The COVID-19 pandemic has seen health-care systems around the world crippled by overburdening, which is now compounded by a mass exodus of personnel due to vaccination refusal. Many countries have mandated vaccination for health-care workers, with those refusing left without a job. After this mandate went into effect in France in September, 2021, 3000 health-care workers were suspended for not complying. Although this affects all health-care sectors, this sudden dearth of employees has taken a particular toll on the care of older adults—an already underfunded sector plagued by high staff turnover and access barriers for patients. The UK mandate of double jabs for all care home employees, with a deadline of Nov 11, 2021, is expected to result in approximately 50 000 vacancies, leading not only to diminished care of existing residents but to an inability in accommodating referrals from primary care.
However, the crippled health-care systems cannot simply be restored by addressing depleted resources and staff shortages in the immediate aftermath of the pandemic. Instead, we must recognise that changing demographics require a broader overhaul of health-care models. Older adults have complex needs, driven by age-related syndromes, such as a frailty, and by age-related issues, such as multimorbidity. As these issues are not simply additive but synergistic, interacting with each other, as well as strongly influenced by the socioeconomic and environmental experiences of each patient, they cannot be addressed in isolation but must be viewed within a holistic framework. Our current models of care are heavily disease-focused, targeting specific body systems, and, like many aspects of our society, are therefore disproportionately tailored to younger people and focused on restoring people to an idealised state of health. There is little or no provision for ensuring chronic disease management and maximising quality of life. The inadequacy of current health-care systems in managing the complex needs of older patients is mirrored in the very clinical trials that inform treatment regimens, in which adults with multimorbidity are largely excluded.
Health-care systems must recognise the heterogeneity of older populations and shift to greater patient-focused care. The 2018 WHO report on Integrated Care for Older People set out guidelines for adapting health care to population ageing. A key aspect is the need to supplant current fragmented care systems with integration across different areas of both health care and social care, with primary care playing a central role from which referrals to other services can branch out. Harnessing lessons from the pandemic, the British Geriatrics Society published Ambitions for change: Improving healthcare in care homes in August, 2021. The report calls for sweeping policy changes to equip care homes, which will continue to experience an increase in admissions, with the resources for on-site care to prevent referrals to hospital. More broadly, it urges for a transition to personalised and integrated health care for older people, with a focus on recognising each patient's individual needs and correspondingly developing individualised care plans that empower patients to voice their own preferences and goals. This revamped approach to geriatric care is, in part, achieved by routine Comprehensive Geriatric Assessments, tailored skill sets in the workforce, and greater use of digital technology. Digital technology not only has the potential to facilitate access to diagnostics and treatment, for example via telemedicine, but can also promote integrated services; a key barrier to integration is the lack of routine data collection and data linkage across sectors, with data on care home residents especially scarce. Capitalising on electronic health records, stored within a central and shared dataset, could alleviate strain on a single sector, enhance communication between health and social care, and, ultimately, provide the optimal care for older patients.
The deficiencies of health care, particularly in geriatric care, have already been recognised and have prompted several changes, reflected in the increasing presence of advanced clinical practitioners in care homes and the use of care navigators to support patients with multiple needs in navigating fragmented systems and identifying appropriate services. Although important, these changes are crutches for antiquated health-care systems that no longer reflect our global populations. As we come out of the pandemic and adjust to a new normal, we must harness the opportunity to not only rebuild but reconceptualise our models of care.