PRINCIPLES FOR MEDICAL CARE OF OLDER PERSONS

1. Access to health services

Like all people, older persons in all parts of Canada should have timely access to medical and supportive health care services that are clinically appropriate and delivered in the appropriate setting. This includes:

• rapid access to primary medical care;

• access to a full range of medical, surgical, diagnostic, treatment and rehabilitative services and

• access to specialized programs designed to address physical and mental problems experienced by older persons.

Access to an acceptable standard of clinical care should not be denied on the basis of age or disability.

2. Health promotion and illness prevention in the care of older persons

Health promotion and disease and disability prevention should be integrated into the medical care of older people. Proven preventive measures for specific conditions should be offered at primary, secondary and tertiary levels of care. Strategies demonstrated to promote well-being, maximize functional independence and minimize disability and dependency should be emphasized.

Promotion and prevention strategies should also be directed towards family caregivers to enhance their caregiving capacity and their quality of life.

3. Particular needs of frail elderly persons

The "frail elderly" are those older persons with multiple interactive, acute or chronic health problems compounded with functional and/or cognitive impairments and the need for supportive care. To achieve optimal health outcomes and quality of life and to minimize inappropriate use of resources, these elderly persons should have rapid access to an integrated range of specialized medical and other health care services.

4. The health care team

High quality medical care of older persons requires an integrated system of care that includes, but is not limited to:

• the primary care physician;

• medical and geriatric specialists, including geriatric psychiatrists;

• community-based health care professionals and support services and

• the patients' families and caregivers.

To serve their older patients, physicians require access to a range of acute, rehabilitative, long-term care facilities and palliative care services.

5. Effective planning for geriatric services

Those planning for the health care needs of our growing aging population should:

• urgently respond to the changing demography;

• address access issues created by geographic isolation;

• apply the findings of relevant health care research;

• ensure that older persons and their families are involved in the planning process;

• ensure that caregivers are also involved in the planning process;

• pilot new strategies and evaluate and refine them prior to implementation;

• continuously evaluate to determine optimal methods of service delivery;

• be responsive to linguistic and cultural diversity;

• remain open and flexible to innovation and

• ensure that adequate human resources are available to provide medical care to older persons.

6. Serving people in all regions of Canada

Innovative strategies are required to provide geriatric expertise to practitioners in remote and rural areas. Regular outreach services by geriatric specialists, telemedicine case conferencing and telephone consultations to specialists in urban settings are some of the strategies that should be supported. Practitioners, especially those in rural areas, should be supported in maintaining and enhancing expertise in the care of the elderly.

7. Ethical issues in the care of older persons

The ethical principles of respect for persons, autonomy and justice should inform all aspects of medical care of older persons, from systems planning to institutional policies to interactions at the bedside. The special needs of older persons in the following areas should be given particular attention:

• providing the information required for informed consent to medical procedures;

• determining competency to make decisions about medical care;

• determining an appropriate proxy for those who are not competent to make such decisions;

• resolving conflicts between providers of care and those receiving care, or their proxies;

• safeguarding privacy and confidentiality and

• withholding and withdrawing life-sustaining treatment.

8. Legal issues in the care of older persons

There are important legal issues to consider with respect to the medical and other health-related care of older persons. As with ethical considerations, the law should adequately and appropriately protect the interests of older persons at all levels of health care policy and services.

Areas that should be legally recognized and provided for include, but are not necessarily limited to, the following:

• enabling capable individuals to plan in advance their care and make their preferences known to their families, physicians and care providers through "living wills" or other forms of advance directive;

• empowering a previously designated or appointed proxy decision-maker to consent to health care for persons who are incapable of giving consent;

• ensuring that those individuals who are unable to consent to health care due to mental incapacity have timely, adequate access to needed health care;

• protecting vulnerable persons from those acting against their best interests or against their previously expressed wishes and

• ensuring that individuals are protected against policies or practices that unjustifiably discriminate with respect to access to and receipt of quality health care services.

Health care providers should be aware of the legal requirements governing themselves and the health care facilities/institutions within the jurisdictions in which they practise.

9. Education in the care of older persons

Education of the public, patients, their families and care-givers and physicians and other health care personnel in issues related to health care of older persons should be supported by professional associations and ministries of health. In particular, there is a need for accurate and comprehensive information on:

• aging processes and how they affect individuals;

• how individuals may maintain and improve their health;

• disease processes common in older persons and how they may be prevented, treated and managed;

• the need to tailor interventions to specific individuals (e.g., doses of medication);

• the benefits and risks of all health interventions including traditional and alternative therapies and

• resources available to address the range of health and social issues affecting older persons.

10. Research in the care of older persons

Research to improve the health of older persons should be promoted and supported. This includes, but is not limited to:

• health promotion and disease and disability prevention;

• basic research into disease process;

• studies of efficacy of treatments in individual patients;

• evaluation of pharmacotherapy (new and old) and pharmaco-economics;

• longitudinal studies of the natural history of chronic conditions;

• gender and cross-cultural issues in aging;

• how new information is best disseminated and incorporated into practice;

• ethical issues of late life and end of life and

• palliative care.