Sunnybrook Leads the Way: First Canadian Hospital to Achieve Age-Friendly Health System Status

All older adults deserve safe, high-quality health care that is based on what matters most to them as individuals, and delivered reliably in every setting. Sunnybrook Health Sciences Centre is leading the way in making sure that older adults receive age-friendly health care. Sunnybrook was recently named the first Canadian hospital to receive the Age-Friendly Health System designation from the Institute for Healthcare Improvement (IHI).

Sunnybrook’s patient population is comprised largely of older adults – with nearly 60% (58.4%) of our inpatients in 2023/24 being over the age of 65. Projections estimate that the population of adults over 65 in Ontario will increase by 23% by 2029 (Kralj and Sweetman, 2024). In anticipation of the growing number of seniors who will be accessing health care in the coming years, Sunnybrook has committed to Safe Senior Care among their top quality priorities for several years. The Sunnybrook Senior Friendly Team collaborates with leaders across the organization on quality improvement (QI) efforts shaped around the IHI’s four essential elements of an age-friendly health system, known as the 4Ms: What Matters, Medication, Mentation and Mobility.

• What matters: Sunnybrook has implemented training and education on Person Centred Language as part of a grant-funded study led by the Regional Geriatric Program of Toronto.
• Medication: Sunnybrook created Order Set Guidelines to be applied to all standardized order sets that undergo review at the organization. This ensures that senior friendly prescribing and antipsychotic stewardship best practices are incorporated on all order sets.
• Mentation: Sunnybrook has partnered with leaders at GEMINI to obtain quarterly reports of our delirium rates, to raise awareness and engage interprofessional teams across the organization in delirium reduction efforts.
• Mobility: Sunnybrook has established the regular audit & feedback of mobility data to patient care units to help support quality huddles and team discussions about enhancing daily mobility.
• Sunnybrook has invested in two Senior Friendly & Behaviour Support Specialists to collaborate with teams on advancing age-friendly best practices and other harm prevention strategies.
• Sunnybrook has created a portal to help patients, families, and clinicians learn how to prevent or reduce physical and mental decline while older patients are in the hospital.

Many interprofessional teams across the organization are also prioritizing safe and equitable care for seniors, through local quality improvement (QI) initiatives.

The Pharmacy department led practice-based projects with the support of pharmacy residents, to identify opportunities to improve medication use and safety in older patients. Camille Angle, a recent graduate of the pharmacy residency program, studied prescribing patterns of antipsychotics and subsequent continuation at discharge in hospitalized older patients who had never been on antipsychotic prior to admission. Leona Spasik, a current Sunnybrook pharmacy resident, is leading a research project to characterize prescribing of sedative hypnotics in hospitalized older adults and their appropriateness as aligned with Choosing Wisely Canada recommendations.

A QI project, led by Dr. Mark Woo and Dr. Meenakshi Gupta, and overseen by Dr. Mireille Norris, was implemented on a complex general medicine unit to increase awareness of the use of delirium order sets as a key intervention in the management and treatment of delirium. Daily identification of eligible at-risk patients at interprofessional rounds, and the design and dissemination of communication posters assisted in raising awareness and usage.

A TAHSN Practice-Based Research & Innovation Fellowship project (led by Occupational Therapist Stephanie Horner) implemented several process changes on a general medicine unit, to improve daily mobilization of patients and enhance sleep quality. Results indicated improvements the quality of patients’ sleep (patient feedback) and increased daily mobility on the unit.

New models of senior friendly care are also being evaluated, with the addition of Recreation Therapy one of the inpatient units, to compliment current interprofessional practices for safe senior care and delirium prevention. Recreation therapy provides meaningful support to individuals as they strive to improve their lives through leisure.

Learn more about Sunnybrook’s Senior Friendly care here.

Sunnybrook is honoured to achieve the Age-Friendly Health System Participant designation from the Institute for Healthcare Improvement. They are committed to continue to serve this patient population and are looking forward to implementing new projects to assist with these efforts.