The Aging Shock: Why Quebec ERs Are Overwhelmed by 75+ Patients

A Disproportionate Presence on Stretchers

Patients aged 75 and over are not just more numerous in emergency rooms - they consume resources out of proportion to their share of total visits. According to the MSSS reference framework^[1], in 2022-2023, these patients accounted for 14.9 % of all ER visits, but 30.3 % of stretcher patients - double their weight in total ER traffic.

This over-representation has direct consequences on wait times. Among 75+ patients on stretchers, 37.2 % waited more than 24 hours; 12.4 % waited more than 48 hours^[1]. And when they arrive at the ER, approximately half are subsequently hospitalized - regardless of their initial triage priority^[1].

Time spent on a stretcher is not just an administrative figure: it carries measurable clinical consequences. A study published in JAMA Internal Medicine based on a French cohort found that spending a night on a stretcher increases the risk of in-hospital death for elderly patients by nearly 40 %^[7]. Meanwhile, according to the Canadian Institute for Health Information, more than 40 % of hospitalized seniors in Canada in 2023-2024 were at risk for frailty - a condition associated with stays three times longer and a readmission rate twice as high^[8].

Montreal's Suburbs: A Double Demographic Penalty

The pressure from 75+ patients is not evenly distributed across Quebec. It concentrates in the regions aging fastest - and precisely where ERs are already most congested. By 2041, according to Institut de la statistique du Québec projections, the population aged 65 and over is expected to grow by 80 % in Laval, 27 % in the Laurentians, and between 22 and 25 % in Lanaudière^[2].

These are exactly the three regions with the highest overcrowding rates in Quebec in 2025-2026: Laval at 32 %, Laurentides at 31.4 %, Lanaudière at 26.6 %. In January 2025, stretcher occupancy rates reached 173 % in Laval and 156 % in the Laurentians^[4]. According to Santé Québec, patients arriving at ERs are now "often sicker, older, and have more complex needs"^[4].

Between 2021-2022 and 2025-2026, the number of 75+ patients in Quebec ERs grew from 449,000 to 582,000, a 29.6 % increase - versus 15.9 % for all visits. This acceleration is structural: Quebec counted 21.1 % of its population aged 65 and over as of July 1, 2024, up from 9 % in 1981^[2]. By 2031, that share is projected to reach 25 %^[2].

When the ER Becomes the Only Option

Aging alone does not explain overcrowding. It amplifies it, on ground already weakened by insufficient primary care and home support. In 2023, Quebec's home support system covered only 10.7 % of actual needs: 25.4 million hours delivered out of 234 million required^[9]. More than 16,600 people were waiting for a first service in 2023-2024^[9]; 3,500 seniors were waiting for a CHSLD placement; 700 private senior residences have closed since 2018^[5]. Every door closed upstream eventually opens at the ER.

By 2035, support needs for Quebec seniors will rise from 289,000 to 400,000 people - a 38 % increase^[5]. Without additional home care and residential capacity, a growing proportion of those 111,000 extra people will end up in ER corridors - contributing to the 430,000 patients who left Quebec ERs without care in 2024, the highest rate in Canada^[6]. Two in ten returned within 48 hours.

What the Data Does Not Show

The overcrowding rate we measure - the share of stretcher patients waiting more than 24 hours - does not capture wait times before seeing a professional, nor patients who leave without being seen. The 75+ visit figures (449,000 to 582,000) come from the MSSS cumulative file; 2025-2026 data is partially provisional.

The JAMA study cited is based on a French cohort, not a Quebec one: it illustrates a clinically plausible mechanism but does not constitute a direct measure of mortality in Quebec ERs. ISQ projections cover 65+ rather than 75+ specifically - the trend holds, but the magnitudes are not directly transposable.