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Opinion How we deal with illness and ageing is painfully outdated

Our current model of healthcare was developed to deal with a very different world: one in which people did not survive long into old age and acute illness was the main cause of death.

THERE ARE TWO major issues facing the future of the Irish healthcare system.
The first issue is our ageing population. The CSO report on population and labour force projections predicts that the number of people aged 65 and over will more than double in the next three decades: going from 532,000 in 2011 to almost 1.4 million by 2046. It also predicts the number of people over 80 to triple in the next 30 years. This means greater strain on an already strained healthcare system.

The second, related, issue is a change in the disease profile of the population: chronic lifestyle disease (heart disease, diabetes, stroke, obesity, etc) is now the leading cause of mortality in the world. These are diseases caused by our behaviour and they require long-term ongoing management, rather than once-off treatment. According to the Irish Medical News, more than 50 per cent of the population already had more than two chronic diseases in Ireland in 2011 and it is estimated that chronic diseases account for 80 per cent of all healthcare costs. This is set to increase as chronic disease is more prevalent in the elderly.

The convergence of these issues calls for nothing short of a paradigm-shift in how healthcare is delivered in Ireland. Why?

Large hospitals designed to give urgent treatment

Well, our current model of healthcare delivery evolved to deal with a very different world: one in which people did not survive so long into old age and acute illness was the main cause of death. Thus, large hospitals were established to deal with the urgent or immediate treatment of diseases with a rapid onset, and a relatively short course. Illnesses such as pneumonia, small pox, and tuberculosis, for example, were among the leading causes of death in the early part of the twentieth century.

We developed a system of episodic care: patients were concerned with their health only when they got sick. We had a provider-centric system: one where doctors, working from a centralised hospital setting, played the role of paternalistic expert care-givers who treat patients to cure illness. Hospitals had the monopoly on expensive medical machinery and sterile environments.

The shift to chronic illness

However, the shift from acute to chronic illness, along with our ageing population, has called into question whether this model is the most efficient way of administering care. We need a greater focus on promoting health, rather than just treating illness. We need a shift towards prevention, ongoing management and more patient responsibility in healthcare. We need to move from a provider-centric system, towards a patient-centric system.

A patient-centric system shifts the focus of care from the centralised hospital to the patient and their home. It acknowledges that an ageing population and increasing chronic disease demands that the patient take a more active role in the day-to-day management of their health to avoid the onset of acute episodes.

Instead of the patient being a passive recipient of medical information, they will enter into a dynamic partnership with their doctors and become active participants in their health management.

But how do we make such a shift?

Digital and home healthcare technologies

One key to making this shift is by exploring the use of digital and home healthcare technologies. Digital innovations have now made it possible for consumers to use portable devices (such as their smartphone) to access their medical information, monitor their vital signs, take tests at home and carry out a wide range of tasks.

It is possible to remotely and continuously monitor fluctuations in heart beat, blood pressure readings, the rate and depth of breathing, body temperature, oxygen concentration in the blood, glucose, brain waves, activity, mood – all the things that make us tick. No longer does the hospital have the monopoly on useful medical technology.

All this information can then be communicated back to a doctor or nurse who can remotely monitor the patient and offer educational content, motivation and advice that may prevent the onset of more acute episodes.

These technologies have the potential to facilitate this paradigm shift by making it no longer necessary for patients to make an expensive trip to a hospital or doctors office to seek advice or update their healthcare professional about their health management.

Known as Connected health, such solutions have the potential to not only support current care delivery but also fundamentally change the model to a more efficient and sustainable one. Embracing this shift can help to reduce rising healthcare costs by offering a substitute for expensive – and increasingly scarce – professional labour (doctors, nurses, etc) and move away from the high-cost hospital institutions to patients own homes.

It is also consistent with the majority of patient preferences for more active, dignified ageing, where the elderly can have a greater level of independence, more involvement in their daily care decisions and can remain living at home for longer periods of time.

Health as a state of wellbeing

The Department of Health’s white paper on Universal Health Insurance has indicated that care of chronic disease will be part of the package paid for by the state. Further, the report indicates that should recognise health as a state of wellbeing and “not merely the absence of disease and infirmity” and that the delivery of care should be “safe, timely, efficient and as close to home as possible”.

These are welcome indications from the Department but for this change to occur it needs to be driven by the vision of all those involved: policymakers, healthcare providers, innovators, and patients. To achieve that consensus, we must all engage in the conversation.

Robert Grant has a PhD in Philosophy from Trinity College Dublin, where he is currently a tutor in Logic and the History of Philosophy. He is also research analyst at RelateCare. He blogs at robert-grant.squarespace.

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11 Comments
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    Mute me so harney
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    May 4th 2014, 12:50 PM

    It’s a vicious circle really – you make advances, people live longer, they then get sicker, you need to make more advances – and on and on it goes …

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    Mute Catherine Mill
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    May 4th 2014, 8:19 PM

    t’s a vicious circle really – you make advances, people live longer, they then get sicker, you need to make more advances – and on and on it goes …”

    That is the whole idea- and in the process money/profit is made from the human beings.
    It is not a health service.
    Its a medical mafia making massive profits from service users.

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    Mute Ben Gunn
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    May 4th 2014, 1:51 PM

    We could try redefining the purpose of the HSE. It should change it’s brief from merely treating the sick to concentrating on keeping people healthy.

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    Mute Aine Nibhern
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    May 4th 2014, 1:05 PM

    I see the author is from Trinity College. I really enjoyed the lecture in Trinity about the work of Viktor Frankl on Thursday. Frankl was a Psychiatrist, neurologist, Pholosopher and survivor of the concentration camps. He wrote “Man’s search for Meaning”.

    If I was to listen to mainstream Psychiatry and doctors, after an adverse reaction to an “anti-depressant” which I took for anxiety / panic, I would have turned my anxiety into a chronic “illness” due to the way people are treated when this happens. No one tells the truth about the drugs, with a few exceptions:

    A book written by medical journalist Robert Whitaker gives a clearer picture of what actually happened to me in this Capitalist world ~

    Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America ~ http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452425

    In my experience, the current approach to dealing with people in distress is disabling people, as opposed to enabling them. I’m speaking overall but realize there may be some who feel some benefit for mind altering drugs.

    One day I will have recovered from the drugs and the abuse of power. But with a very different perspective on life.

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    Mute Claire Margaret Guerin
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    May 4th 2014, 7:11 PM

    From the point of view of someone with a chronic illness, I agree with this and with the article. Health-care, especially where chronic illness is involved, has to be centred around the patient. Hardly a revolutionary concept – to quote William Osler from a century ago, “”Listen to your patient, he is telling you the diagnosis.” People with chronic illnesses just don’t fit in the emergency model, and basically get cut adrift. Your problem can’t be dealt with in the ten minutes you have to see the doctor? Good luck, and have fun as your illness sucks away your life for the next few decades.

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    Mute Aine Nibhern
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    May 4th 2014, 7:30 PM

    @Claire Sorry to hear that you have a chronic illness and I hope you are not suffering too much.

    “Listen to your patient, he is telling you the diagnosis”. That is the problem with mainstream Psychiatry. I was never listened to. They were too busy labeling and wondering what cocktail of drug I was best suited to. I went to the services/them looking for CBT and ended up with a “chronic” condition. It could have become chronic except that I woke up out of my drug induced haze. Even if about 3 to 5 years seemed to be stolen from my life.

    In my situation “anti-depressants” (which I took for panic) caused Manic Depression type symptoms. Which Psychiatry sees as a serious chronic illness.

    Once I saw the serious symptoms as mainly iatrogenic (caused by the treatment) and started to explore in my own mind what “Depression” is, I knew I could learn to overcome it. Or at least be in the situation where I am in control of any “highs” as opposed to the symptoms being in control of me. And if my mood dipped down there was usually a very good reason for it.

    “Depression is a person’s way of telling himself that something is seriously wrong and needs working through and changing. Unless this can be achieved, there will continue to be a mismatch between his lived experience and his desired experience, between the meaninglessness of everyday life and the innate drive to find meaning, to self-actualize, to be all that he can be. From an existential standpoint, the experience of depression obliges a person to become aware of his mortality and freedom, and challenges him to exercise the latter within the framework of the former. By meeting this very difficult challenge, he can break out of the cast that has been imposed upon him, discover who he truly is and, in so doing, begin to give deep meaning to his life”

    http://www.psychologytoday.com/blog/hide-and-seek/201205/mans-search-meaning

    Plus work on diet, lifestyle and relaxation. As well as addressing any underlying issues that may stem back to the past. My last hurdle is to try and restore sleep after all the drugs I was fooled into taking and damage done by them. A full nights sleep is something I dream about. I will get there.

    [Never stop or change prescribed psychoactive drugs without talking to a good doctor, due to the dangers of withdrawal]

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    Mute richard fallon
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    May 4th 2014, 11:00 PM

    @Aine, I agree 100%.

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    Mute Brenda Larkin
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    May 4th 2014, 9:13 PM

    After 50 years in the health services things are at an all time low when we should be on the crest. A curse of ill health on the politicians who allowed this situation to happen. There is no compassion from the “suits” especially in the HSE who have not a clue what it is like dealing with sick people. Robots in sterile offices all of them !!

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    Mute Paul Roche
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    May 4th 2014, 10:31 PM

    Paradigm shifts all round.
    With Apple building in health monitoring into the next version of iOS (and competing platforms mimicking their innovation) we shall see our devices becoming integral to our healthcare.
    What happens to the security of data and how health insurance companies will have access to data from these innovations will become crucial.

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    Mute gary banner
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    May 6th 2014, 7:19 PM

    Delighted to see that the article hasn’t been met with a call for euthanasia as a so called ‘humane’ solution to an age old problem :)……..

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    Mute Alan Clayton
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    May 4th 2014, 7:07 PM

    The answer is actually close at hand. Please take the trouble to meet http://www.healthfounders.com. Led by the amazing Johnny Walker, base in a docklands enterprise centre, the future of healthcare is being born. Seriously !

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