Long-term care in developed countries and recommendations for Slovak Republic

The aging of our population represents a most significant demographic change. It represents important challenges and consequences for the nation's economic, social, and health institutions and for the health and well-being of older persons and their families. Old people over 60 are now the most rapidly growing segment of the population and represent 20% of all Slovak inhabitants. Because of the high prevalence of morbidity and disability among the elderly they are the most important consumers of health care and social care services, both extramural and intramural. Long-term care is a relatively closed system of health care and social care services. Initially, long-term care policies were formulated as a response to ageing of the population, which brought about growing needs of elderly people for social care and health care, and was associated with relatively rapid increases of necessary costs. All industrial countries are facing similar problems when it comes to the integration of long-term care. In developed countries, current long-term care focuses on all age groups in need of assistance and support from others due to the limitations caused by their state of health. Long-term care within the public services system does not exist in Slovakia.     

Health transition in Mauritius: characteristics and trends

This paper discusses the concept of health transition with particular reference to fast-modernizing and industrializing countries such as the island state of Mauritius. It displays many special characteristics of islands with respect to rapid demographic and epidemiological changes and the need for increasing services for chronic health conditions. Mauritius shows important levels of suicide, especially amongst the younger population. It also has an ageing population profile and there are growing needs for social support for urban and rural elderly residents. The distinctive persistence of traditional (alternative) sources of health care, which in Mauritius reflect the rich cultural and ethnic backgrounds of the island's inhabitants, are discussed. The paper concludes by identifying the need for new policies and expenditure for public health to enable the island to enhance health gain and to meet the challenges of health transition.     

Ageing in the South-East Asian region

The increasing trend in the aging population of countries in the South-East Asia Region (SEAR) transforms these countries from "mature societies" to "aging societies.? The elderly population in this region would be increasing from 18.1% in 1995 to 21.4% of the world elderly population in 2025. Since women have a longer life expectancy than men, the proportion of elderly women in the region would increase to 13.2% by 2025, while the proportion of elderly men would be 11.6%. In SEAR, 11.8 million people reportedly suffered from blindness in 1998; 50-80% of these cases are caused by cataract, which is most common in those aged 60 years and above. Although the aged is one of the most vulnerable population groups, little attention is given to geriatric care. Health services in many countries still focus largely on communicable diseases, maternal care, and child care, rather than on the enormous needs of the elderly population. Care of the elderly should be a priority of the primary health care system, focusing on the promotion of a healthy old-age lifestyle and prevention of behaviors that are hazardous to health.     

Forecasting the use of elderly care: a static micro-simulation model

This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).     

Elderly People and their lack of self-sufficiency: a socio-economic health challenge

Due to the current population ageing in developed countries, the number of seriously disabled elderly people is on the rise, with a remarkable impact on health and socio-health public expenditure. In order to face such situation, governments should take two parallel roads: 1. adopting new models of health care offers through organizational schemes aimed at achieving not only effectiveness but also efficiency and compliance; 2. adopting new funding patterns, capable of fostering private resources through fiscal incentives.     

Teaching public health related to the elderly

It has become axiomatic that the world is aging, not just in the developed countries, but in the less developed regions as well. In 1992 the global elderly population (age 65+) was estimated to be almost 350,000,000 persons, or more than 6% of the world total. During that year the net balance of the world's elderly grew by more than 800,000 persons each month. Projections to the year 2010 indicate that the net monthly gain will rise to more than 1.1 million elderly people. In the early 1990s, 26 countries had more than 2,000,000 elderly persons. The projections suggest that this number could increase to more than 50 nations by the year 2025. And this increase in number of elderly leads to an absolute rise in problems of age-related diseases, such as Alzheimer's disease, cardiovascular disease, stroke, and osteoporosis (with related falls and fractures). At the same time, there is a school of thought that emphasizes the elderly are living longer and healthier lives through better awareness of healthy nutrition, exercise, and other lifestyle factors, as well as improving access to modern medical care that is itself more effective than in previous decades. While the public health practitioner will not be called upon to treat individuals with these pathologies, it is important to know something about them in order to understand their effect on health care systems and to help plan for preventive and health promotion programmes. The preparation of the public health person requires an understanding of these issues and thus some tools for program development for primary, secondary, and tertiary prevention for this high-risk group.     

延边地区空巢老年人主观幸福感与社会支持相关分析

摘要:目的　了解延边地区空巢老年人的主观幸福感和社会支持情况,为社区空巢老年人的健康服务提供科学依据。方法　对延边地区518名空巢老年人进行主观幸福感和社会支持的调查。结果　空巢老年人主观幸福感得分为（31.26±10.25）分,不同人口学特征人群得分差异具有统计学意义;社会支持得分为（35.43±7.57）分;主观幸福感与社会支持正相关（r＝0.386,P＜0.01）。结论　延边地区空巢老年人主观幸福感水平和全国其他地区相比偏低,社会支持处于中等水平。在社区医疗护理服务中注重空巢老年人的健康管理,除了传统的健康管理外应加大心理支持,提高空巢老年人的生活质量。     

Vietnam during economic transition: a tracer study of health service access and affordability.

For many decades, Vietnam had a well-structured public health service with extensive population coverage, with free care at government health facilities until 1989. Since then the country has been going through economic transition, including major changes to the health system. These include the reduction of financial support to public facilities and the introduction of user charges. Concern has been growing about the effect of these changes on access and affordability of health care, particularly for poor families. Using data from the Vietnam National Health Survey conducted in 2001-2002, the authors conducted a tracer study of people with diarrheal illness to examine equity in access to and use of health care and the financial burdens placed on patients in seeking care. The study found that children, the elderly, and the poorly educated were more likely to suffer from diarrhea; poor people often did not seek any care regardless of severity of illness, largely because they could not afford it. The opportunity cost due to lost income was also much greater for poor families. Several new policies have been developed in Vietnam to improve access to basic health care for the poor. However, the effects of such policies require close monitoring and remain to be evaluated.     

Future health care costs--do health care costs during the last year of life matter?

While some studies have shown a considerable effect of ageing upon future health care costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in health care costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care and primary health care services in Denmark on the basis of demographic changes, both with and without account for the high costs in the last year of life. Costs were projected on the basis of a random 19% sample of the Danish population using the cohort-component method. The traditional projection method does not account for the high costs in the last year of life while the 'improved' method does. The Danish population was projected to increase by 8.2% during the period 1995-2020, and health care costs by 18.5% according to the traditional projection method and 15.1% according to the improved one. These results suggest that the high costs in the last year of life does matter in projections of future health care costs and should be taken into account. Furthermore, ageing per se seems to have considerable impact on future health care costs.     

'Ageing with ambition'; a recommendation from the Health Council of The Netherlands

The Health Council of the Netherlands, at the request of the policy committee for the elderly of the Dutch parliament, has deliberated over the intermediate- and long-term developments in the field of 'care and ageing'. In a comprehensive report, the overall conclusion is that there is sufficient room for the ambition to stimulate the health, independence and welfare of the elderly. The effects of biological ageing and the connections that exist between ageing, life span, illness and wellbeing are addressed. The number of people with illnesses and functional disorders will inevitably increase with ageing of the population. Nevertheless, numerous opportunities will arise to achieve health benefits and increase the quality of life. A range of measures is proposed in the field of prevention and treatment. An innovative policy on the elderly, political courage and social solidarity will be necessary in order to achieve 'ageing with ambition'. However, as pointed out in the report, health care is not merely an expense but also an important service industry that provides employment to a large number of people.     

Changing the balance of social care for older people: simulating scenarios under demographic ageing in New Zealand

The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community‐based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual‐level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community‐based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.     

Projecting US Primary Care Physician Workforce Needs: 2010-2025

PURPOSE

We sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act.

METHODS

In this projection of workforce needs, we used the Medical Expenditure Panel Survey to calculate the use of office-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association''s Masterfile to calculate the number of primary care physicians and determine the number of visits per physician. The main outcomes were the projected number of primary care visits through 2025 and the number of primary care physicians needed to conduct those visits.

RESULTS

Driven by population growth and aging, the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. After incorporating insurance expansion, the United States will require nearly 52,000 additional primary care physicians by 2025. Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3% increase in the current workforce.

CONCLUSIONS

Population growth will be the greatest driver of expected increases in primary care utilization. Aging and insurance expansion will also contribute to utilization, but to a smaller extent.Key words: health policy research, primary care issues, insurance, Affordable Care Act, workforce, physician shortage     

Health care of the aged in Korea

Korea's population is now aging very rapidly, but the country has not yet shifted its priorities nor instituted programs to meet the needs of an aging population. While the death rate has already achieved low modern levels, there are still traces of malnutrition and other debilitative conditions among the elderly and ill health is generally believed to be an inevitable accompaniment of old age. This leads to resignation and stoicism rather than active steps to deal with the growing problems. Furthermore, care of the aged is still viewed as a private matter to be handled by the person's family and the state plays a very minor role. Medical practice is largely private with physicians drawing their financial support chiefly from fees of their patients. Only one-fourth of the elderly population is presently served to any significant degree by modern medical practitioners. The basic reason for the general lack of skilled care is economic, although folk medicine still plays a role. Only civil servants are covered by any type of health insurance and only 9% of the elderly receive any health care as social welfare recipients. Ninety-five percent of the elderly live in families, three-fourths of them with children and financially dependent upon the children. Bedfast patients are cared for by spouses or daughters-in-law. But fundamental changes are under way in the structure of families which make home care of incapacitated members impractical and burdensome.(ABSTRACT TRUNCATED AT 250 WORDS)     

Population ageing in developed and developing regions: implications for health policy

Population ageing is now recognised as a global issue of increasing importance, and has many implications for health care and other areas of social policy. However, these issues remain relatively under-researched, particularly in poorer countries, and there is a dearth of specific policy initiatives at the international level. For example, the 1994 International Conference on Population and Development agreed to 15 key principles for future policy, but none of these even make indirect mention of the aged (International Conference on Population and Development, 1995, Documents. Programme of action of the 1994 International Conference on Population and Development. Population and Development Review, 21(2), 437-461). This paper seeks to highlight some of the key issues arising from population ageing. It begins with a brief overview of international trends in demographic ageing, and considers the health needs of different groups of older people. It sketches out some implications for policy, paying particular attention to the financing and organisation of health services. The final part of the paper contains a discussion about how older people have been affected by, and have adapted to, processes of social, economic and political change. Given the wide scope of these concerns, it is not possible to discuss any issue in detail, and the paper does not claim to give the subject matter a comprehensive or global treatment. It must be stressed that patterns of ageing and their implications for policy are highly complex and variable, and, as such, great care should be taken in generalising between the experiences of different groups of older people, and between different settings.     

De-institutionalization and ageing: some results from monitoring the effects in an area-based system of long-term care for elderly people and people with disabilities

This paper illustrates the usefulness of regular monitoring for an area-based system of long-term care for elderly people and people with a disability by presenting data which describe the combined effects of de-institutionalization and population ageing. Data were collected between 1985 and 1989 in Solna, Sweden by means of annual surveys involving registraion of received services and assessment of needs and disability. The sample, (n=2026 year 1, n=1755 year 5), were all the residents of Solna, who, on the day of the survey, were in receipt of long-term public medical and/or social services care from the public sector. Data were collected on demographic variables, actual and appropriate levels of care. The class of disability was based upon five different measures of disability. The number of long-term care hospital and nursing home beds were reduced by 23% whilst the number of people aged over 85 in the area increased by 31%. This development had effects on all levels of care. Actual development of resources fell short of those projected according to population trends, by 15–35% depending on level of care. The proportion of clients, who were ‘under-served’, in the sense that they received a lower level of care than assessed as appropriate by the responsible staff, more than doubled during the period-increasing from 10(n=2026) to 21% (n=1755). Domiciliary services were actually reduced and concentrated on fewer clients with more severe disabilities. There was a general increase in the prevalence and severity of disability in all levels of care except sheltered housing. Incontinence showed the most rapid increase. The findings of this study demonstrate the importance of providing decision-makers with quantitative data which reflect trends in population needs.     

Age-based rationing of health care: a descriptive study of professional attitudes

A national search for actual attitudes toward age-based rationing of health care among professionals in positions to support or change medical policies revealed that support for, or opposition to, medical limits for the elderly depended less upon affiliation, demographic factors, and political-economic ideology than did the sub-issues related to the rapid expansion of medical technology and spiraling health care costs in an unprepared society. The consensus was that American health care standards should continue to protect Granny Doe as well as Baby Doe.     

Awareness of and attitude of elderly subjects regarding health care and welfare in rapidly ageing population in Japan

OBJECTIVES: We aimed to obtain information on the degree of knowledge and understanding about the current systems of health care and welfare held by the elderly, in order to achieve comprehensiveness in family practice. METHOD: We conducted a study on the awareness of healthy elderly persons by direct interview. The study was carried out in Kuni Village in a remote mountainous region in Japan, where the elderly population accounts for 24.8% of the total population. The subjects were self-dependent in their daily living activities and were aged 65 years and older. RESULTS: The subjects' knowledge of health care and welfare systems was generally good, and the degree of their utilization of these systems was also good. But 83.3% of those who did not want to utilize the welfare system indicated their preference to depend on their family for support. CONCLUSION: Family physicians must endeavour to offer comprehensive care to their patients by including these systems for rapidly ageing communities.     

Age-specific increases in health care costs

BACKGROUND: The escalating costs of health care raise questions about demographic, epidemiological and technological determinants and future projections. The objectives of this work are to describe the age pattern of health care costs, to analyse the age-specific cost changes and to project future health care costs in an ageing population. METHODS: Comprehensive cost-of-illness data for the whole Dutch population in 1988 and 1994 are compared by age and type of care. National data on all hospital admissions, nursing days and clinical interventions for the period 1988-1994 is used to describe trends in hospital care. Population forecasts are used to project the age distribution of future health care costs. RESULTS: The distribution of health care costs per capita depends strongly on age. The growth rate of per capita costs increases by age for acute care but decreases by age for long-term care. Both combined cause an average annual growth rate of 4.6%, nearly constant with age. CONCLUSIONS: Ageing will result in increasing health care demands and costs. Secular trends in acute and long-term care indicate major shifts in costs from younger to older people and from long-term to acute care.     

Qualitative analyses of lived experience for residents in the Elderly Care Departments at the community health service centres in Southwestern China

With its huge ageing population, China faces an enormous challenge for its elderly support and care. One of the proposed solutions was to diversify the elderly support systems. Towards this goal, setting up the Elderly Care Departments in the community health service centres is one of such new Chinese endeavour. This qualitative study was conducted among the residents enrolled in existing Elderly Care Departments established at the community health service centres in Chongqing, a Southwestern Chinese city, to evaluate the lived experience of the residents and to find strategies for improvement. Eighteen participants were recruited from the residents of the Elderly Care Departments of three community health service centres in the city. Data were collected through semi‐structured in‐depth individual interviews and were analysed utilising the Colaizzi's phenomenological method. Five main themes were identified: Safety and trust; Satisfaction and relief; Gratitude and mutual understanding; Complaints and helplessness; and Worries and apprehension. We found that set‐up of the Elderly Care Departments at the community health service centres appeared to be consistent with the idea of integrated care and in general, the current running mode was able to provide the elderly with effective medical, nursing and other cares. The psychological and cultural services at these departments, however, need to be further enhanced.