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
תודה רבה