Health System Use by Frail Ontario Seniors An in-depth examination of four vulnerable cohorts November 2011 Health System Use by Frail Ontario Seniors An in-depth examination of four vulnerable cohorts Editors Susan E. Bronskill, PhD Ximena Camacho, MMath Andrea Gruneir, PhD Minnie M. Ho, MHSc November 2011 Health System Use by Frail Ontario Seniors ICES II PUBLICATION INFORMATION Canadian Cataloguing in Publication Data How to Cite This Publication Published by the Institute for Clinical Evaluative Health System Use by Frail Ontario Seniors: An The production of Health System Use by Frail Ontario Sciences (ICES) In-Depth Examination of Four Vulnerable Cohorts. Seniors was a collaborative venture. Accordingly, to give credit to individual authors, please cite individual © 2011 Institute for Clinical Evaluative Sciences ISBN: 978-1-926850-21-4 (Online) chapters and title, in addition to editors and book title. All rights reserved. No part of this publication may be Institute for Clinical Evaluative Sciences (ICES) Bronskill SE, Corbett L, Gruneir A, Stevenson, reproduced, stored in a retrieval system or transmitted G1 06, 2075 Bayview Avenue JE. Introduction. In: Bronskill SE, Camacho X, Gruneir A, in any format or by any means, electronic, mechanical, Toronto, ON M4N 3M5 Ho MM, editors. Health System Use by Frail Ontario photocopying, recording or otherwise, without the Telephone: 416-480-4055 Seniors: An In-Depth Examination of Four Vulnerable proper written permission of the publisher. www.ices.on.ca Cohorts. Toronto, ON: Institute for Clinical Evaluative The opinions, results and conclusions included in this Sciences; 2011. report are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences (ICES) or the Ontario Ministry of Health and Long-Term Care (MOHLTC) is intended or should be inferred. III ICES Health System Use by Frail Ontario Seniors AUTHORS’ AFFILIATIONS Minnie M. Ho, MHSc Epidemiologist, Institute for Clinical Evaluative Sciences Susan E. Bronskill, PhD Scientist, Institute for Clinical Evaluative Sciences / Jeffrey W. Poss, PhD Assistant Professor, Department of Health Policy, Assistant Research Professor, Department Management and Evaluation, University of Toronto of Health Studies and Gerontology, University of Waterloo / Adjunct Scientist, Institute for Clinical Ximena Camacho, MMath Evaluative Sciences Epidemiologist, Institute for Clinical Evaluative Sciences Jacqueline E. Stevenson, BA Laura Corbett, PhD Research and Communications Assistant, Institute Health Policy Consultant for Clinical Evaluative Sciences Sudeep S. Gill, MD, MSc, FRCPC Walter P. Wodchis, PhD Associate Professor, Departments of Medicine Associate Professor, Department of Health (Geriatric Medicine) and Community Health and Policy, Management and Evaluation, University of Epidemiology, Queen’s University / Adjunct Scientist, Toronto / Research Scientist, Toronto Rehabilitation Institute for Clinical Evaluative Sciences Institute / Adjunct Scientist, Institute for Clinical Andrea Gruneir, PhD Evaluative Sciences Scientist, Women’s College Research Institute / Assistant Professor, Department of Health Policy, Management and Evaluation, University of Toronto / Adjunct Scientist, Institute for Clinical Evaluative Sciences Health System Use by Frail Ontario Seniors ICES IV ACKNOWLEDGEMENTS Additional Support Funding Support This document is the product of many collaborative The authors also wish to express appreciation to This research was funded by the Ontario Ministry of efforts. The authors wish to acknowledge the the following people for their assistance: Health and Long-Term Care (Grant No. 04601AC). contributions of the following individuals at the David Henry (ICES), Larry Chambers (Élisabeth Bruyère Institute for Clinical Evaluative Sciences: Research Institute), John Hirdes (Ontario Home Care Research Network), Pat Stoddart (formerly Central Research Practice West Local Health Integration Network), Barbara Liu Jessica Leah, MPH (Regional Geriatric Program of Toronto), Georgina White Epidemiologist and Rod Millard (Ontario Association of Community Care Access Centres), Rebecca Comrie and Valerie Qi Li, MSc Hopson (formerly ICES), Grace Karam and Kathryn Analyst Mosley (Women’s College Hospital) and Deborah Sattler (Ontario Ministry of Health and Long-Term Care). Communications Susan Shiller, MSc Director, Communications Nancy MacCallum, MLIS Editor and Publications Coordinator V ICES Health System Use by Frail Ontario Seniors ABOUT OUR ORGANIZATION ICES clinically focused and useful in changing “ICES brings together the best and practice. Other team members have statistical The Institute for Clinical Evaluative Sciences the brightest talent across Ontario. training, epidemiological backgrounds, project (ICES) is an independent, non-profit organization Many of our scientists are not only management or communications expertise. that produces knowledge to enhance the The variety of skill sets and educational internationally recognized leaders effectiveness of health care for Ontarians. backgrounds ensures a multi-disciplinary Internationally recognized for its innovative use in their fields but are also practicing approach to issues and creates a real-world of population-based health information, ICES clinicians who understand the mosaic of perspectives that is vital to shaping evidence supports health policy development Ontario’s future health care system. grassroots of health care delivery.” and guides changes to the organization and delivery of health care services. ICES receives core funding from the Ontario Ministry of Health and Long-Term Care. In Key to our work is our ability to link population- addition, our faculty and staff compete for based health information, at the patient- peer-reviewed grants from federal funding level, in a way that ensures the privacy and agencies, such as the Canadian Institutes of confidentiality of personal health information. Health Research, and receive project-specific Linked databases reflecting 13 million of 33 funds from provincial and national organizations. million Canadians allow us to follow patient These combined sources enable ICES to have populations through diagnosis and treatment a large number of projects underway, covering and to evaluate outcomes. a broad range of topics. The knowledge that ICES brings together the best and the brightest arises from these efforts is always produced talent across Ontario. Many of our scientists independent of our funding bodies, which are not only internationally recognized leaders is critical to our success as Ontario’s in their fields but are also practicing clinicians objective, credible source of Evidence who understand the grassroots of health care Guiding Health Care. delivery, making the knowledge produced at Health System Use by Frail Ontario Seniors ICES VI TABLE OF CONTENTS 1 KEY FINDINGS 70 CHAPTER 5 / MEDICALLY COMPLEX HOME CARE CLIENTS II Publication Information 2 CHAPTER 1 / INTRODUCTION Profiling risk following acute III Authors’ Affiliations care hospitalization 6 CHAPTER 2 / OVERVIEW OF COHORTS IV Acknowledgements Definitions and study methodology 70 Introduction V About Our Organization 71 Methods 6 Introduction 73 Results V I I List of Exhibits 6 Population Definition 89 Conclusion 23 Measures 91 CHAPTER 6 / OLDER ADULTS NEWLY 29 CHAPTER 3 / OLDER WOMEN PLACED IN LONG-TERM CARE A look at gender differences An examination of service use and in health system use functional status during the wait 29 Introduction 91 Introduction 30 Methods 92 Methods 31 Results 93 Results 45 Conclusion 115 Conclusion 47 CHAPTER 4 / COMMUNITY-DWELLING 117 CHAPTER 7 / CONCLUDING REMARKS OLDER ADULTS WITH DEMENTIA Tracking encounters with the 1 1 8 APPENDICES health system 47 Introduction 48 Methods 49 Results 68 Conclusion VII ICES Health System Use by Frail Ontario Seniors LIST OF EXHIBITS Exhibit 2.10 / Observation and follow-up windows Exhibit 3.8 / Percentage of Ontario adults aged for the cohort of older adults newly placed in 76 and older with long-term care use in the year Exhibit 2.1 / Observation and follow-up windows long-term care following April 1, 2007 (baseline), by age group, for the cohort of older women sex and type of contact Exhibit 2.11 / Contribution of each Local Health Exhibit 2.2 / Contribution of each Local Health Integration Network in Ontario to the cohort of older Exhibit 3.9 / Prevalence of health conditions with the Integration Network in Ontario to the cohort of adults newly placed in long-term care, 2007/08 potential to limit functioning in Ontario adults aged older women, 2007 76 and older, by sex, 2007 Exhibit 2.12 / Distribution of adults aged 66 and Exhibit 2.3 / Distribution of Ontario adults aged older newly placed in long-term care by location at Exhibit 4.1 / Demographic and broad health status 76 and older by age group and sex, in Ontario and time of placement, in Ontario and by Local Health measures of Ontario adults aged 66 and older living by Local Health Integration Network, 2007 Integration Network, 2007/08 in the community, by sex and presence of physician- Exhibit 2.4 / Observation and follow-up windows diagnosed dementia, 2007 Exhibit 3.1 / Demographic and broad health status for the cohort of community-dwelling older adults measures of Ontario women aged 76 and older, overall Exhibit 4.2 / Number and relative percent of Ontario with physician-diagnosed dementia and by age group, 2007 adults aged 66 and older living in the