The continuing evolution of family practice services to the elderly in Canada.

The number of elderly individuals in Canada is increasing rapidly and thus producing a major change in the health-care needs faced by the Canadian health-care system. Continued escalation in the cost of institutional care is imposing a severe constraint on that type of medical service. At the same time it is becoming clear that the preservation of the family and continued accommodation within the home are major positive factors in the quality of life of all Canadians, especially elderly Canadians. The present health-care system has three major modes of service: the clinic, the hospital bed, and the nursing home bed. In future there will be development and expansion of home-care/home-support services which are affordable, accessible, adaptable, comprehensive, continuous and well co-ordinated. There will be increased out-patient access to the complex diagnostic and therapeutic tools and services necessarily located at hospitals. This involves changes in the institutional priorities of hospitals, and an increase in the co-ordination of services for non-admitted patients. The family physician has an important role in the planning of medical services in Canada as it adapts to changes in demography, resources and knowledge. The needs of Canadians must continue to be the major determinant of the way the health-care system continues to evolve.