organization of health care services for the elderly: russia a.m.clarfield md, frcpc professor of...

Organization of Health Care Services for the Elderly: Russia

A.M.Clarfield MD, FRCPCProfessor of Gerontology

Ben Gurion University,Israel

The typical “geriatric” patient

• chronic disease• multiple disease (co-morbidity)• multiple drugs (polypharmacy)• social isolation and poverty physiological function

LOSS OF RESERVE

An Approach

• Caveat:

An Approach

• education• health promotion• prevention• strengthen primary care • [acute care]• rehabilitation home• long-term care institution

Education

• medical school

- preclinical

- clinical

• residency – primary care

- internal medicine

- others (eg. urology, orthopedics)

• CME

• mortality in the elderly IHD CVA Influenza (“grippe” )

• morbidity in the elderly Osteoporosis Fractures Influenza (“grippe” )

Premature:

Smoking in Russia (1993)

• 67% of men!

• 30% of women

• Increase in children

Accelerated aging

Health Promotion (examples)Health Promotion (examples)

• Smoking in middle age

• Exercise (Timur Shaov)

Prevention (primary and secondary)

• Osteoporosis (Calcium)

• Influenza vaccine

• Cholesterol (>250 mg%- 20% of population)

• treatment of hypertension

( Russia: >140/90 : 60% men,

25% women)

• polypill

(Wald and Law, BMJ, 2003)

Prevention (primary and secondary)

Strengthen Primary Care

Rehabilitation

• post CVA - hospital

- home

• post hip fracture – hospital

• Yad Sarah

Long-term care (20% of 65+)

• home care (~ 15%) [preferred]

• institutional (~ 5%)

What is to be done? (next)

An Approach

• education• health promotion• prevention• strengthen primary care • [acute care]• rehabilitation home• long-term care institution

Thank You

Спасибо

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