Organization of Health Care Services for the Elderly: Russia
A.M.Clarfield MD, FRCPC
Professor 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
Premature:
• mortality in the elderly IHD CVA Influenza (“grippe” ) • morbidity in the elderly Osteoporosis Fractures Influenza (“grippe” )
Smoking in Russia (1993)
• 67% of men! • 30% of women • Increase in children
Accelerated aging
Health Promotion (examples)
• Smoking in middle age
• Exercise (Timur Shaov)
Prevention (primary and secondary)
• Osteoporosis (Calcium)
• Influenza vaccine
Prevention (primary and secondary)
• Cholesterol (>250 mg%- 20% of population) • treatment of hypertension ( Russia: >140/90 : 60% men, 25% women) • polypill (Wald and Law, BMJ, 2003)
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
תודה רבה