Building a better health-care system for older Canadians

As a youth, Andrew Costa remembers feeling frustrated with Canadian health care.

He watched as his beloved grandparents were misdiagnosed and underserviced by doctors and specialists.

His faith in the system further diminished when, as an undergraduate university student volunteering in an emergency department, he saw older adults languishing in the waiting room with non-urgent health needs.

As McMaster University’s inaugural Schlegel Research Chair in Clinical Epidemiology and Aging, Costa uses data from home care, long-term care, hospitals and emergency departments, to understand how the health-care system is responding to the needs of older adults, as well as to develop better models of care.

“When I was young, I had the impression the health-care system was held together by glue and masking tape,” he says. “Still today, I believe there has to be a better way, especially for the aging population. We don’t seem to be prepared and there is a lot of room for improvement through innovation.”

A current project garnering attention among his peers and the public is the DIVERT-Care trial. The initiative is one of the largest home care trials in Canada. Working in concert with health-care professionals in regions of Ontario, Newfoundland and B.C., Costa is looking to understand why many older home care patients end up in emergency waiting rooms.

He will be recommending changes so older adults get the care they need at home.

“We don’t have a solution for home care patients that need acute care, and the hospital emergency department is too often the default,” he says. “The idea for the DIVERT-Care trial is that we have things in place where we can care for older adults in their home environment. If cost-effective, I expect that this study will influence practice, policy and funding in the community sector for some time.”

Samir Sinha is the director of geriatrics at the Sinai Health System and the University Health Network Hospitals, and he has known Costa for six years. Both are members of the interRAI Collaboration, a network of researchers and practitioners in more than 35 countries committed to improving care for people who are disabled or have medically complex conditions.

He says Costa’s ability to focus on both the system and the solutions makes him an agent for social change, especially when it comes to the DIVERT-Care trial and its predecessor, the DIVERT Scale screening tool.

“Home care agencies have been lining up to pilot this tool and restructure the way they organize their services to be more responsive to these clients identified as being particularly at risk,” Sinha says.

“His work is also being further supported with research grants to further evaluate its use in settings across Canada. I firmly believe that Andrew’s work will really revolutionize the way home care service for complex older patients is organized in the near future, and that is nothing short of remarkable.”

Costa’s hometown is Cambridge, Ont. He completed a BSc (Honours) in Health Science and a PhD in Aging, Health and Well-being at nearby University of Waterloo. He then served as a Canadian Institutes of Health Research (CIHR) postdoctoral fellow at the Institute for Clinical Evaluative Sciences at Sunnybrook Health Sciences, Mount Sinai and the University of Toronto.

Costa joined McMaster faculty in 2014. He holds a number of titles at the university, among which include assistant professor in Health Research Methods, Evidence and Impact; associate member in the Department of Medicine and member of the McMaster Institute for Research on Aging.

He’s also the research director at the Michael G. DeGroote School of Medicine Waterloo Regional Campus, where he is implementing innovative approaches in medical education as it applies to older adults.

Costa notes that by 2020, most physicians can anticipate that at least 30 per cent of their outpatients, 60 per cent of their inpatients, and 95 per cent of their continuing care patients will be aged 65 and older.

“If we are going to have any sort of systematic change, it has to start with the way we train health-care providers,” he says. “Older adults are different physically, emotionally and socially from adults. They also have multiple diseases interacting.”

Costa is also the founder and driving force of the Big Data and Geriatric Models of Care Research and Education Cluster at the Waterloo Regional Campus. The cluster is a collection of scientists and clinicians that use ‘big data’ to inform and evaluate better models of care for older adults in communities across Canada. The focus is on community care, emergency care, hospitals, and long-term care.

He says time is of the essence to ensure older patients receive the care they need.

“We haven’t even seen the full impact of aging Canadians on the health-care system,” he says. “The baby boomers are just set to retire and we don’t have the table set for them to come into the health-care system in the way that we would like.”

Costa’s work has been recognized with a Rising Star Award from the CIHR Institute of Health Services and Policy Research and an Age+ Prize from the CIHR Institute of Aging. While his focus is primarily on older adults in Canadian health care, he has a broad understanding of the issue through trials and partnerships with researchers in other countries around the world.

Costa’s thriving research career is mirrored with a busy personal life. He and his wife, Leah, spend much of their free time keeping up with their young daughter, Ella.