovations. Opportunities should be maximized to invest in research and innovation activities that support ageing. For example, the Government of Canada’s Advisory Panel on Healthcare Innovation’s report Unleashing Innovation: Excellent Healthcare for Canada emphasizes clear opportunities to help focus, consolidate, fund and most importantly, scale innovations that can better address ageing, equity and sustainability for all Canadians.[7]