The healthcare system is wrestling with the impact of demographics on demand for care. We hear anecdotally of heightened patient acuity and increased prevalence of chronic disease. Southlake is a leading healthcare organization serving the northern York Region and southern Simcoe County. We have analyzed all in-patient data over the last four years and observed massive increases in multi-comorbidity levels in older in-patient cohorts. This article will review the analysis and highlight the impact of this phenomenon on critical areas of hospital operations such as patient flow, care transitions and cost. It will also review the medical management implications of increased chronic disease prevalence in this patient population. Finally, we share a series of initiatives that have been successful in helping the hospital respond to these challenges. We believe these are relevant for acute hospitals and their community-based partners across Canada.

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