organization of health care services for the elderly: russia a.m.clarfield md, frcpc professor of...
TRANSCRIPT
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Organization of Health Care Services for the Elderly: Russia
A.M.Clarfield MD, FRCPCProfessor of Gerontology
Ben Gurion University,Israel
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The typical “geriatric” patient
• chronic disease• multiple disease (co-morbidity)• multiple drugs (polypharmacy)• social isolation and poverty physiological function
LOSS OF RESERVE
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An Approach
• Caveat:
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An Approach
• education• health promotion• prevention• strengthen primary care • [acute care]• rehabilitation home• long-term care institution
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Education
• medical school
- preclinical
- clinical
• residency – primary care
- internal medicine
- others (eg. urology, orthopedics)
• CME
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• mortality in the elderly IHD CVA Influenza (“grippe” )
• morbidity in the elderly Osteoporosis Fractures Influenza (“grippe” )
Premature:
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Smoking in Russia (1993)
• 67% of men!
• 30% of women
• Increase in children
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Accelerated aging
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Health Promotion (examples)Health Promotion (examples)
• Smoking in middle age
• Exercise (Timur Shaov)
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Prevention (primary and secondary)
• Osteoporosis (Calcium)
• Influenza vaccine
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• 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)
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Strengthen Primary Care
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Rehabilitation
• post CVA - hospital
- home
• post hip fracture – hospital
• Yad Sarah
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Long-term care (20% of 65+)
• home care (~ 15%) [preferred]
• institutional (~ 5%)
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What is to be done? (next)
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An Approach
• education• health promotion• prevention• strengthen primary care • [acute care]• rehabilitation home• long-term care institution
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Thank You
Спасибо
תודה רבה