Summary of research program
The Solidage and Prisma teams are combining forces to propose a unified research program addressing two issues of primary importance for health authorities in Canada. The first issue is concerned with frailty in the elderly population. The second issue deals with the consequences of frailty in the elderly population for the organization and management of health and social care. Thus, our research program is oriented toward the understanding of the process of frailty in elderly populations, and toward the development of managerial and clinical tools adapted to integrated social and health care delivery in clinical practice.
The frailty concept has stimulated the interest of both clinicians and researchers because it appears to improve our understanding of the aging process and the heterogeneity of the health and functional status of older persons. It provides a conceptual basis to move away from the organ by organ approach to an integrative one. Traditionally, the classification of older persons has been based on comorbidity, some measure of mental status, and the level of disability. This approach misses a large proportion of the older functionally independent population in whom frailty markers can be identified and who are in fact vulnerable for adverse health outcomes and for increased utilisation of health services. The ability to understand the heterogeneity of the older population and to identify vulnerability in a more sensitive way may provide opportunities for the development of population health and clinical approaches, new organizational models of care and innovative management practices.
The program has three main objectives:
- 1) to understand the nature, prevalence, incidence, profiles, trajectories, predictors and consequences of frailty
- 2) to promote the implementation of integrated care for the frail elderly through the modification of professional practices and the development of patient assessment tools
- 3) to develop programs and implementation strategies to enhance the use of population health evidence, managerial and clinical tools within integrated social and health care organizations.
The general strategy for achieving the three research objectives is based on several different approaches including the collection of new data, secondary data analysis and quantitative and qualitative methodologies. The six research questions specific to the program are:
- What are the domains of frailty and how do they predict adverse outcomes?
- What are the prevalence, incidence and profiles of frailty in Canada, and how do they affect the development and planning of services for frail elderly persons?
- What are the utilization patterns and costs of health and social care associated with frailty?
- What are the conditions that foster or inhibit the adoption of planning and budgeting tools, organizational methods, and collaborative practices designed to improve the efficacy and effectiveness of integrated care for elderly persons?
- What level and range of services should be defined for particular profiles of care needs in frail elderly persons?
- How can the knowledge exchange and transfer process between the research team and the partners be maximized?
The research team will work with partners from ministerial, regional and local health and social care authorities, with public health authorities and with representatives from an elderly persons organization. The collective knowledge and experience of the researchers and their partners will be used to develop health and social care at the local, regional and provincial levels. Thus, decision-makers involved in integrated systems of care, representatives of the elderly population and their caregivers, along with researchers experienced in the study of frailty, are brought together to work toward the collective goal of developing appropriate, effective and efficient systems, programs and clinical interventions.
The program is also relevant to the health reform initiatives in many Canadian provinces with its emphasis on population health and tools for integration of care. The issue in many jurisdictions is no longer whether to integrate, but rather on how to integrate. Our research program and knowledge exchange and transfer strategy are directed towards Canadian health and social services as a whole. Additionally, one component of the program, the study of frailty in the populations of different countries, allowing the diversity of the trajectories, antecedents and consequences of frailty to be more fully captured, will be of international interest.